The effect and safety of exercise therapy in patients with systemic sclerosis: a systematic review.
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ABSTRACT:
SUBMITTER: Liem SIE
PROVIDER: S-EPMC6913710 | biostudies-literature | 2019
REPOSITORIES: biostudies-literature
Publications
The effect and safety of exercise therapy in patients with systemic sclerosis: a systematic review.
Liem Sophie I E SIE Vliet Vlieland Theodora P M TPM Schoones Jan W JW de Vries-Bouwstra Jeska K JK
Rheumatology advances in practice 20191209 2
Given the shortcomings of previous literature reviews evaluating the effect and safety of exercise therapy in SSc, we aimed to carry out a systematic review of the literature specifically on this topic. A structured search strategy was performed in Medline (via PubMed) and other electronic databases from 1990 to 3 September 2019. Randomized controlled trials, observational designs, conference abstracts and trial registrations were included if they concerned SSc patients ≥18 years of age, exercis ...[more]
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Project description:BackgroundThere has been an exponential growth in the number of clinical research studies regarding exercise training in multiple sclerosis, and literature reviews and meta-analyses have documented the many benefits of exercise training. This research further requires careful review for documenting the safety of exercise training in multiple sclerosis, as clarity on safety represents a major hurdle in the clinical prescription of exercise behaviour.ObjectivesTo enhance understanding of the feasibility of exercise in multiple sclerosis, we (1) provide a protocol of a systematic review and meta-analysis that summarises rates and risks of clinical relapse, adverse events (i.e., an unfavourable outcome that occurs during the intervention delivery time period), and serious adverse events (i.e., an untoward occurrence that results in death or is life threatening, requires hospitalisation, or results in disability during the intervention delivery time period), as well as retention, adherence, and compliance, from randomised controlled trials of exercise training in persons with multiple sclerosis; and (2) identify moderators of relapse, adverse events, and serious adverse event rates.MethodsEight field-relevant databases will be searched electronically. Studies that involve a randomised controlled trial of exercise training (with non-exercise, non-pharmacological, comparator), report on safety outcomes, and include adults with multiple sclerosis will be included. Rates and relative risks of the three primary outcomes (relapse, adverse event, and serious adverse event) will be calculated and reported each with standard error and 95% confidence interval. Random-effects meta-analysis will estimate mean population relative risk for outcomes. Potential sources of variability, including participant characteristics, features of the exercise stimulus, and comparison condition, will be examined with random-effects meta-regression with maximum likelihood estimation.DiscussionThe results from this systematic review and meta-analysis will inform and guide healthcare practitioners, researchers, and policymakers on the safety of exercise training in persons with multiple sclerosis. Where possible, we will identify the impact of exercise type, exercise delivery style, participant disability level, and the prescription of exercise guidelines, on the safety of exercise training. The result will identify critical information on the safety of exercise in persons with multiple sclerosis, while also identifying gaps in research and setting priorities for future enquiries.Systematic review registrationPROSPERO 2020 CRD42020190544.
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Project description:Background:Evidence suggests that exercise can alleviate symptoms associated with multiple sclerosis (MS). However, it is unclear whether exercise alleviates symptoms of anxiety, present in one-third of people with MS. This systematic review and meta-analysis investigates whether exercise interventions are effective in reducing anxiety in people with MS. Methods:CINAHL, Embase, MEDLINE, PsycINFO, and the Cochrane Controlled Clinical Trials Register were searched to identify relevant randomized controlled trials (RCTs) published up to March 30, 2018. The primary outcome was postintervention difference in anxiety scores between intervention and control groups. Using a restricted maximum likelihood random-effects model, standardized mean differences were pooled and heterogeneity was estimated. Risk of bias was assessed using an a priori modified Cochrane Risk of Bias 2.0 tool. Results:Four RCTs with 133 participants were included. Exercise type included walking, aerobic activities, and cycling. Intervention duration ranged from 8 to 26 weeks. The pooled standardized mean difference in anxiety score was -0.16 (95% CI, -0.50 to 0.19), without heterogeneity. Two studies had high risk of bias, and two had some risk of bias. Conclusions:Based on available RCT data, exercise does not seem to have an effect on anxiety in people with MS. These results should be interpreted with caution because studies had concerns of bias and small sample sizes, and anxiety was not the primary outcome measure. Future studies should exhibit sufficient reporting standards, alongside publishing protocols. There is opportunity to investigate the effect of exercise in people with MS experiencing clinically relevant levels of anxiety rather than in the general MS population.
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Project description:OBJECTIVE:To assess the efficacy and safety of intradialytic exercise for haemodialysis patients. DESIGN:Systematic review and meta-analysis. DATA SOURCES:Databases, including PubMed, Embase, the Cochrane Library, China Biology Medicine and China National Knowledge Infrastructure, were screened from inception to March 2017. ELIGIBILITY CRITERIA:Randomised controlled trials (RCTs) aimed at comparing the efficacy and safety of intradialytic exercise versus no exercise in adult patients on haemodialysis for at least 3?months. A minimum exercise programme period of 8?weeks. DATA EXTRACTION:Study characteristics and study quality domains were reviewed. Studies were selected, and data extracted by two reviewers. DATA ANALYSIS:The pooled risk ratios and mean differences (MDs) with 95% CIs for dichotomous data and continuous data were calculated, respectively. RESULTS:A total of 27 RCTs involving 1215 subjects were analysed. Compared with no exercise, intradialytic exercise increased dialysis adequacy (Kt/V) (MD 0.07, 95%?CI 0.01 to 0.12, p=0.02) and maximum volume of oxygen that the body can use during physical exertion peak oxygen consumption (MD 4.11, 95%?CI 2.94 to 5.27, p<0.0001), alleviated depression standardised mean difference (-1.16, 95%?CI -1.86 to -0.45, p=0.001) and improved physical component summary-short form-36 (SF-36) level (MD 7.72, 95%?CI 1.93 to 13.51, p=0.009). Also, intradialytic exercise could significantly reduce systolic blood pressure (MD -4.87, 95%?CI -9.20 to -0.55, p=0.03) as well as diastolic blood pressure (MD -4.11, 95%?CI -6.50 to -1.72, p=0.0007). However, intradialytic exercise could not improve mental component summary-SF-36 level (MD 3.05, 95%?CI -1.47 to 7.57, p=0.19). There was no difference in the incidence of adverse events between the intradialytic exercise and control groups. CONCLUSIONS:Intradialytic exercise resulted in benefits in terms of improving haemodialysis adequacy, exercise capacity, depression and quality of life for haemodialysis.
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