Wellness Check: Exercise

Guidelines from many countries recommend physical activity during uncomplicated pregnancy

1. In this scoping review, public health guidelines from most countries recommended moderate intensity aerobic activity and muscle strengthening exercises during uncomplicated pregnancies.

2. However, guidance was limited with respect to specific subgroups such as highly active women, specific trimesters, and different cultures.

Evidence Rating Level: 1 (Excellent)

Health professionals routinely recommend physical activity (PA) during pregnancy for its beneficial health effects, not only for the mother, but also for the neonate. Within the past decade, the body of research on this topic has expanded and it is unclear if there is a consensus regarding the public health recommendations from various countries. As a result, the objective of the present scoping review was to evaluate the current public health guidance surrounding PA during pregnancy in various countries

Of 22,232 identified articles, national guidelines from 30 countries published from 2010-2021 were included in the review. In addition to database searches, sources from the grey literature as well as international experts were included in the present study. Studies were included if they were published in 2010 or later and endorsed by government departments. Studies were excluded if they focused on specific medical conditions or did not include specific exercise recommendations. The review was conducted in accordance with PRISMA guidelines. The primary objective was comparing and synthesizing public health guidelines regarding PA in pregnancy from various countries.

The results demonstrated that most guidelines recommended some amount of moderate intensity aerobic activity and muscle-strengthening exercises in uncomplicated pregnancies. However, guidance was lacking with respect to trimester-specific advice, how to measure PA intensity, and how to address specific cultural beliefs (e.g., that pregnancy should focus on rest and recuperation). Despite these findings, the study was limited in its comprehensiveness by government censoring in certain countries, which may have resulted in some public health guidelines being omitted. Nonetheless, this review demonstrated high concordance regarding public health guidelines surrounding PA in uncomplicated pregnancy in various countries around the world.

Exercise may be as effective as pharmacotherapy in managing osteoarthritis pain

1. In this network meta-analysis, there was no difference between exercise, oral non-steroidal anti-inflammatory drugs (NSAIDs), and paracetamol with respect to pain relief associated with osteoarthritis (OA) at up to 24 weeks of follow-up.

2. Furthermore, there was no significant difference between the three groups with respect to functional improvement at up to 24 weeks of follow-up.

Evidence Rating Level: 1 (Excellent)

Osteoarthritis (OA) represents a significant disease burden in older individuals and current pharmacological therapy such as oral non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol may lead to adverse side effects. Although exercise is a mainstay of treatment, it is unknown whether it has analgesic effects equivalent to that of pharmacotherapy. As a result, the objective of the present network meta-analysis was to summarize the trials that directly or indirectly compared exercise with oral NSAIDs and paracetamol to evaluate its analgesic effect in osteoarthritis.

Of 46,635 identified studies, 152 (n= 17,431) randomized controlled trials were included from database inception to January 2022. Studies were included if they compared exercise therapy with oral NSAIDs and paracetamol on osteoarthritis pain or function. Studies were excluded if they were secondary analyses, used a cross-over design, investigated post-operative pain, or had less than 1 week of follow-up. Study quality was assessed using the Cochrane risk of bias assessment tool. The study was conducted following PRISMA guidelines The primary outcome was OA pain or function.

The results demonstrated that exercise had similar effects on pain control and functional improvement compared to oral NSAIDs and paracetamol at short-, medium-, and long-term follow-up. Although the analgesic and functional benefits of exercise gradually decreased over time, there was no significant difference in these effects compared to the pharmacotherapy groups. The study was limited by the inclusion of only participants who had knee or hip OA which may limit generalizability to other types of OA. Nonetheless, this review provided further evidence of the benefits of exercise in OA– particularly its potential to rival the functional and analgesic effects of pharmacotherapy.

Former professional football players may be at greater risk of chronic disease

1. In this retrospective cohort study, there was an increased prevalence of age-, race-, and body mass index (BMI)-adjusted cardiovascular, musculoskeletal, and neurodegenerative diseases in former professional American-style football (ASF) players compared to the general population.

2. Additionally, the proportion of individuals without any chronic diseases was lower in former ASF players compared to the general population.

Evidence Rating Level: 2 (Great)

Participation in American-style football (ASF) has been shown to have several health consequences. Participants have been noted to develop vascular, cognitive, endocrine, and neurological conditions following their playing years. However, the mechanisms underpinning these multiorgan repercussions are poorly understood. As a result, the objective of the present study was to investigate the impact of playing professional ASF on chronic disease burden.

Of 4174 individuals from the Football Players Health Study (FPHS), 2864 former ASF players ages 25-59 who played after 1960 were included in the study. The former players filled out a survey regarding playing career, demographics, and chronic disease. The general population cohort was taken from two surveys: the National Health and Nutrition Examination Survey (NHANES; n=1481) from 2015-2018 and the National Health Interview Survey (NHIS; n=6298) from 2019. Statistical analyses were performed using standardized prevalence rates for age, race, and body mass index. The primary outcome was the prevalence of chronic disease.

The results demonstrated that several chronic medical conditions including, arthritis and dementia/Alzheimer’s, were higher among former ASF players than the general population across all age groups. Furthermore, the prevalence of individuals with no chronic diseases was significantly lower among ASF players compared to the general population. However, the study was limited by self-reported data which may have introduced inaccurate reporting. Nonetheless, these results provide further evidence that participation in professional ASF may increase the risk of chronic disease in an individual’s future.

Exercise improves outcomes in patients with cardiovascular disease

1. In this systematic review and meta-analysis, the addition of exercise to usual care in patients with cardiovascular disease, hypertension, and type 2 diabetes was associated with improvements in all-cause mortality and serious adverse events.

2. Additionally, there were no significant differences in these findings across regions or between types of exercise and duration of follow-up.

Evidence Rating Level: 1 (Excellent)

Cardiovascular disease puts a significant burden on the healthcare system, and hypertension and type 2 diabetes remain the most prevalent risk factors and comorbidities of cardiovascular disease. Although exercise is one of the most important lifestyle interventions for cardiovascular disease, there has been limited research evaluating its benefits on important outcomes such as mortality risk, serious adverse events, and quality of life. As a result, the objective of the present systematic review and meta-analysis was to assess the effects of adding exercise to usual care in patients with hypertension, type 2 diabetes, and cardiovascular disease.

Of 32,739 identified records, 950 trials (n=21,633) were included in the analysis from database inception to 2020. All trials that evaluated the effects of adding exercise to usual care in patients with either hypertension, type 2 diabetes, or cardiovascular disease were included. The review was conducted according to PRISMA guidelines. Risk of bias was assessed using the Cochrane risk of bias tool. Statistical analyses were performed using fixed-effect and random effect models. The primary outcomes were all-cause mortality, serious adverse events, and quality of life.

The results demonstrated that exercise added to usual care conferred a benefit with respect to all-cause mortality and serious adverse events. There was also a benefit of added exercise on quality of life, however the effect size was small. Furthermore, there were no differences in outcomes based on region, type of exercise, duration of follow-up, or type of participants. Despite these findings, the study was limited by the high risk of bias, primarily due to the methodology of the included trials, which may have overestimated the benefits of exercise. Nonetheless, these results provided further evidence to suggest that exercise may improve important outcomes, such as all-cause mortality, for those with cardiovascular disease.

Image: PD

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