Efficacy of interventions to increase physical activity for people with heart failure: a meta-analysis

ABSTRACTObjectivesThis meta-analysis aims to 1) evaluate the efficacy of physical activity interventions in heart failure and 2) to identify intervention characteristics significantly associated with the interventions’ efficacy.MethodsRandomised controlled trials reporting intervention effects on physical activity in heart failure were combined in a meta-analysis using a random-effect model. Exploratory meta-analysis was performed by specifying the general approach (e.g. cardiac rehabilitation), strategies used (e.g. action planning), setting (e.g. centre-based), mode of delivery (e.g. face-to-face or online), facilitator (e.g. nurse), contact time, and behaviour change theory use as predictors in the random-effect model.ResultsInterventions (n=21) had a significant overall effect (SMD = 0.54,95% CI: [0.13; 0.95], p < 0.005). Combining an exercise programme with behaviour change intervention was found efficacious (SMD = 1.26, 95% CI: [0.26; 2.26], p < 0.05). Centre-(SMD = 0.98, 95% CI: [0.35; 1.62],p < 0.001), and group-based (SMD = 0.89, 95 % CI: [0.29; 1.50],p < 0.001) delivery by a physiotherapist (SMD = 0.84, 95% CI: [0.03; 1.65]], p < 0.01) were significantly associated with efficacy. The following strategies were identified efficacious: prompts/cues (SMD = 3.29, 95% CI: [1.97; 4.62]), credible source (SMD=2.08, 95% CI:[0.95;3.22]), adding objects to the environment (SMD=1.47, 95% CI:[0.41;2.53]), generalisation of the target behaviour (SMD=1.32, 95% CI:[0.22;2.41]), monitoring of behaviour by others without feedback (SMD=1.02, 95% CI:[0.05;1.98]), self-monitoring of outcome(s) of behaviour (SMD=0.79, 95% CI:[0.06;1.52]), graded tasks (SMD=0.73, 95% CI:[0.22;1.24]), behavioural practice/rehearsal (SMD=0.72, 95% CI:[0.26;1.18]), action planning (SMD=0.62, 95% CI:[0.03;1.21]), and goal setting (behaviour) (SMD=0.56, 95% CI:[0.03;1.08]).ConclusionThe meta-analysis suggests intervention characteristics that may be suitable for promoting physical activity in heart failure. There is moderate evidence in support of an exercise programme combined with a behaviour change intervention delivered by a physiotherapist in a group- and centre-based settings.SUMMARYWhat is already known about this subject?Individuals diagnosed with heart failure (HF) are advised to engage in physical activity. However, physical activity levels remain extremely low in this population group. Cardiac Rehabilitation (CR) is routinely offered to newly diagnosed HF patients. CR is multifaceted; It is unknown which specific components result in physical activity improvements once the programme has ended. It is essential to understand how best to improve everyday physical activity engagement in HF.What does this study add?This meta-analysis assessed what constitutes a successful physical activity intervention designed for individuals living with HF. The findings pinpoint specific intervention features and component that contribute to physical activity improvements in HF. Centre-based interventions that are delivered by a physiotherapist, in group format, that combine exercise with behaviour change intervention are promising for attaining physical activity improvementsHow might this impact on clinical practice?The findings of this meta-analysis may inform physical activity intervention designed for individuals diagnosed with HF. There is a need for additional training for physiotherapists in delivering behaviour change interventions alongside an exercise programme that includes the identified efficacious strategies.Note: all statistics are reported using Word Build-in: “Equation.”

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Efficacy of interventions to increase physical activity for people with heart failure: a meta-analysis

Open Heart ◽

10.1136/openhrt-2021-001687 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001687

Author(s):

Aliya Amirova ◽

Theodora Fteropoulli ◽

Paul Williams ◽

Mark Haddad

Keyword(s):

