Sex Differences in Effects of Exercise on Physical Function in Aging: A Systematic Review with Meta-Analysis

PURPOSE

Our objective was to synthesize and determine whether there are sex differences in physical function following exercise interventions in older adults.

MATERIALS AND METHODS

A systematic search was conducted in four databases from inception to July 8th, 2023 searching for prospective trials that conducted exercise interventions in older adults and results for physical function were reported by sex. Pooled standardized mean differences (SMDs) with their 95% confidence intervals (CIs) were estimated using a randomeffects method. The Sidik-Jonkman estimator was used to calculate the variance of heterogeneity (I²).

RESULTS

A total of 19 studies involving 20,133 older adults (mean age ≥60 years, 33.7% female) were included. After exercise interventions, males reported significantly greater pre-post changes compared to females for upper body strength (SMD=-0.40, 95% CI: -0.71 to -0.09; I²=75.6%; n=8), lower body strength (SMD=-0.32, 95% CI: -0.55 to -0.10; I²=52.0%; n=11), and cardiorespiratory fitness (SMD=-0.29, 95% CI: -0.48 to -0.10; I²=89.1%; n=12). Conversely, the pooled SMDs showed a significant effect favoring females for motor fitness (SMD=0.21, 95% CI: 0.03 to 0.39; I²=0%; n=7). Limited and inconsistent results were observed for flexibility.

CONCLUSIONS

Our study suggests the existence of sex-related differences on physical function after an exercise intervention in the older population.

Comparative effects of different types of exercise on health-related quality of life during and after active cancer treatment: A systematic review and network meta-analysis

BACKGROUND

The positive influence of most types of exercise has been reported repeatedly, but what the most effective exercise approaches are for improving health-related quality of life (HRQoL) in people with cancer remains unknown. The aim of this systematic review and network meta-analysis was to synthesize the evidence from intervention studies to assess the effects of different types of exercise on HRQoL during and after cancer treatment.

METHODS

MEDLINE, SPORTDiscus, the Cochrane Library, Web of Science, and Scopus were searched for randomized controlled trials aimed at testing the effects of exercise interventions meant to improve HRQoL in people with cancer. Separate analyses were conducted for HRQoL as measured by general and cancer-specific questionnaires. We also evaluated whether the effects of exercise were different during and after cancer treatment in both the physical and mental HRQoL domains.

RESULTS

In total, 93 studies involving 7435 people with cancer were included. Network effect size estimates comparing exercise intervention vs. usual care were significant for combined exercise (0.35, 95% confidence interval (95%CI): 0.14-0.56) for HRQoL as measured by general questionnaires, and for combined (0.31, 95%CI: 0.13-0.48), mind-body exercise (0.54, 95%CI: 0.18-0.89), and walking (0.39, 95%CI: 0.04-0.74) for HRQoL as measured by cancer-specific questionnaires.

CONCLUSION

Exercise programs combining aerobic and resistance training can be recommended to improve HRQoL during and after cancer treatment. The scarcity and heterogeneity of these studies prevents us from making recommendations about other exercise modalities due to insufficient evidence.

Effect of different types of exercise on fitness in people with multiple sclerosis: A network meta-analysis

BACKGROUND

It is assumed that people with multiple sclerosis (MS) who participate in programs of physical exercise improve their physical fitness.

OBJECTIVE

The aim of this network meta-analysis (NMA) was to analyze the effect of different types of exercise on muscular fitness and cardiorespiratory fitness (CRF) among people with MS and to determine the best type of exercise according to disease severity.

METHODS

MEDLINE, the Physiotherapy Evidence Database, the Cochrane Library, SPORTDiscus, Scopus, and Web of Science were searched from inception to April 2022 to identify randomized controlled trials (RCTs) concerning the effect of physical exercise on fitness in people with MS. We ranked the types of physical exercise by calculating the surface under the cumulative ranking (SUCRA).

RESULTS

We included 72 RCTs involving 2543 MS patients in this NMA. A ranking of five types of physical exercise (aerobic, resistance, combined [aerobic and resistance], sensorimotor training, and mind-body exercises) was achieved. Combined and resistance training had the highest effect sizes (0.94, 95% CI 0.47, 1.41, and 0.93, 95% CI 0.57, 1.29, respectively) and the highest SUCRA (86.2% and 87.0%, respectively) for muscular fitness. The highest effect size (0.66, 95% CI 0.34, 0.99) and SUCRA (86.9%) for CRF was for aerobic exercise.

