Exercise improves arterial stiffness in children and adolescents
1. In this systematic review and network meta-analysis, resistance training, high-intensity interval training (HIIT), and aerobic exercise interventions were superior to controls in reducing arterial stiffness in children and adolescents.
2. However, sensorimotor training did not show a benefit in reducing arterial stiffness compared to controls.
Evidence Rating Level: 1 (Excellent)
Arterial stiffness (AS) is an important variable as it is an early marker of atherosclerotic cardiovascular disease (ACVD). In the adult population, exercise has been shown to reduce AS. However, this has yet to be comprehensively evaluated in pediatric populations. As a result, the objective of the present systematic review and network meta-analysis was to evaluate the effectiveness of various exercise modalities in reducing AS in pediatric patients.
Of 2414 identified records, 14 (n=1003 participants) studies were included from various databases from 2015-2022. Studies were included if they evaluated the effects of exercise on pulse wave velocity (PWV) in both children and adolescents. Studies were excluded if they only reported the acute effects of exercise on PWV, or if they included adult populations. The review was performed using PRISMA guidelines, Meta-analyses statement extension for NMA guidelines, and the Cochrane Handbook for Systematic Reviews of Interventions recommendations. The risk of bias was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Statistical analyses were performed using meta-regression and subgroup analyses. The primary outcome was the reduction in AS measured by PWV.
The results demonstrated that the most effective exercise intervention for reducing AS was aerobic exercise. However, for pediatric patients with a higher cardiometabolic risk, high-intensity interval training (HIIT) was more effective at reducing AS. Sensorimotor training was the only intervention that had no effect on AS. Despite these results, the study was limited by the different instruments used to measure PWV, which may have influenced the overall effect size of the intervention. Nonetheless, the present study demonstrated the potential role for exercise to mitigate the development of AVCD at an early age.
Minimalist footwear reduces patellofemoral joint loads during running
1. In this systematic review and meta-analysis, it was found that minimalist footwear reduced the load experienced by the patellofemoral joint during running more than conventional footwear.
2. In addition, medial support insoles and rocker-soled shoes did not impact patellofemoral joint loads while walking or running.
Evidence Rating Level: 1 (Excellent)
Symptoms associated with patellofemoral pain and patellofemoral osteoarthritis may be persistent even several years after diagnosis. Strategies that alter joint biomechanics (e.g., through footwear and insoles) have therapeutic potential but have not been studied extensively. As a result, the objective of the present study was to evaluate the efficacy of footwear interventions on the biomechanical load experienced while running, and/or walking in individuals with and without patellofemoral pain or osteoarthritis.
Of 11,953 identified records, 33 studies (22 footwear studies, 11 insole studies, n= 578 total participants) were included from various databases from inception to October 2022. Studies were included if they investigated either healthy adults or those diagnosed with patellofemoral pain or arthritis, used a biomechanical foot-based intervention, had a control group that received either no intervention or another eligible biomechanical foot intervention, and measured patellofemoral loads during walking and/or running. Grey literature was excluded. The review was performed using PRISMA guidelines. The risk of bias was assessed using the Revised Cochrane Risk of Bias 2 tool for randomized cross-over trials. The primary outcome was patellofemoral joint load during walking and/or running.
The results demonstrated that only minimalist footwear showed a reduction in patellofemoral joint loads during running compared to conventional footwear. Furthermore, medial support insoles and rocker-soled shoes did not impact joint loads during running or walking. However, no studies examined the effects of foot taping or bracing on joint loads. Despite these results, the study was limited by the use of only one author to conduct data extraction, which may have affected the accuracy of the results. Nonetheless, the findings of the present study suggested that minimalist footwear may have a therapeutic benefit by reducing joint loads in those with patellofemoral pain or osteoarthritis.
Physical activity may improve disease-free survival following resection of stage III colon cancer
1. In this cohort study, physical activity was associated with improved disease-free survival in postoperative stage III colon cancer patients in the first year following surgical resection.
2. Furthermore, there was an overall survival benefit associated with physical activity that persisted in the first three years following surgical resection.
Evidence Rating Level: 2 (Good)
The literature has demonstrated that there is a benefit of doing physical activity after surgical resection of stage III colon cancer. However, prior studies have focused primarily on absolute rates of disease recurrence and death, rather than the risk at a specific time. As a result, the objective of the present study was to better characterize how exercise affects the time course of cancer recurrence in postoperative patients with stage III colon cancer.
The present prospective nested cohort study included 1696 patients with surgically resected stage III colon cancer from the National Cancer Trials Network in the USA and Canada from 2010-2015. Participants were enrolled between 21 and 56 days following surgical resection of stage III colonic adenocarcinoma and had an Eastern Cooperative Oncology Group (ECOG) performance status of ≤2. Participants were excluded if they had disease recurrence or died within 60 days of the first assessment. Physical activity was measured using a validated questionnaire at 4 and 14 months after surgical resection. The Müller and Wang plot method was used for statistical analysis. The primary outcome was disease-free survival.
The results demonstrated that physical activity was associated with improved disease-free survival in the first postoperative year. Furthermore, at no point during the surveillance period did the risk of recurrence of physically active patients exceed that of physically inactive patients. There was also a survival benefit associated with physical activity that persisted in the first three years following surgical resection. Despite these results, the study was limited by the cohort not being randomized, which may have led to confounding. Nonetheless, the present study added evidence to support physical activity in colon cancer survivors.
Physical activity improves symptoms of depression and anxiety in many adult populations
1. In this umbrella review, physical activity was effective in reducing the symptoms of depression and anxiety, not only in those with mental health disorders and chronic diseases, but also in the general population.
2. In addition, the greatest benefit of physical activity was seen in interventions involving high-intensity physical activity.
Evidence Rating Level: 1 (Excellent)
Despite the established benefits of physical activity (PA) in improving mental health, its therapeutic value has not yet been widely adopted by practitioners. At present, the literature has focused on the benefits of PA in specific subgroups, but no study has undertaken a comprehensive review to summarize the overall findings. As a result, the objective of the present study was to synthesize the evidence regarding all modes of PA on symptoms of depression, anxiety, and psychological distress in a heterogeneous population of adults.
Of 1208 identified records, 97 (n=128,119 participants) studies were included from various sources from database inception to January 2022. Studies were included if they investigated the effect of any PA intervention on symptoms of depression and anxiety. Studies were excluded if PA was combined with another intervention or if the intervention consisted of a single PA session. The review was performed using PRISMA guidelines. Evidence grading was performed using the Oxford Centre for Evidence-Based Medicine Levels of evidence and grades for recommendations. The primary outcome was symptoms of depression and anxiety.
The results demonstrated that PA was effective in reducing the symptoms of depression and anxiety across all adult populations studied. The greatest benefit of PA was seen in pregnant and postpartum women, those with depression, HIV, or kidney disease, and otherwise healthy individuals. Furthermore, interventions involving high-intensity PA conferred the greatest benefit. Despite these results, the study was limited by the lack of blinding of participants in PA trials which may have affected the current findings. Nonetheless, the present study added further evidence to support the inclusion of PA as a mainstay treatment in managing symptoms of depression and anxiety.
Image: PD
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