Physical Activity ◽

Heart Failure ◽

Meta Analysis ◽

Behavioural Change ◽

Mode Of Delivery ◽

Random Effect ◽

Random Effect Model ◽

Action Planning ◽

Exercise Programme ◽

Effect Model

ObjectivesThis meta-analysis aims to (1) evaluate the efficacy of physical activity interventions in heart failure and (2) to identify intervention characteristics significantly associated with the interventions’ efficacy.MethodsRandomised controlled trials reporting intervention effects on physical activity in heart failure were combined in a meta-analysis using a random-effect model. Exploratory meta-analysis was performed by specifying the general approach (eg, cardiac rehabilitation), strategies used (eg, action planning), setting (eg, centre based), mode of delivery (eg, face to face or online), facilitator (eg, nurse), contact time and behavioural change theory use as predictors in the random-effect model.ResultsInterventions (n=21) had a significant overall effect (SMD=0.54, 95% CI (0.13 to 0.95), p<0.0005). Combining an exercise programme with behavioural change intervention was found efficacious (SMD=1.26, 95% CI (0.26 to 2.26), p<0.05). Centre-based (SMD=0.98, 95% CI (0.35 to 1.62), and group-based (SMD=0.89, 95% CI (0.29 to 1.50),) delivery by a physiotherapist (SMD=0.84, 95% CI (0.03 to 1.65),) were significantly associated with efficacy. The following strategies were identified efficacious: prompts/cues (SMD=3.29, 95% CI (1.97 to 4.62)), credible source (standardised mean difference, SMD=2.08, 95% CI (0.95;3.22)), adding objects to the environment (SMD=1.47, 95% CI (0.41 to 2.53)), generalisation of the target behaviour SMD=1.32, 95% CI (0.22 to 2.41)), monitoring of behaviour by others without feedback (SMD=1.02, 95% CI (0.05 to 1.98)), self-monitoring of outcome(s) of behaviour (SMD=0.79, 95% CI (0.06 to 1.52), graded tasks (SMD=0.73, 95% CI (0.22 to 1.24)), behavioural practice/rehearsal (SMD=0.72, 95% CI (0.26 to 1.18)), action planning (SMD=0.62, 95% CI (0.03 to 1.21)) and goal setting (behaviour) (SMD=0.56, 95% CI (0.03 to 1.08)).ConclusionThe meta-analysis suggests intervention characteristics that may be suitable for promoting physical activity in heart failure. There is moderate evidence in support of an exercise programme combined with a behavioural change intervention delivered by a physiotherapist in a group-based and centre-based settings.PROSPERO registerationCRD42015015280.

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Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis

JMIR mhealth and uhealth ◽

10.2196/16695 ◽

2020 ◽

Vol 8 (7) ◽

pp. e16695 ◽

Cited By ~ 1

Author(s):

Praveen Indraratna ◽

Daniel Tardo ◽

Jennifer Yu ◽

Kim Delbaere ◽

Matthew Brodie ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Mobile Phone ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Ischemic Heart ◽

Valuable Adjunct

Background Cardiovascular disease (CVD) remains the leading cause of death worldwide. Mobile phones have become ubiquitous in most developed societies. Smartphone apps, telemonitoring, and clinician-driven SMS allow for novel opportunities and methods in managing chronic CVD, such as ischemic heart disease, heart failure, and hypertension, and in the conduct and support of cardiac rehabilitation. Objective A systematic review was conducted using seven electronic databases, identifying all relevant randomized control trials (RCTs) featuring a mobile phone intervention (MPI) used in the management of chronic CVD. Outcomes assessed included mortality, hospitalizations, blood pressure (BP), and BMI. Methods Electronic data searches were performed using seven databases from January 2000 to June 2019. Relevant articles were reviewed and analyzed. Meta-analysis was performed using standard techniques. The odds ratio (OR) was used as a summary statistic for dichotomous variables. A random effect model was used. Results A total of 26 RCTs including 6713 patients were identified and are described in this review, and 12 RCTs were included in the meta-analysis. In patients with heart failure, MPIs were associated with a significantly lower rate of hospitalizations (244/792, 30.8% vs 287/803, 35.7%; n=1595; OR 0.77, 95% CI 0.62 to 0.97; P=.03; I2=0%). In patients with hypertension, patients exposed to MPIs had a significantly lower systolic BP (mean difference 4.3 mm Hg; 95% CI −7.8 to −0.78 mm Hg; n=2023; P=.02). Conclusions The available data suggest that MPIs may have a role as a valuable adjunct in the management of chronic CVD.

