Wellness Check: Exercise

Both physical activity and diet quality may be important in improving outcomes

1.  Those with the lowest risk of mortality had the highest diet quality score and higher levels of physical activity.

2. High levels of physical activity did not counteract the detrimental effects of a poor diet concerning mortality risk.

Evidence Rating Level: 2 (Good)

Regular physical activity and a healthy diet are known to play important roles in preventing chronic disease. However, only a small number of studies have explored the interaction between diet and physical activity concerning long-term outcomes such as mortality. As a result, the objective of the present study was to examine the association of diet and different intensities of physical activity on all-cause, cardiovascular disease (CVD) and cancer mortality in British adults from the UK biobank study.

Between April 2007-December 2010, 502 632 participants (aged 40-69 years) were included. Patients were excluded if they had comorbidities such as renal, cardiac, neurological, pulmonary disease. The median follow-up was 11.2 years.  Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) whereas diet quality was assessed using a dietary index. Data analysis was performed using Cox proportional hazards model and sensitivity analyses. Results demonstrated that those with the lowest risk of mortality had the highest diet quality score and higher levels of physical activity. Furthermore, high levels of physical activity did not counteract the detrimental effects of a poor diet concerning mortality risk.

However, the study was limited by the fact that both physical activity and diet were measured at one time point only, thereby limiting the evaluation of long-term behaviors. Despite this, the study’s comprehensive analysis and long follow-up provided strong evidence for health professionals to be strong advocates for both physical activity and higher diet quality.

Physical activity may enhance the influenza vaccination response

 1. Physical activity significantly increased the odds for H1 seroconversion following influenza vaccination among all participants and titer response among the acute exercise group.

2. Acute-exercised participants had higher antibody responses compared to rested controls and physically active compared to inactive.

Evidence Rating Level: 2 (Good)

It is well known that exercise has positive effects on the immune system, including vaccination responses. Despite this, no prior studies have examined if the effect of exercise differs between physically active and inactive populations nor have they considered the potential interaction effect of acute exercise and physical exercise on vaccination responses. As a result, the present systematic review evaluated whether the immune response varied with acute exercises versus rested control, sufficient versus insufficient physical exercise (PA), or interactions between these.

Of 313 identified studies, 7 (n=550) were included in the final analysis from inception to March 2021. Studies were included if they had both antibody and PA measurements. Acute exercise was comprised of a bout of 15-50 minutes of resistance or aerobic exercise. PA was measured using self-reported questionnaires. Antibody response was calculated separately by strain variants. The relationship between acute exercise, PA, and antibody outcomes was performed using generalized linear mixed-effects models with random intercept. Age-sensitivity analyses were performed. The risk of bias was assessed using the Cochrane revised risk-of-bias tool. Results demonstrated that physical activity significantly increased the odds for H1 seroconversion following influenza vaccination among all participants and titer response among the acute exercise group. Furthermore, acute-exercised participants had higher antibody responses compared to rested controls and physically active compared to inactive.

Despite this, the study was limited by the lack of any participants aged 36-65. However, the results of the present paper allow for new directions for exploring exercise as a method for improving antibody response to vaccines, particularly in older individuals.

Supervised exercise Interventions may significantly benefit childhood cancer survivors

1. Supervised exercise interventions significantly improved muscle strength, daily physical activity, body mass index, and fatigue; though there was no statistically significant improvement in quality of life.

2. The mean retention rate and adherence to the exercise interventions were 87%.

 Evidence Rating Level: 2 (Good)

Childhood cancer survivors (CCs) are at risk of facing complications related to their underlying condition or treatment. In adult patients, the addition of supervised exercise interventions has been shown to not only reduce cancer-related sequelae but also improve quality of life. Since evidence for exercise is lacking in the CCSs, the objective of the present systematic review and meta-analysis was to determine the effectiveness of exercise interventions on health outcomes in CCs and determine the retention, adherence rate, and safety of these interventions.

Of 8783 identified records, 9 (n=642) were included in the systematic review and 7 (n=551) in the meta-analysis from database inception to May 2022. Studies were included if participants had a cancer diagnosis and underwent a supervised exercise intervention by medical staff which was compared to placebo or usual care. Studies were excluded if they reported telephone monitoring, activity monitoring, or manual therapy. Study quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. Statistical analysis was performed using either a fixed-effect model or random effects (if heterogeneity was substantial). The results demonstrated that supervised exercise interventions significantly improved muscle strength, daily physical activity, body mass index, and fatigue, though there was no statistically significant improvement in quality of life. Furthermore, the mean retention rate and adherence to the exercise interventions were 87%

Despite this, the study was limited by the heterogeneity within studies which has introduced a moderate risk of bias. However, the present study has demonstrated the safety and potential for supervised exercise to improve the physical condition of CCs during and after treatment.

Adding aerobic and resistance exercise to treatment plans may benefit patients with fibromyalgia

 1. Aerobic exercise seemed to reduce pain perception, depression, improved quality of life as well as mental and physical health-related quality of life.

2. Resistance exercise decreased pain perception and improved quality of life and improved the physical dimension of health-related quality of life. There was a non-significant positive effect on depression and the mental dimension of health-related quality of life.

Evidence Rating Level: 2 (Good)

Exercise plays an important role in the non-pharmacological management of fibromyalgia. Unfortunately, adherence rates to exercise have been low due to the contradictory information regarding the exercise prescription. As a result, the objective of the present systematic review and meta-analysis was to summarize the evidence of different forms of exercise on pain, depression, and quality of life in patients with fibromyalgia.

Of 747 screened records, 18 (n=1184; 97.46% females) were included from database inception to December 2021. Studies were included if they evaluated the effect of either aerobic, resistance, or stretching exercises performed out of the water on pain, depression, or quality of life in patients with fibromyalgia. Interventions that used more than one exercise typology or that were performed in hot water were excluded. Study quality was assessed using the Cochrane Collaboration Risk of Bias Tool. The strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Data analysis was performed through random effect models. Results demonstrated that aerobic exercise seemed to reduce pain perception, depression, improved quality of life as well as mental and physical health-related quality of life. Resistance exercise decreased pain perception, improved quality of life, and the physical dimension of health-related quality of life but had a non-significant positive effect on depression and the mental dimension of health-related quality of life. Stretching exercise reduced pain perception and improved quality of life however there was a non-significant effect on depression.

Despite this, the study was limited by the heterogeneity of the study’s populations, reported outcomes, and interventions. However, the study’s results suggest that exercise should be encouraged in patients with symptomatic fibromyalgia.

 Image: PD

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