CONCLUSIONS

Combined and resistance training seem to be the most effective exercises to improve muscular fitness and aerobic exercise for CRF in people with MS.

Body composition phenotypes and bone health in young adults: A cluster analysis

BACKGROUND AND AIMS

Lean mass is considered the best predictor of bone mass, as it is an excellent marker of bone mechanical stimulation, and changes in lean mass are highly correlated with bone outcomes in young adults. The aim of this study was to use cluster analysis to examine phenotype categories of body composition assessed by lean and fat mass in young adults and to assess how these body composition categories are associated with bone health outcomes.

METHODS

Cluster cross-sectional analyses of data from 719 young adults (526 women) aged 18-30 years from Cuenca and Toledo, Spain, were conducted. Lean mass index (lean mass (kg)/height (m)2), fat mass index (fat mass (kg)/height (m)2), bone mineral content (BMC) and areal bone mineral density (aBMD) were assessed by dual-energy X-ray absorptiometry.

RESULTS

A cluster analysis of lean mass and fat mass index z scores resulted in a classification of a five-category cluster solution that could be interpreted according to the body composition phenotypes of individuals as follows: high adiposity-high lean mass (n = 98), average adiposity-high lean mass (n = 113), high adiposity-average lean mass (n = 213), low adiposity-average lean mass (n = 142), and average adiposity-low lean mass (n = 153). ANCOVA models showed that individuals in clusters with a higher lean mass had significantly better bone health (z score: 0.764, se: 0.090) than their peers in other cluster categories (z score: -0.529, se: 0.074) after controlling for sex, age, and cardiorespiratory fitness (p < 0.05). Additionally, subjects belonging to the categories with a similar average lean mass index but with high or low-adiposity levels (z score: 0.289, se: 0.111; z score: 0.086, se: 0.076) showed better bone outcomes when the fat mass index was higher (p < 0.05).

CONCLUSIONS

This study confirms the validity of a body composition model using a cluster analysis to classify young adults according to their lean mass and fat mass indices. In addition, this model reinforces the main role of lean mass on bone health in this population and that in phenotypes with high-average lean mass, factors associated with fat mass may also have a positive effect on bone status.

Effect of Vitamin D Supplementation on Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis

Vitamin D supplementation has been considered a possible treatment to reduce the risk of disease activity and progression in people with multiple sclerosis (MS). However, its effect on disease symptoms remains unclear. The aim of this meta-analysis was to conduct a systematic review to assess the effect of vitamin D on fatigue in this population. The systematic review was conducted using the MEDLINE, Cochrane Library, Embase and Web of Science databases from inception to May 2023. Randomized controlled trials (RCTs) reporting pre-post changes in fatigue after vitamin D supplementation were included. Pooled effect sizes and 95% confidence intervals (95% CIs) were calculated by applying a random effects model with Stata/SE (Version 16.0; StataCorp., College Station, TX, USA). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A total of five studies with 345 individuals (271 females; age range: 25.4-41.1 years) were included. A significant reduction in fatigue was perceived when vitamin D supplementation was compared with a control group: -0.18 (95% CI: -0.36 to -0.01; I² = 0%). Thus, our findings show that the therapeutic use of vitamin D on fatigue in people with MS could be considered. Nevertheless, due to the lack of agreement on the dose to be applied, it is recommended to use it under medical prescription.

Assessment of functional respiratory complaints and related factors in people with hypermobile Ehlers-Danlos syndrome: Cross-sectional study

BACKGROUND

Hypermobile Ehlers-Danlos Syndrome (hEDS) is the most common type of EDS. Apart from joint symptoms, people with hEDS have systemic manifestations as a chronic modification of the breathing pattern (functional respiratory complaints (FRCs)) and mental disorders. However, the prevalence of FRCs, and its relationship with mental disorders, have not yet been estimated for this population.

OBJECTIVES

To assess the FRCs, central sensitization, disease perception, depression, and anxiety in people with hEDS from Belgium; and to identify the clustering of FRCs and determine any association with the characteristics assessed for this sample.