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Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis (Preprint)

10.2196/preprints.16695 ◽

2019 ◽

Author(s):

Praveen Indraratna ◽

Daniel Tardo ◽

Jennifer Yu ◽

Kim Delbaere ◽

Matthew Brodie ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Mobile Phone ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Ischemic Heart ◽

Valuable Adjunct

BACKGROUND Cardiovascular disease (CVD) remains the leading cause of death worldwide. Mobile phones have become ubiquitous in most developed societies. Smartphone apps, telemonitoring, and clinician-driven SMS allow for novel opportunities and methods in managing chronic CVD, such as ischemic heart disease, heart failure, and hypertension, and in the conduct and support of cardiac rehabilitation. OBJECTIVE A systematic review was conducted using seven electronic databases, identifying all relevant randomized control trials (RCTs) featuring a mobile phone intervention (MPI) used in the management of chronic CVD. Outcomes assessed included mortality, hospitalizations, blood pressure (BP), and BMI. METHODS Electronic data searches were performed using seven databases from January 2000 to June 2019. Relevant articles were reviewed and analyzed. Meta-analysis was performed using standard techniques. The odds ratio (OR) was used as a summary statistic for dichotomous variables. A random effect model was used. RESULTS A total of 26 RCTs including 6713 patients were identified and are described in this review, and 12 RCTs were included in the meta-analysis. In patients with heart failure, MPIs were associated with a significantly lower rate of hospitalizations (244/792, 30.8% vs 287/803, 35.7%; n=1595; OR 0.77, 95% CI 0.62 to 0.97; P=.03; I2=0%). In patients with hypertension, patients exposed to MPIs had a significantly lower systolic BP (mean difference 4.3 mm Hg; 95% CI −7.8 to −0.78 mm Hg; n=2023; P=.02). CONCLUSIONS The available data suggest that MPIs may have a role as a valuable adjunct in the management of chronic CVD.

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Informing behaviour change intervention design using Bayesian meta-analysis: physical activity in heart failure

10.1101/2021.09.05.21262643 ◽

2021 ◽

Author(s):

A. Marat ◽

L. Taylor ◽

B. Volkmer ◽

N. Ahmed ◽

A.M. Chater ◽

...

Keyword(s):

Physical Activity ◽

Behaviour Change ◽

Meta Analysis ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Behaviour Change Intervention ◽

Quantitative Evidence ◽

Qualitative And Quantitative ◽

Barriers And Enablers ◽

Qualitative Evidence

AbstractEmbracing the Bayesian approach, we aimed to synthesise evidence regarding barriers and enablers to physical activity in HF in a way that can inform behaviour change intervention development. This approach helps in concluding on the uncertainty in the evidence and facilitates the synthesis of qualitative and quantitative evidence. Qualitative and observational studies investigating barriers and enablers to physical activity in adults diagnosed with HF were included in a Bayesian meta-analysis. Evidence from three qualitative and 16 quantitative studies was synthesised. Qualitative evidence was annotated using Theoretical Domains Framework and represented as a prior distribution using an expert elicitation task. The maximum a posteriori probability (MAP) and Credible Intervals (CrI) was calculated as a summary statistic for the probability distribution of physical activity conditioned on each determinant, according to qualitative evidence alone and qualitative and quantitative evidence combined. Evidence concerning the modifiable barriers and enablers is highly uncertain: social support (MAP=0.11,CrI:[0.08;0.13]), negative attitude (MAP=0.22,CrI:[0.17;0.27]), positive attitude ( MAP=0.27,CrI:[0.23;0.31]), self-efficacy( MAP=0.31,CrI:[0.29;0.33]), symptom distress (MAP=021,CrI:[0.18;0.24]). The contextual barriers – low, moderate and high uncertainty respectively – are age (MAP=0.22,CrI:[0.22;0.23]), low Left Ventricular Ejection Fraction (MAP=0.20,CrI:[0.19;0.22]), and depression (MAP=0.14,CrI:[0.12;0.16]). This work extends the limited research on the modifiable barriers and enablers for physical activity by individuals living with HF.

