scholarly journals What Is the Dose-Response Relationship Between Exercise and Cardiorespiratory Fitness After Stroke? A Systematic Review

2019 ◽  
Vol 99 (7) ◽  
pp. 821-832
Author(s):  
Margaret Galloway ◽  
Dianne L Marsden ◽  
Robin Callister ◽  
Kirk I Erickson ◽  
Michael Nilsson ◽  
...  
Keyword(s):  
Cardiorespiratory Fitness ◽  
Data Extraction ◽  
High Rate ◽  
Peak Oxygen Consumption ◽  
Current Evidence ◽  
Study Selection ◽  
Walking Capacity ◽  
Exercise Dose ◽  
Test Distance ◽  
6 Minute Walk Test

Abstract Background Exercise after stroke improves cardiorespiratory fitness and walking capacity; however, the effect of altering exercise dose (via frequency, intensity, time, and type) on fitness or walking capacity is unclear. Purpose The purpose of this study was to synthesize the current evidence for the effects of different doses of exercise on cardiorespiratory fitness and walking capacity in people after stroke. Data Sources Seven relevant electronic databases were searched using keywords relating to stroke and cardiorespiratory fitness. Study Selection Trials that compared more than 1 dose of exercise for people (≥ 18 years old) after stroke and measured peak oxygen consumption or 6-minute walk test distance as an outcome were included. Two reviewers independently appraised all trials. Data Extraction Two reviewers independently extracted data from included articles. Intervention variables were extracted in accordance with the Template for Intervention Description and Replication checklist. Data Synthesis Data were synthesized narratively. Nine trials involving 279 participants were included. Three of 5 trials comparing exercise intensity showed that higher-intensity training was associated with greater improvements in cardiorespiratory fitness. The effects of other exercise dose components (frequency, time, and type) on fitness were not determined. Overall, walking capacity improved as program length increased. Limitations All trials had a high risk of bias, and most had a high rate of attrition. Most trials included people more than 6 months after stroke and who walked independently, limiting the generalizability of the findings. Conclusions Exercising at an intensity greater than 70% of heart rate reserve can be more effective in increasing cardiorespiratory fitness after stroke than exercising at lower intensities. More trials that compare exercise doses by manipulating only 1 dose parameter at a time for people after stroke are needed.

scholarly journals Commercial tobacco and indigenous peoples: a stock take on Framework Convention on Tobacco Control progress

2018 ◽  
Vol 28 (5) ◽  
pp. 574-581 ◽  
Author(s):  
Raglan Maddox ◽  
Andrew Waa ◽  
Kelley Lee ◽  
Patricia Nez Henderson ◽  
Genevieve Blais ◽  
...  
Keyword(s):  
New Zealand ◽  
Tobacco Control ◽  
Indigenous Peoples ◽  
Tobacco Use ◽  
Data Extraction ◽  
Indigenous Populations ◽  
High Rate ◽  
Search Terms ◽  
Study Selection ◽  
Indigenous Participation

BackgroundThe health status and needs of indigenous populations of Australia, Canada and New Zealand are often compared because of the shared experience of colonisation. One enduring impact has been a disproportionately high rate of commercial tobacco use compared with non-indigenous populations. All three countries have ratified the WHO Framework Convention on Tobacco Control (FCTC), which acknowledges the harm caused to indigenous peoples by tobacco.Aim and objectivesWe evaluated and compared reporting on FCTC progress related to indigenous peoples by Australia, Canada and New Zealand as States Parties. The critiqued data included disparities in smoking prevalence between indigenous and non-indigenous peoples; extent of indigenous participation in tobacco control development, implementation and evaluation; and what indigenous commercial tobacco reduction interventions were delivered and evaluated.Data sourcesWe searched FCTC: (1) Global Progress Reports for information regarding indigenous peoples in Australia, Canada and New Zealand; and (2) country-specific reports from Australia, Canada and New Zealand between 2007 and 2016.Study selectionTwo of the authors independently reviewed the FCTC Global and respective Country Reports, identifying where indigenous search terms appeared.Data extractionAll data associated with the identified search terms were extracted, and content analysis was applied.ResultsIt is difficult to determine if or what progress has been made to reduce commercial tobacco use by the three States Parties as part of their commitments under FCTC reporting systems. There is some evidence that progress is being made towards reducing indigenous commercial tobacco use, including the implementation of indigenous-focused initiatives. However, there are significant gaps and inconsistencies in reporting. Strengthening FCTC reporting instruments to include standardised indigenous-specific data will help to realise the FCTC Guiding Principles by holding States Parties to account and building momentum for reducing the high prevalence of commercial tobacco use among indigenous peoples.