METHODS

This cross-sectional study assessed socio-demographic characteristics, Nijmegen questionnaire (NQ), Central Sensitization Inventory (CSI), Brief Illness Perception Questionnaire, and the Hospital Anxiety and Depression Scale (HADS) in people with hEDS from Belgium. A two-step cluster analysis was performed to identify clusters according to NQ, and to understand how the other questionnaires are grouped among these clusters.

RESULTS

The Spearman correlation coefficients showed that all the outcomes were significantly and positively correlated with each other (p<0.05). Furthermore, 84.9% of the sample had symptoms suggestive of FRCs, and 54.3% had probable anxiety. Three clusters were grouped (no FRCs, mild FRCs, and severe FRCs), with NQ, HADS-D and CSI-part A being the variables that contributed the most. People from cluster of severe FRCs got the worst scores for all the questionnaires.

CONCLUSION

FRCs, central sensitization, depression, and anxiety are prevalent comorbidities in people with hEDS. Moreover, those people with FRCs had worse results in the investigated parameters, with depression being the variable that contributed the most to the clusters of FRCs. Consequently, investigating mechanisms for these co-occurring symptom profiles may improve our understanding of pathogenesis and indicate new management strategies to alleviate these symptoms and lead to the development of more effective care for persons with hEDS.

Effects of exercise interventions to reduce chemotherapy‐induced peripheral neuropathy severity: a meta‐analysis

OBJECTIVES

The two aims of this systematic review and meta-analysis were to (1) analyze the effect of exercise on chemotherapy-induced peripheral neuropathy (CIPN) severity and (2) determine the best type of exercise for the management of CIPN.

METHODS

We systematically searched the MEDLINE, WOS, Sportdiscus, Scopus, and Cochrane databases from inception to December 2020 for experimental studies addressing the effect of exercise on CIPN severity, as measured by symptom severity (SSS) and peripheral deep sensitivity (PDS). The DerSimonian and Laird method was used to compute pooled estimates of the standardized mean differences (SMDs) and its respective 95% confidence intervals (CIs). Subgroup analyses were performed based on the types of exercise and the frequency and length of the interventions.

RESULTS

Thirteen studies were included in this meta-analysis. In the analyses comparing exercise interventions versus controls, there was an improvement in the SSS (SMD = -0.21; 95% CI: -0.40 to -0.01; %change: -20.34%) and the PDS (SMD = 0.49; 95% CI: 0.06 to 0.91; %change: 31.64%) in favor of the intervention group. In the pre-post analyses, there was an improvement in the SSS (SMD = -0.72; 95% CI: -1.10 to -0.34; %change: -15.65%) and the PDS (SMD = 0.47; 95% CI: 0.15 to 0.79; %change:18.98%).

CONCLUSIONS

This meta-analysis provides an overview of the evidence supporting exercise as a suitable intervention to reduce the severity of CIPN by reducing the severity of the symptoms and the peripheral deep sensitivity among patients with cancer or cancer survivors. Furthermore, sensoriomotor training and mind-body exercises appear to be more effective in reducing symptom severity, and active nerve-specific exercises and mind-body exercises seem to be more effective in improving peripheral deep sensitivity.

Effectiveness and Safety of Different Treatment Modalities for Patients Older Than 60 Years with Distal Radius Fracture: A Network Meta-Analysis of Clinical Trials

The aim of this study was to compare the clinical effectiveness and complications of different treatment modalities for elderly patients with distal radius fracture (DRF).

METHODS

We performed a network meta-analysis (NMA) of randomized clinical trials (RCTs). Eight databases were searched. The eligibility criteria for selecting studies were RCTs that compared different treatment modalities (surgical or nonoperative) in patients older than 60 years with displaced or unstable intra-articular and/or extra-articular DRFs.

RESULTS

Twenty-three RCTs met the eligibility criteria (2020 patients). For indirect comparisons, the main findings of the NMA were in volar locking plate (VLP) versus cast immobilization, with the mean differences for the patient-rated wrist evaluation (PRWE) questionnaire at -4.45 points (p < 0.05) and grip strength at 6.11% (p < 0.05). Additionally, VLP showed a lower risk ratio (RR) of minor complications than dorsal plate fixation (RR: 0.02) and bridging external fixation (RR: 0.25). Conversely, VLP and dorsal plate fixation showed higher rates of major complications.