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Perceived barriers and enablers influencing physical activity in heart failure: a qualitative one-to-one interview study

10.1101/2021.12.01.21267008 ◽

2021 ◽

Author(s):

Aliya Amirova ◽

Rebecca Lucas ◽

Martin R Cowie ◽

Mark Haddad

Keyword(s):

Physical Activity ◽

Heart Failure ◽

Physical Activity Intervention ◽

Theoretical Domains Framework ◽

Action Planning ◽

Activity Levels ◽

Structured Interviews ◽

Barriers And Enablers ◽

One To One ◽

Specialist Nurses

AbstractIn heart failure (HF), increased physical activity is associated with improved quality of life, reduced hospitalisation, and increased longevity and is an important aim of treatment. However, physical activity levels in individuals living with HF are typically extremely low. This qualitative study with one-to-one interviews systematically explores perceived clinical, environmental, and psychosocial barriers and enablers in older adults (>70 years old) living with HF. Semi-structured interviews (N = 16) based on the Theoretical Domains Framework elicited 78 belief statements describing the barriers and enablers to physical activity. Theoretical domains containing these beliefs and corresponding constructs that were both pervasive and common were deemed most relevant. These were: concerns about physical activity (Beliefs about Consequences), self-efficacy (Beliefs about Capabilities), social support (Social Influences), major health event (Environmental Context and Resources), goal behavioural (Goal), action planning (Behavioural Regulation). This work extends the limited research on the modifiable barriers and enablers for physical activity participation by individuals living with HF. The research findings provide insights for cardiologists, HF-specialist nurses, and physiotherapists to help co-design and deliver a physical activity intervention more likely to be effective for individuals living with HF.

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What Intervention Techniques Are Effective in Changing Positive Affective Variables and Physical Activity? A Systematic Review and Meta-Analysis

Frontiers in Psychology ◽

10.3389/fpsyg.2021.628993 ◽

2021 ◽

Vol 12 ◽

Author(s):

Cheng Chen ◽

Emily Finne ◽

Alexandra Kopp ◽

Darko Jekauc

Keyword(s):

Physical Activity ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Identification Problem ◽

Inclusion Criteria ◽

Positive Effects ◽

Effect Model ◽

Analytic Review ◽

Affective Variables

A recent meta-analysis has demonstrated that positive affective variables (PAVs) partially mediate physical activity (PA) interventions. However, the effectiveness of each intervention technique on PAVs and PA is still unknown. Thus, this meta-analytic review included two primary objectives: (1) to summarize intervention effects on PA and PAVs; (2) to examine each behavior change technique's effectiveness in modifying PAVs and PA. Following PRISMA protocols, we had searched five electronic databases by April 1, 2020. The random-effect model in the Comprehensive Meta-Analysis Version 3 was adopted to perform these meta-analytic analyses. The search identified 1,742 articles, and 37 studies (49 datasets) met our inclusion criteria. Finally, inferential statistics yielded that: the utilization of “teach to use prompts/cues,” “facilitate social comparison,” and “provide information on consequences of behavior in general” had positive effects on PA or PAVs outcomes; the utilization of “barrier identification/problem solving” and “plan social support/social change” negatively affected on PA or PAVs outcomes. However, there was considerable heterogeneity in the findings. Nonetheless, this paper has considerable implications for guiding future comparative intervention studies to achieve more reliable outcomes.

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The Effect of Physical Activity on Glycemic Variability in Patients With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Frontiers in Endocrinology ◽

10.3389/fendo.2021.767152 ◽

2021 ◽

Vol 12 ◽

Author(s):

Xingyun Zhu ◽

Lina Zhao ◽

Jing Chen ◽

Chu Lin ◽

Fang Lv ◽

...