scholarly journals The association between running injuries and training parameters: A systematic review

2021 ◽  
Author(s):  
Anny Fredette ◽  
Jean-Sébastien Roy ◽  
Kadija Perreault ◽  
Frédérique Dupuis ◽  
Christopher Napier ◽  
...  
Keyword(s):  
Data Extraction ◽  
Current Evidence ◽  
Body Parts ◽  
Prospective Data ◽  
Conflicting Evidence ◽  
Study Selection ◽  
Running Injuries ◽  
Recreational Runners ◽  
And Training ◽  
Frequency Intensity

ABSTRACT Objective: To synthesise the current evidence on the incidence of running-related injuries (RRI) and their association with training parameters (distance, duration, frequency, intensity), as well as recent changes in training parameters. Data sources: Searches were conducted in Medline/Ovid, CINAHL, Embase and SportDiscus up to July 7, 2020. Study selection: Included articles had to report prospective data on RRIs and training parameters, or any changes in parameters, and be published in English or French. Two reviewers independently screened titles, abstracts and full-texts. Data extraction: Data extraction and quality assessment (QualSyst) were performed by two independent raters. Data synthesis: Thirty-six articles totaling 23,047 runners were included. Overall, 6,043 runners (26.2%) sustained an RRI (incidence range: 8.8% to 91.3%). The incidence of RRI was 14.9% in novice runners (range: 9.4 to 94.9%), 26.1% in recreational runners (range: 17.9 to 79.3%) and 62.6% in competitive runners (range: 52.6 to 91.3%). The three most frequently injured body parts were the knee (25.8%), foot/ankle (24.4%) and lower leg (24.4%). Overall, there was conflicting evidence about the association between weekly running distance, duration, frequency, intensity or specific changes in training parameters and the onset of RRIs. Conclusions: Despite high rates of RRIs, current evidence does not consistently link RRIs with specific training parameters or recent changes in training parameters. Therefore, caution should be taken when recommending optimal parameters or progressions. Given the multifactorial nature of RRIs, future studies also need to consider the interaction between training parameters, as well as psychosocial, hormonal, lifestyle and recovery outcomes to better understand the onset of RRIs.

Managing Diabetes and Preventing Heart Disease: Have We Found a Safe and Effective Agent?

2018 ◽  
Vol 53 (5) ◽  
pp. 510-522 ◽  
Author(s):  
Judy W. M. Cheng ◽  
Vincent J. Colucci ◽  
James S. Kalus ◽  
Sarah A. Spinler
Keyword(s):  
High Risk ◽  
Glycemic Control ◽  
Data Extraction ◽  
Microvascular Complications ◽  
Arterial Disease ◽  
Current Evidence ◽  
Study Selection ◽  
Cv Disease ◽  
Peripheral Arterial ◽  
Double Blinded

Objective: While improving glycemic control with antihyperglycemics has been demonstrated to reduce microvascular complications, the benefits of reduction in cardiovascular diseases (CVDs) have not been demonstrated with older agents. This article reviews current evidence of the CV outcomes of newer antihyperglycemics approved since 2008. Data Sources: Peer-reviewed articles were identified from MEDLINE (1966 to October 31, 2018) using search terms exenatide, liraglutide, lixisenatide, dulaglutide, semaglutide, alogliptin, linagliptin, saxagliptin, sitagliptin, canagliflozin, dapagliflozin, empagliflozin, mortality, myocardial infarction (MI), heart failure (HF), and stroke. Study Selection and Data Extraction: A total of 12 pertinent double-blinded randomized controlled trials were included. Data Synthesis: Liraglutide, empagliflozin, and canagliflozin have been shown in patients with CV diseases and high risk of developing CV disease to be superior to placebo in improving CV outcomes. Saxagliptin and alogliptin have both been demonstrated to increase HF hospitalization, whereas sitagliptin has not. Relevance to Patient Care and Clinical Practice: In contrast to older-generation antihyperglycemics, selected new antihyperglycemic agents have been shown to be superior to placebo in improving CV outcomes. Clinicians may now be able to provide high-risk patients agents that not only help in providing glycemic control, but also prevent both macrovascular and microvascular complications. Conclusion: Liraglutide, empagliflozin, and canagliflozin have been shown to be superior to placebo in improving CV outcomes. However, there are differences among agents in terms of HF and peripheral arterial disease outcomes. Future studies should focus on evaluating other clinical CV outcomes in patients without existing CVD and perhaps single drug regimens for diabetes.