CONCLUSIONS

Compared with other treatment modalities, VLP showed statistically significant differences for some functional outcomes; however, most differences were not clinically relevant. For complications, although most differences were not statistically significant, VLP was the treatment modality that reported the lowest rate of minor and overall complications but also showed one of the highest rates of major complications in these patients. PROSPERO Registration: CRD42022315562.

Prevalence of Neuropsychiatric Disorders in Duchenne and Becker Muscular Dystrophies: A Systematic Review and Meta-analysis

OBJECTIVE

To estimate the prevalence of neuropsychiatric disorders, including autism spectrum disorders (ASDs), attention-deficit hyperactivity disorder (ADHD), depression, anxiety disorders, and obsessive-compulsive disorder (OCD), in populations with Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD).

DATA SOURCES

MEDLINE (via PubMed), Scopus, Web of Science, and Cochrane Library from inception to November 2021.

STUDY SELECTION

Observational studies of individuals with DMD or BMD that estimated the prevalence of ASDs, ADHD, depression, anxiety disorders, and OCD in each population.

DATA EXTRACTION

A random-effects meta-analysis was performed on each outcome and each population (ie, DMD, BMD).

DATA SYNTHESIS

Twenty-three studies were included in the meta-analysis. In DMD, there was a prevalence of 7.0% of ASDs, 18.0% of ADHD, 11.0% of depression, 24.0% of anxiety disorders, and 12.0% of OCD. Furthermore, in BMD, there was a prevalence of 6.0% of ASDs, 28.0% of ADHD, 7.0% of depression, 25.0% of anxiety disorders, and 7.0% of OCD.

CONCLUSIONS

The prevalence of these neuropsychiatric disorders is higher among patients with DMD or BMD than among the general population, and the presence of these disorders may negatively influence optimal medical management.

Dietary Calcium Intake and Fat Mass in Spanish Young Adults: The Role of Muscle Strength

Obesity is declared as a chronic multifaceted health problem, and young adults may be particularly vulnerable to weight gain. This study aims to identify the role of dietary calcium intake and the muscle strength index in handling excess of fat mass in young adults and to examine if the relationship between dietary calcium intake and fat mass percentage is mediated by muscle strength. A cross-sectional study including 355 Spanish college students (aged 21.05 ± 3.11) was performed during the 2017–2018 academic year. Pearson correlation coefficients were estimated to determine the relationship between dietary calcium intake, fat mass percentage, body mass index, muscle strength components, and total energy intake. ANCOVA models were used to analyze the differences in the muscle strength index by total dietary calcium intake categories, as well as the differences in % fat mass by total dietary calcium intake and muscle strength index categories, controlling for different sets of confounders. A mediator analysis was conducted to test if the relationship between dietary calcium intake and fat mass percentage was explained by muscle strength. Data on the fat mass percentage, dietary calcium intake, and muscle strength index as the sum of the standardized z-score of the standing long jump and z-score of handgrip/weight were collected. The muscle strength index was significantly better in young adults with higher dietary calcium intake. Moreover, the fat mass percentage was significantly lower in those with a higher dietary calcium intake and a better muscle strength index. Finally, the relationship between dietary calcium intake and fat mass percentage was fully mediated by muscle strength (z = −1.90; p < 0.05), explaining 33.33% of this relationship. This study suggests that both a major dietary calcium intake and muscle strength are associated with fat mass percentage. Moreover, muscle strength mediates the link between dietary calcium intake and fat mass percentage. Therefore, both high dietary calcium intake and exercise activities aimed at improving muscle strength levels may help to prevent the cardiometabolic risk associated with an excess of fat mass in young people.