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Systematic Review ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Glycemic Variability ◽

Control Group ◽

Effect Model ◽

Patients With Diabetes

PurposeThe effect of physical activity on glycemic variability remains controversial. This meta-analysis aimed to assess the overall effect of physical activity treatment on glycemic variability in patients with diabetes.MethodsPubMed/MEDLINE, Embase, and Cochrane databases were searched for clinical trials that conducted in patients with type 1 diabetes mellitus and type 2 diabetes mellitus with reports of the mean amplitude of glycemic excursion (MAGE), time in range (TIR), time above range (TAR), or time below range (TBR). Eligible trials were analyzed by fixed-effect model, random effect model, and meta-regression analysis accordingly.ResultsIn total, thirteen trials were included. Compared with the control group, physical activity intervention was significantly associated with increased TIR (WMDs, 4.17%; 95% CI, 1.11 to 7.23%, P<0.01), decreased MAGE (WMDs, -0.68 mmol/L; 95% CI, -1.01 to -0.36 mmol/L, P<0.01) and decreased TAR (WMDs, -3.54%; 95% CI, -5.21 to -1.88%, P<0.01) in patients with diabetes, but showed insignificant effects on TBR. Patients with higher baseline BMI levels was associated with a greater decrease in MAGE (β=-0.392, 95% CI: -0.710, -0.074), and patients with lower baseline HbA1c levels was associated with a greater increase in TBR during physical activities (β=-0.903, 95% CI: -1.550, -0.255).ConclusionPhysical activity was associated with significantly decreased glycemic variability in patients with diabetes. Patients with higher BMI might benefit more from physical activity therapy in terms of a lower MAGE. Hypoglycemia associated with physical activity treatment still warranted caution, especially in patients with intensive glycemic control.Systematic Review RegistrationPROSPERO [CRD42021259807].

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Influence of physical activity on recurrence and survival of colorectal cancer patients: A meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1583 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1583-1583 ◽

Cited By ~ 1

Author(s):

Gaetan Des Guetz ◽

Thierry Bouillet ◽

Bernard Uzzan ◽

Kader Chouahnia ◽

Patrick Nicolas ◽

...

Keyword(s):

Physical Activity ◽

Colorectal Cancer ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Cochrane Library ◽

Vascular Events ◽

Effect Model ◽

Keywords Colorectal Cancer ◽

The Impact

1583 Background: Colorectal cancer (CRC) predominates in developed countries among sedentary populations. A meta-analysis (MA) showed that physical activity (PA) decreased the incidence of new cases of CRC. The impact of PA on recurrence and mortality of non-metastatic CRC patients is still controversial. Methods: We performed a literature-based meta-analysis of all published observational studies, using the following keywords (colorectal cancer, physical activity, survival) in PubMed and EMBASE. We searched for a dedicated MA in the Cochrane Library (none found). We cross-checked all references. Pre- and post-diagnostic PA levels were assessed with MET (Metabolic Equivalent Task). Usually, high PA levels corresponded to > 17 MET hours/week. Overall survival (OS) and cancer-specific survival (CSS) were assessed by means of Hazard Ratios (HRs) with their 95 % Confidence Interval (CI). We pooled adjusted HRs since the variables of adjustment were almost identical between studies (age, sex, BMI, tobacco use, alcohol and red meat consumptions ). By convention, when higher PA levels were associated to an improved survival compared with lower PA levels, HRs for detrimental events were < 1. We used EasyMA software. We used fixed effect model whenever possible and random effect model only in case of between-study heterogeneity. Results: Eight studies (11298 participants) published from 2006 to 2013 met the inclusion criteria, representing 3110 males and 3710 females, 3072 colon and 1318 rectum cancers. Mean age was 67 years (range 21-82 years). HR CSS for post-diagnostic PA (higher PA level vs. lower) was 0.61 (CI: 0.44-0.86; random effect model). The corresponding HR for OS was 0.62 (CI: 0.54-0.71). HR CSS for pre-diagnostic PA was 0.80 (CI: 0.69-0.92). The corresponding HR for OS was 0.74 (CI: 0.63-0.86). Conclusions: This MA is the first to show that higher PA levels are associated with a better CSS, suggesting that sustained PA should be advised for non-metastatic CRC patients. OS also significantly improved, not surprisingly since PA should reduce risk of cardio-vascular events. These findings should be tempered by the rather small number of studies included.