Lacosamide for the Treatment of Refractory Status Epilepticus

2011 ◽  
Vol 45 (11) ◽  
pp. 1445-1449 ◽  
Author(s):  
Erica M Fernandez ◽  
Andrew J Franck
Keyword(s):  
Status Epilepticus ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Current Evidence ◽  
Refractory Status ◽  
Successful Termination ◽  
Study Selection ◽  
Animal Data

Objective: To evaluate current evidence for the use of lacosamide in the treatment of refractory status epilepticus. Data Sources: Literature was accessed via PubMed (through July 2011) using the terms lacosamide and status epilepticus. Study Selection and Data Extraction: All reports on the use of lacosamide in patients with status epilepticus were included for evaluation. Reviews and animal data were excluded. Data Synthesis: Treatment of status epilepticus is challenging, and most patients fail to respond to initial treatment. Recently, several reports have been published on the use of lacosamide for status epilepticus. Eleven reports (5 case reports and 6 case series) were identified. Lacosamide was credited with successful termination of status epilepticus in a majority of these reports, However, the data are weakened by the heterogeneity of the reports, their descriptive nature, and the common divergence from current recommendations for the treatment of status epilepticus, Conclusions: While lacosamide has been reported as an effective treatment for refractory status epilepticus, there is insufficient evidence for its routine use. For cases in which the risks associated with anesthetizing drugs are believed to outweigh the benefits, such as in complex partial status epilepticus, lacosamide may be a reasonable option after more established drug therapies fail.

Vasopressin in Cardiac Arrest

2005 ◽  
Vol 39 (10) ◽  
pp. 1687-1692 ◽  
Author(s):  
Sheri L Koshman ◽  
Peter J Zed ◽  
Riyad B Abu-Laban
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Statistical Power ◽  
English Language ◽  
Data Extraction ◽  
Spontaneous Circulation ◽  
Current Evidence ◽  
Successful Resuscitation ◽  
Search Terms ◽  
Study Selection

Objective: To review the efficacy and safety of vasopressin in cardiac arrest. Data Sources: MEDLINE, EMBASE, and PubMed were searched (all to June 2005) for full-text English-language publications describing trials in humans. Search terms were vasopressin, epinephrine, adrenaline, heart arrest, cardiac arrest, and clinical trial. Study Selection and Data Extraction: Prospective, randomized, controlled trials that evaluated efficacy or safety endpoints of vasopressin in the management of cardiac arrest were included. Efficacy outcomes included return of spontaneous circulation, successful resuscitation, survival to hospital admission, 2hour survival, and survival to hospital discharge. Safety outcomes were as defined by each trial. Data Synthesis: Three prospective trials were identified and included in this review. Vasopressin does not appear to offer any therapeutic advantage compared with epinephrine in the treatment of both in-hospital and out-of-hospital cardiac arrest, regardless of the presenting arrest rhythm. Although there is a suggestion that vasopressin may be effective in treatment of asystole, the evidence for this arises from a subgroup analysis that should be viewed as hypothesis generating. There are limited data describing the safety of vasopressin in cardiac arrest. CONCLUSIONS: The current evidence for the use of vasopressin in cardiac arrest is indeterminate. Given the similarly equivocal evidence of efficacy for epinephrine, either drug could be considered the first-line agent in cardiac arrest. Placebo-controlled studies with appropriate statistical power are warranted to evaluate meaningful clinical outcomes, such as survival to hospital discharge. Further evaluation of the role of vasopressin in asystolic cardiac arrest and its use in combination with epinephrine is also justified.