Physical Exercise vs. Metformin to Improve Delivery- and Newborn-Related Outcomes Among Pregnant Women With Overweight: A Network Meta-Analysis

Background: Overweight/obesity is associated with the risk of delivery- and newborn-related complications in pregnancy. Interventions such as exercise or metformin could reduce the risk of these complications. Objective: To estimate and compare the effects of different types of exercise interventions (i.e., aerobic, resistance, combined exercise) and metformin on delivery- and newborn-related outcomes among pregnant women with overweight/obesity. Methods: MEDLINE, Scopus, Web of Science, Cochrane Library databases and the gray literature were searched from inception to September 2021. This systematic review was registered in PROSPERO (CDR: 42019121715). Randomized controlled trials (RCTs) of metformin or an exercise intervention aimed at preventing cesarean section, preterm birth, macrosomia, or birth weight among pregnant women with overweight/obesity were included. Random effects meta-analyses and frequentist network meta-analyses (NMA) were conducted for each outcome. Results: Fifteen RCTs were included. In the NMA, metformin reduced the risk of cesarean section (RR = 0.66, 95% CI: 0.46, 0.95), combined exercise reduced the risk of macrosomia (RR = 0.37, 95% CI: 0.14, 0.95), and aerobic exercise reduced birth weight (mean difference = -96.66 g, 95% CI: -192.45, -0.88). In the subgroup among pregnant women with obesity, metformin reduced the risk of cesarean section (RR = 0.66, 95% CI: 0.45, 0.97). Conclusions: Combined exercise could reduce the risk of macrosomia in pregnant women with overweight, whereas metformin could reduce the risk of cesarean section in pregnant women with obesity. However, previous evidence suggests a larger effect of physical exercise in other outcomes for this population group. Therefore, the medicalization of healthy pregnant women with obesity is not justified by the current evidence. Systematic Review Registration: PROSPERO: CRD42019121715; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019121715.

Effect of Exercise on Fatigue in Multiple Sclerosis: A Network Meta-analysis Comparing Different Types of Exercise

OBJECTIVE

A network meta-analysis (NMA) of current evidence was conducted to determine if physical exercise has a positive influence on multiple sclerosis (MS) fatigue and type of exercise with the largest effect on fatigue also according to disease severity.

DATA SOURCES

MEDLINE, Embase, SPORTDiscus, Physiotherapy Evidence Database, Cochrane Library, and Web of Science. The search strategy combined relevant terms related to (1) MS; (2) clinical trials; (3) exercise; and (4) fatigue from inception to February 2021.

STUDY SELECTION

Randomized controlled trials concerning the effectiveness of different types of exercise on total and physical fatigue in people with MS were included.

DATA EXTRACTION

The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0), and the Grading of Recommendations, Assessment, Development, and Evaluation tool was used to evaluate the quality of the evidence.

DATA SYNTHESIS

A total of 58 studies were examined. Data were pooled using a random-effects model. A ranking of 7 and 8 different exercise interventions for physical and total fatigue scores, respectively, was achieved. The highest effects for pairwise comparisons were for combined exercise and resistance training vs control (ranging between -0.74 and -1.24). In the NMA, combined exercise (-1.51; 95% confidence interval [CI], -2.01 to -1.01) and resistance training (-1.15; 95% CI, -1.81 to -0.49) compared with the control group achieved the highest effects for physical and total fatigue, respectively.

CONCLUSIONS

Exercise should be considered an effective fatigue management strategy. Among the different exercise modalities, combined exercise is the most effective exercise modality for improving both physical and total fatigue. Resistance training is also an effective exercise for total fatigue among people diagnosed with MS.

EFFECT OF MANUAL THERAPY INTERVENTIONS ON RANGE OF MOTION AMONG INDIVIDUALS WITH MYOFASCIAL TRIGGER POINTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

OBJECTIVE

Patients with myofascial trigger points (MTPs) frequently manifest restricted range of motion (ROM) during physical evaluation. Multiple manual therapy interventions have been developed for the treatment of MTPs, but their effect on ROM has not been clarified through a systematic review and meta-analysis. Thus, this systematic review aimed to assess the effect of manual therapy interventions on ROM among individuals with MTPs.

METHODS

A systematic search was conducted in PubMed, Web of Science, Cochrane, Scopus and Clinical Trials.gov. Articles analysing the effect of manual therapy interventions on ROM were included. The risk of bias was assessed using the Cochrane RoB2 tool. The DerSimonian-Laird method was used to compute the pooled effect size (ES) and its 95% confidence interval (95% CI) for ROM.

RESULTS

A total of 13 randomized controlled trials (RCTs) were included in this systematic review and meta-analysis. The pooled ES for ROM was 0.52 (95% CI: 0.42; 0.63). The pooled ES for ROM evaluated in centimetres was 0.36 (95% CI: 0.14; 0.59) and the pooled ES for ROM evaluated in degrees was 0.57 (95% CI: 0.47; 0.68).

