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Ahler JR, Busk H, Holm PM, Bricca A, Poulsen DV, Skou ST, Tang LH. Benefits and harms of structured outdoor physical activity for people with somatic or mental diseases: A systematic review and meta-analysis. Prev Med 2024; 183:107966. [PMID: 38641081 DOI: 10.1016/j.ypmed.2024.107966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To examine the benefits and harms of structured outdoor physical activity (PA) for people living with one or more somatic or mental diseases. METHODS We identified articles from inception until Marts 2023 in MEDLINE, EMBASE, CINAHL and CENTRAL and citation tracking in Web of Science. We included randomized controlled trials (RCTs) and observational studies examining structured outdoor PA reporting physical function, health-related quality of life (HRQOL), pain or mental outcomes. We used random-effect meta-analyses and investigated heterogeneity in subgroups, sensitivity and meta-regression analyses. Observational studies and studies with insufficient data were summarized narratively. Certainty of evidence was assessed with GRADE. RESULTS From 4098 hits, 20 studies (19 RCTs and 1 cohort) were included (n: 1759 participants). Studies varied in type of disease and intervention. End of intervention results suggested a small effect on HRQOL (k = 10, SMD = 0.45, 95%CI: 0.19 to 0.71) and physical function (k = 14, SMD = 0.39, 95%CI: 0.13 to 0.64), while effects were moderate on mental outcomes (k = 13, SMD = -0.52, 95%CI: -0.82 to -0.23) favoring the outdoor intervention over comparators (no intervention, usual care, indoor PA or outdoor intervention without exercise). We were not able to conclude on outdoor interventions' effect on pain. Four studies reported adverse events including non-serious (pain, falls, fatigue) and serious (hospitalization, pneumonia). Certainty of evidence was overall very low. CONCLUSION Structured outdoor PA may improve HRQOL and physical function, as well as mental health outcomes. The very low certainty of evidence calls for high quality RCTs to determine benefits and harms of structured outdoor PA.
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Affiliation(s)
- Jonas R Ahler
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Henriette Busk
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, DK-1958 Frederiksberg C, Denmark
| | - Pætur M Holm
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; Faculty of Health Sciences, University of Faroe Islands, Tórshavn, Faroe Islands
| | - Alessio Bricca
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Dorthe V Poulsen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, DK-1958 Frederiksberg C, Denmark
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Lars H Tang
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Fernández-Ávila DG, Patiño-Hernández D, Moreno-Luna S, Brance L, Arbeláez Á, Vilar AC, Lozada C, Ríos C, Toro C, Ramírez C, Pons-Estel G, Ugarte-Gil M, Narváez M, Albanese M, Roa O, Ruiz O, Burgos P, Xavier R, Fuentes Y, Soriano E. Development of a novel clinimetric tool: PAtient Reported Disease Activity Index in Rheumatoid Arthritis (PARDAI-RA) by PANLAR, for the assessment of patients living with rheumatoid arthritis. Clin Rheumatol 2024; 43:1277-1285. [PMID: 38355831 PMCID: PMC10944809 DOI: 10.1007/s10067-024-06868-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/13/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Clinical experience has shown that a single measure is not sufficient to assess disease activity in rheumatoid arthritis (RA). Various clinimetric tools are necessary to address the many clinical situations that can arise. METHODS In order to develop a comprehensive measurement tool, the Pan American League of Associations for Rheumatology searched for the most frequent measures of disease activity applied in RA by means of a semi-systematic review of the available literature. RESULTS We found that the most frequently reported measures of disease activity were the 28-joint Disease Activity Score, C-reactive protein, and the erythrocyte sedimentation rate, followed by patient-reported measures of pain and stiffness and many other composite indices and patient-reported outcome measures. The most frequent physician-reported sign of disease was the swollen joint count, and the most frequently self-reported feature was the increase in disease activity or flares. CONCLUSION In this article, we present a new clinimetric tool developed based on expert consensus and on data retrieved from our search. Disease activity can be better assessed by combining various data sources, such as clinical, laboratory, and self-reported outcomes. These variables were included in our novel clinimetric tool. Key Points • The goal of treatment of RA is to achieve the best possible control of inflammation, or even remission; therefore, disease management should include systematic and regular evaluation of inflammation and health status. • Clinimetric tools evaluate a series of variables (e.g., symptoms, functional capacity, disease severity, quality of life, disease progression) and can reveal substantial prognostic and therapeutic differences between patients. • Our clinimetric tool, which is based on a combination of data (e.g., clinical variables, laboratory results, PROMs), can play a relevant role in patient assessment and care.
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Affiliation(s)
- Daniel G Fernández-Ávila
- Rheumatology Division, Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogotá, Colombia.
| | | | | | - Lorena Brance
- Rheumatology Division, Universidad Nacional de Rosario, Santa Fe, Argentina
| | | | | | - Carlos Lozada
- Rheumatology Division, University of Miami, Coral Gables, USA
| | - Carlos Ríos
- Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
| | - Carlos Toro
- Centro de Referencia en Osteoporosis y Reumatología, Cali, Colombia
| | | | - Guillermo Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | | | | | - Orlando Roa
- Rheumatology Division Keralty, Bogotá, Colombia
| | - Oscar Ruiz
- Rheumatology Division Keralty, Bogotá, Colombia
| | - Paula Burgos
- Clinic Immunology and Rheumatology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Ricardo Xavier
- Rheumatology Service Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Enrique Soriano
- Rheumatology Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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