Exercise Dose and Aerobic Fitness Response in Alzheimer’s Dementia in the FIT-AD Trial

2021 ◽  
Author(s):  
Dereck Salisbury ◽  
Michelle A Mathiason ◽  
Fang Yu
Keyword(s):  
Oxygen Consumption ◽  
Aerobic Exercise ◽  
Cardiorespiratory Fitness ◽  
Cardiopulmonary Exercise Test ◽  
Exercise Group ◽  
Alzheimer’S Dementia ◽  
Peak Oxygen Consumption ◽  
Walking Distance ◽  
Alzheimer's Dementia ◽  
Exercise Dose

The purpose of this study was to examine the effects of a 6-month cycling aerobic exercise intervention on cardiorespiratory fitness and the dose-response relationship in community-dwelling older adults with mild-to-moderate Alzheimer’s dementia. The FIT-AD trial was a single blind, 2-parallel group, pilot randomized controlled trial. The aerobic exercise group participated in a 6-month, thrice weekly, moderate-vigorous intensity cycling intervention while control group performed stretching. Cardiorespiratory fitness was evaluated by peak oxygen consumption from cardiopulmonary exercise test and peak walking distance from the shuttle walk test and 6-minute walk test. Aerobic exercise dose was calculated using the novel heart rate physical activity score. The aerobic exercise group significantly increased peak oxygen consumption (1.28 ml/kg/min; p=.03) in subgroup who achieved maximal criteria on cardiopulmonary exercise test. Changes in peak oxygen consumption and peak walking distance on the shuttle walk and 6-minute walk tests did not significantly differ between aerobic exercise and stretching groups. Notably, the aerobic exercise dose was strongly and significantly correlated to change in peak oxygen consumption (r=.60; n=16; p=.01), in subset who met maximal test criteria. Emphasis on exercise dose is needed in aerobic exercise programs to maximize cardiorespiratory fitness gains in persons with mild-moderate Alzheimer’s dementia.

scholarly journals The effects of exercise training on muscle oxygenation of patients with intermittent claudication

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
P Chatzinikolaou ◽  
N Cornelis ◽  
J Claes ◽  
R Buys ◽  
I Fourneau ◽  
...  
Keyword(s):  
Intermittent Claudication ◽  
Near Infrared ◽  
Saturation Index ◽  
Ankle Brachial Index ◽  
Muscle Oxygenation ◽  
Lower Limbs ◽  
Current Evidence ◽  
Test Time ◽  
Treadmill Test ◽  
Walking Capacity

Abstract Funding Acknowledgements Type of funding sources: None. Background. Intermittent claudication (IC) is characterized by a cramp-like pain during walking caused by insufficient blood flow to the lower limbs during exercise. The walking impairment caused by IC can lead to a vicious cycle of physical inactivity, decreased quality of life and progression of cardiovascular risk factors. Although current evidence supports the benefits of walking training to increase walking capacity, little is known about its effect on muscle oxygenation in this population. Purpose. The aim of this study was to investigate the effects of a hybrid 12-week walking program (combined center- and home-based walking) on muscle oxygenation of IC patients. Methods. Thirty-seven patients with IC were enrolled of which 33 completed follow-up measurements (age 71 ± 9 yrs, body mass index 26 ± 4 kg/m2, ankle brachial index (ABI) 0.7 ± 0.2) after the 12-week intervention. Outcome measures were pain-free walking capacity (PFWC), maximal walking capacity (MWC) and calf muscle oxygenation, respectively evaluated using a submaximal treadmill test, a Gardner treadmill test and near-infrared spectroscopy (NIRS). Results. After the 12-week intervention, significantly higher values (reported as median and interquartiles) for PFWC (162 m [122, 217] to 272 m [150, 401]; p < 0.001) and MWC (458 m [260, 638] to 611 m [333, 840]; p < 0.001) were observed. As shown in Table 1, NIRS data measured during the submaximal walking test showed an increased availability of oxygenated hemoglobin (p = 0.048) and decreased deoxyhemoglobin (p = 0.013), while total hemoglobin remained unchanged after the 12-week intervention. During the Gardner test, time to reach minimum tissue saturation index (TSI%) increased (p < 0.001), yet no change was noted on minimum TSI during exercise, despite increased MWC. Despite a trend towards faster recovery times, no significant changes were observed after the 12-week intervention. Conclusion. Hybrid walking exercise therapy improves deoxygenation kinetics and walking capacity in IC patients. Increased availability of oxygenated hemoglobin might underly the improvement in walking capacity.