CONCLUSION

Manual therapy interventions may be an effective approach for improving ROM among individuals with MTPs.

Effectiveness of Pilates and Yoga to improve bone density in adult women: A systematic review and meta-analysis

BACKGROUND

The ageing population brings about the appearance of age-related health disorders, such as osteoporosis or osteopenia. These disorders are associated with fragility fractures. The impact is greater among postmenopausal women due to an acceleration of bone mineral density (BMD) loss.

OBJECTIVE

To estimate the effectiveness of Pilates or Yoga on BMD in adult women.

METHODS

Five electronics databases were searched up to April 2021. Randomized controlled trials (RCTs), non-RCTs and pre-post studies were included. The main outcome was BMD. Risk of bias was evaluated using the Cochrane risk of bias tool. A random effects model was used to pool data from primary studies. Subgroup analyses based on the type of exercise were conducted.

RESULTS

Eleven studies including 591 participants aged between 45 and 78 years were included. The mean length of the interventions ranged from 12 to 32 weeks, and two studies were performed for a period of at least one year. The pooled effect size for the effect of the intervention (Pilates/Yoga) vs the control group was 0.07 (95% Confidence interval [CI]: -0.05 to 0.19; I2 = 0.0%), and 0.10 (95% CI: 0.01 to 0.18; I2 = 18.4%) for the secondary analysis of the pre-post intervention.

CONCLUSIONS

Despite of the non-significant results, the BMD maintenance in the postmenopausal population, when BMD detrimental is expected, could be understood as a positive result added to the beneficial impact of Pilates-Yoga in multiple fracture risk factors, including but not limited to, strength and balance.

Maternal Education and Academic Achievement in Schoolchildren: The Role of Cardiorespiratory Fitness

OBJECTIVES

To examine the relationship between maternal education, cardiorespiratory fitness, and academic achievement in schoolchildren, specifically whether the association between maternal education and academic achievement is mediated by cardiorespiratory fitness.

STUDY DESIGN

This is a secondary analysis of a cross-sectional study including 478 Spanish schoolchildren aged 8-11 years. ANOVA was used to test differences in cardiorespiratory fitness by maternal education level. ANCOVA was used to test the differences in academic achievement by the educational level of mothers and the cardiorespiratory fitness of children, controlling for each other. A mediation analysis was used to test if the relationship between maternal education and academic achievement was explained by cardiorespiratory fitness.

RESULTS

A higher level of maternal education was associated with a higher cardiorespiratory fitness level and academic achievement in children; moreover, the cardiorespiratory fitness level in children was associated with better academic achievement (P < .05). Finally, cardiorespiratory fitness acted as a partial mediator of the relationship between maternal education and academic achievement in boys (z = 1.81; P = .03) but not in girls (z = 0.86; P = .19), explaining 6.54% of this relationship for the total sample and 6.67% for boys.

CONCLUSIONS

This study suggests that the benefits of maternal education on academic achievement are partially explained by the mediating role of cardiorespiratory fitness.

What type of physical exercise should be recommended for improving arterial stiffness on adult population? A network meta-analysis

AIMS

Physical exercise has been associated with a reduction in arterial stiffness, a subclinical process underlying cardiovascular disease. However, the effect of different types of exercise (aerobic, resistance, combined, interval training, stretching, or mind-body modalities) on arterial stiffness is unclear. This network meta-analysis aimed to examine the effectiveness of different types of exercise on arterial stiffness as measured by pulse wave velocity in adults.

METHODS AND RESULTS

We searched Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE (via Pubmed), Embase, and Web of Science databases, for randomized clinical trials including at least a comparison group, from their inception to 30 June 2020. A frequentist network meta-analysis was performed to compare the effect of different types of physical exercise on arterial stiffness as measured by pulse wave velocity. Finally, 35 studies, with a total of 1125 participants for exercise intervention and 633 participants for the control group, were included. In the pairwise meta-analyses, the exercises that improved arterial stiffness were: interval training [effect size (ES) 0.37; 95% confidence interval (CI) 0.01-0.73], aerobic exercise (ES 0.30; 95% CI 0.13-0.48) and combined exercise (ES 0.22; 95% CI 0.04-0.40). Furthermore, the network meta-analysis showed that mind-body interventions were the most effective type of exercise to reduce the pulse wave velocity (ES 0.86; 95% CI 0.04-1.69). In addition, combined exercise (ES 0.35; 95% CI 0.08-0.62), aerobic exercise (ES 0.33; 95% CI 0.09-0.57), and interval training (ES 0.33; 95% CI 0.02-0.64) showed significant improvements.