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Prevalence and risk factors for antibiotic utilization in Chinese children

BMC Pediatrics ◽

10.1186/s12887-021-02706-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shasha Guo ◽

Qiang Sun ◽

Xinyang Zhao ◽

Liyan Shen ◽

Xuemei Zhen

Keyword(s):

Risk Factors ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Healthcare Research ◽

Chinese Children ◽

Rural Setting ◽

Antibiotic Prescribing ◽

Antibiotic Utilization ◽

At Home

Abstract Background Antibiotic resistance poses a significant threat to public health globally. Irrational utilization of antibiotics being one of the main reasons of antibiotic resistant. Children as a special group, there's more chance of getting infected. Although most of the infection is viral in etiology, antibiotics still are the most frequently prescribed medications for children. Therefore, high use of antibiotics among children raises concern about the appropriateness of antibiotic prescribing. This systematic review aims to measuring prevalence and risk factors for antibiotic utilization in children in China. Methods English and Chinese databases were searched to identify relevant studies evaluating the prevalence and risk factors for antibiotic utilization in Chinese children (0-18 years), which were published between 2010 and July 2020. A Meta-analysis of prevalence was performed using random effect model. The Agency for Healthcare Research and Quality (AHRQ) and modified Jadad score was used to assess risk of bias of studies. In addition, we explored the risk factors of antibiotic utilization in Chinese children using qualitative analysis. Results Of 10,075 studies identified, 98 eligible studies were included after excluded duplicated studies. A total of 79 studies reported prevalence and 42 studies reported risk factors for antibiotic utilization in children. The overall prevalence of antibiotic utilization among outpatients and inpatients were 63.8% (35 studies, 95% confidence interval (CI): 55.1-72.4%), and 81.3% (41 studies, 95% CI: 77.3-85.2%), respectively. In addition, the overall prevalence of caregiver’s self-medicating of antibiotics for children at home was 37.8% (4 studies, 95% CI: 7.9-67.6%). The high prevalence of antibiotics was associated with multiple factors, while lacking of skills and knowledge in both physicians and caregivers was the most recognized risk factor, caregivers put pressure on physicians to get antibiotics and self-medicating with antibiotics at home for children also were the main factors attributed to this issue. Conclusion The prevalence of antibiotic utilization in Chinese children is heavy both in hospitals and home. It is important for government to develop more effective strategies to improve the irrational use of antibiotic, especially in rural setting.

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A meta-analysis comparing short-term weight and cardiometabolic changes between olanzapine/samidorphan and olanzapine

Scientific Reports ◽

10.1038/s41598-021-87285-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Manit Srisurapanont ◽

Sirijit Suttajit ◽

Surinporn Likhitsathian ◽

Benchalak Maneeton ◽

Narong Maneeton

Keyword(s):

Weight Gain ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Dropout Rates ◽

Lower Percentage ◽

Current Evidence ◽

Weight Changes ◽

Short Term ◽

Short Term Treatment

AbstractThis study compared weight and cardiometabolic changes after short-term treatment of olanzapine/samidorphan and olanzapine. Eligible criteria for an included trial were ≤ 24 weeks, randomized controlled trials (RCTs) that compared olanzapine/samidorphan and olanzapine treatments in patients/healthy volunteers and reported weight or cardiometabolic outcomes. Three databases were searched on October 31, 2020. Primary outcomes included weight changes and all-cause dropout rates. Standardized mean differences (SMDs) and risk ratios (RRs) were computed and pooled using a random-effect model. This meta-analysis included four RCTs (n = 1195). The heterogeneous data revealed that weight changes were not significantly different between olanzapine/samidorphan and olanzapine groups (4 RCTs, SDM = − 0.19, 95% CI − 0.45 to 0.07, I2 = 75%). The whole-sample, pooled RR of all-cause dropout rates (4 RCTs, RR = 1.02, 95% CI 0.84 to 1.23, I2 = 0%) was not significant different between olanzapine/samidorphan and olanzapine groups. A lower percentage of males and a lower initial body mass index were associated with the greater effect of samidorphan in preventing olanzapine-induced weight gain. Current evidence is insufficient to support the use of samidorphan to prevent olanzapine-induced weight gain and olanzapine-induced cardiometabolic abnormalities. Samidorphan is well accepted by olanzapine-treated patients.

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