scholarly journals Epidemiology of hepatitis E virus infection in animals in Africa: a systematic review and meta-analysis

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Abdou Fatawou Modiyinji ◽  
Jean Joel Bigna ◽  
Sebastien Kenmoe ◽  
Fredy Brice N. Simo ◽  
Marie A. Amougou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hepatitis E Virus ◽  
Data Extraction ◽  
Meta Analysis ◽  
Hepatitis E ◽  
Epidemiological Studies ◽  
Cross Sectional ◽  
Resource Limited ◽  
Study Selection ◽  
Language Restriction

Abstract Background Hepatitis E virus (HEV) is a major cause of acute hepatitis in humans worldwide and have high burden in the resource-limited countries. Better knowledge of the epidemiology of hepatitis in animals in Africa can help to understand the epidemiology among humans. The objective of this study was to summarize the prevalence of HEV infection and distribution of HEV genotypes among animals in Africa. Methods In this systematic review and meta-analysis, we comprehensively searched PubMed, EMBASE, African Journals Online, and Africa Index Medicus from January 1st, 2000 to March 22th, 2020 without any language restriction. We considered cross-sectional studies of HEV infection in animals in Africa. Study selection, data extraction, and methodological quality of included studies were done independently by two investigators. Prevalence data were pooled using the random-effects meta-analysis. This review was registered in PROSPERO, CRD42018087684. Results Twenty-five studies (13 species and 6983 animals) were included. The prevalence (antibodies or ribonucleic acid [RNA]) of HEV infection in animals varied widely depending on biological markers of HEV infection measured: 23.4% (95% confidence interval; 12.0–37.2) for anti-HEV immunoglobulins G, 13.1% (3.1–28.3) for anti-HEV immunoglobulins M, and 1.8% (0.2–4.3) for RNA; with substantial heterogeneity. In subgroup analysis, the immunoglobulins G seroprevalence was higher among pigs 37.8% (13.9–65.4). The following HEV genotypes were reported in animals: Rat-HEV genotype 1 (rats and horses), HEV-3 (pigs), HEV-7 (dromedaries), and Bat hepeviruses (bats). Conclusions We found a high prevalence of HEV infection in animals in Africa and HEV genotypes close to that of humans. Some animals in Africa could be the reservoir of HEV, highlighting the need of molecular epidemiological studies for investigating zoonotic transmission.

Lead in Mineral or Multivitamin-Multimineral Products

2021 ◽  
pp. 106002802110233
Author(s):  
C. Michael White
Keyword(s):  
English Language ◽  
Data Extraction ◽  
The United States ◽  
Third Party ◽  
Reference Level ◽  
Study Selection ◽  
Pubmed Search ◽  
Zinc Supplements ◽  
Average Lead ◽  
Year 2000

Objective Assess the current daily interim reference level of lead and the amount contained in current mineral and multivitamin-multimineral (MVM) products. Data Sources PubMed search from 1980 to May 15, 2021, limited to the English language, via the search strategy ((mineral OR multivitamin OR calcium OR iron OR magnesium OR copper OR zinc OR chromium OR selenium) AND (heavy metals OR Pb OR lead)). Study Selection and Data Extraction Narrative review of studies assessing lead content in mineral or MVM products. Data Synthesis Products containing different calcium forms (dolomite, bone meal, natural carbonate) have historically had higher lead levels than others (refined carbonate, lactate, gluconate, acetate, sevelamer), but the gap has closed considerably since the year 2000. Although only limited assessments of magnesium and zinc supplements have been conducted, no alarming average lead amounts were found. MVM products assessed since 2007 had low median or mean lead concentrations. However, large interproduct differences exist, with many products having very little lead and some products having concerning amounts. Relevance to Patient Care and Clinical Practice It is difficult for pharmacists and consumers to know the amount of lead in an actual product unless it is tested in an independent third-party lab. The United States Pharmacopeia and NSF International will provide a seal on the products stating that the products have a low level of lead, but even so, children could receive more lead than the Food and Drug Administration’s Interim Reference Level. Conclusions The threat from lead exposure in mineral and MVM products have diminsihed considerably over time but some products can still have excessive amounts. Without third-party testing, it is difficult for clinicians and consumers to know which outlier products to avoid.

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