CONCLUSION

Our findings showed that aerobic exercise, combined exercise, interval training, and mind-body exercises were the most effective exercise modalities for reducing arterial stiffness, assuming an important role in the prevention of cardiovascular diseases.

The effect of hallux valgus open and percutaneous surgery on AOFAS scale: a systematic review and meta-analysis

PURPOSE

To estimate the comparative effect of open and percutaneous hallux valgus (HV) surgery on patients' quality of life (QoL) using the American Orthopedic Foot and Ankle Society (AOFAS) scale including total score and individual domains (pain, function, and alignment).

METHODS

MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2020 for studies on the effect of HV surgery on patients' QoL using the AOFAS score. A standardized mean difference score was calculated on the total AOFAS score and on each AOFAS domain (pain, function, and alignment) using Cohen's d index.

RESULTS

Considering the 53 published studies included, the pooled effect size (ES) estimates for the AOFAS total score were 3.69 (95% CI 3.37-4.01; I² = 95.5%) for open surgery and 3.40 (95% CI 2.99-3.80, I² = 88.2%) for percutaneous surgery. The total pooled ES estimate was 3.61 (95% CI 3.35-3.87, I² = 94.5%). Considering the pain domain, the pooled ES estimates were 2.21 (95% CI 1.98-2.43, I² = 64%) for open surgery and 2.52 (95% CI 1.83-3.20, I² = 92.6%) for percutaneous surgery. For the function domain, the pooled ES estimates were 1.37 (95% CI 0.93-1.81, I² = 91%) for open surgery and 2.28 (95% CI 1.10-3.47, I² = 96.8%) for percutaneous surgery. Finally, the pooled ES estimates for the alignment domain were 3.99 (95% CI 3.51-4.47, I² = 85.7%) for open surgery and 2.66 (95% CI 2.23-3.09, I² = 78.5%) for percutaneous surgery.

CONCLUSION

Our data support that HV surgery increases the total AOFAS score as well as the AOFAS scores by domain (pain, function, and alignment). Furthermore, our data show that HV surgery increases patients' QoL, after both open and percutaneous surgery, without differences between them.

Effect of eHealth to increase physical activity in healthy adults over 55 years: A systematic review and meta-analysis

To estimate the effect of eHealth interventions on increasing physical activity (PA) in healthy adults over 55 years, a systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE, Cochrane, Web of Science, SPORTDiscus, and Scopus databases were searched, from inception to February 2020, for experimental studies reporting the effect of eHealth interventions on steps/day, daily moderate-to-vigorous physical activity (MVPA min/day), PA min/week, and MVPA min/week among adults over 55 years. The DerSimonian and Laird method was used to compute a pooled effect size (ES) estimate and the respective 95% confidence interval (95% CI). Eighteen studies were included in this meta-analysis with adults whose age ranged from 58 to 74.2 years. The interventions lasted between four and 52 weeks. The ES estimates of eHealth interventions on increasing PA were 0.59 (95% CI: 0.15-1.02) for steps/day, 0.49 (95% CI: 0.17-0.80) for daily MVPA, 0.13 (95% CI: 0.01-0.24) for total weekly PA and 0.31 (95% CI: 0.13-0.48) for weekly MVPA. Considering clinical improvements, the mean change difference estimates were an increase of 1616.28 steps/day (95% CI: 386.25-2846.31), 7.41 minutes of daily MVPA (95% CI: 3.24-11.57), 40.54 minutes of total weekly PA (95% CI: -8.71 to 89.79) and 56.35 minutes of weekly MVPA (95% CI: 17.43-95.27). In conclusion, eHealth interventions are effective in increasing PA levels among adults over 55 years, resulting in increased steps/day, MVPA min/day, PA min/week and MVPA min/week.