Does drug dispensing improve the health outcomes of patients attending community pharmacies? A systematic review

Abstract Background Drug dispensing is a clinical pharmacy service that promotes access to medicines and their rational use. However, there is a lack of evidence for the impact of drug dispensing on patients’ health outcomes. Thus, the purpose of this study was to assess the influence of drug dispensing on the clinical, humanistic, and economic outcomes of patients attending community pharmacies. Methods A systematic literature search was performed in April 2021 using PubMed, Web of Science, Cochrane Library, LILACS, and Open Thesis. Two reviewers screened titles, abstracts, and full-text articles according to the eligibility criteria. Methodological quality was assessed using tools from the Joanna Briggs Institute, and the literature was synthesized narratively. Results We retrieved 3,685 articles and included nine studies that presented 13 different outcomes. Regarding the design, they were cross-sectional (n = 4), randomized clinical trials (n = 4), and quasi-experimental (n = 1). A positive influence of drug dispensing on health outcomes was demonstrated through six clinical, four humanistic and three economic outcomes. Eight studies (88,9 %) used intermediate outcomes. The assessment of methodological quality was characterized by a lack of clarity and/or lack of information in primary studies. Conclusions Most articles included in this review reported a positive influence of drug dispensing performed by community pharmacists on patients’ health outcomes. The findings of this study may be of interest to patients, pharmacists, decision makers, and healthcare systems, since they may contribute to evidence-based decision-making, strengthening the contribution of community pharmacists to health care. Trial registration Registration: PROSPERO CRD42020191701.

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Impact of Pharmacists’ Interventions and Patients’ Decision on Health Outcomes in Terms of Medication Adherence and Quality Use of Medicines among Patients Attending Community Pharmacies: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094392 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4392

Author(s):

Kingston Rajiah ◽

Shreeta Sivarasa ◽

Mari Kannan Maharajan

Keyword(s):

Medication Adherence ◽

Health Outcomes ◽

Systematic Reviews ◽

Effective Interaction ◽

Self Care ◽

Community Pharmacists ◽

Community Pharmacies ◽

Quality Use Of Medicines ◽

The Impact ◽

Decision Choice

Community pharmacists are responsible for providing the appropriate information on the use of medications to patients, which may enhance their medication adherence. The extent of control that patients have on their health care preferences creates many challenges for community pharmacists. This study aimed to determine the impact of pharmacist interventions and patient decisions on health outcomes concerning medication adherence and the quality use of medicines among patients attending community pharmacies. Appropriate studies were identified in a systematic search using the databases of Medline, Scopus, Google Scholar, and PubMed. The search included literature published between 2004 and 2019. The database searches yielded 683 titles, of which 19 studies were included after the full-text analysis with a total of 9313 participants. Metaprop command in Stata software version 14 was used for the analysis. This study was undertaken based on the general principles of the Cochrane Handbook for Systematic Reviews of Interventions and subsequently reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA) extension. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was directly used to rate the quality of evidence (high, moderate, low, or very low). The results revealed the effective interaction between patients and community pharmacists, the importance of pharmacist intervention on medication adherence and quality use of medicine, and the role of community pharmacists in counselling patients. Decision/choice of patients in self-care and self-medication is a factor contributing to health outcomes. Effective interaction of community pharmacists with patients in terms of medication adherence and quality use of medicines provided a better health outcome among patients. The community pharmacists influenced the decision/choice of patients in self-care and self-medications.

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Exploring the independent prescribing role of the community pharmacists in Wales

International Journal of Pharmacy Practice ◽

10.1093/ijpp/riab015.042 ◽

2021 ◽

Vol 29 (Supplement_1) ◽

pp. i35-i35

Author(s):

S S Alghamdi ◽

R Deslandes ◽

S White ◽

K Hodson ◽

A Mackridge ◽

...

Keyword(s):

Community Pharmacy ◽

Community Pharmacists ◽

Community Pharmacies ◽

Committee Report ◽

Independent Prescribing ◽

General Practices ◽

The Government ◽

Clinical Records ◽

The Impact

Abstract Introduction Since 2019, the role of independent pharmacist prescribers (IPPs) in primary care has extended to community pharmacies in Wales [1]. This was in response to a Welsh Pharmaceutical Committee report in 2019 that outlined a plan to include an IPP in each community pharmacy in Wales by 2030. This aimed to relieve pressure on general practices, enhance patient care and reduce referral and admission rates to secondary care [2]. As funding was provided by the Government, the number of community pharmacists completing the independent prescribing course increased and many have implemented their prescribing role. Aim To explore the views of community IPPs regarding their prescribing role within community pharmacies in Wales. Methods Semi-structured face-to-face and telephone interviews were conducted with community IPPs from all seven health boards (HBs) in Wales. Ethical approval was obtained from the School of Pharmacy and Pharmaceutical Sciences at Cardiff University and the School of Pharmacy and Bioengineering at Keele University. Purposive sampling was used to identify potential participants. Gatekeepers (HB community pharmacy leads and directors of IPP courses in Wales) sent invitation emails, participant information sheet and consent form to potential participants. Written consent was obtained. Interviews were audio-recorded and transcribed ad verbatim. Thematic analysis was used to analyse the data. Results Thirteen community IPPs across Wales participated. Six themes were identified, including the utilisation of their role as community IPPs, their experiences with their independent prescribing training, motivation to obtain their prescribing qualification and utilise it, the impact, barriers and facilitators to implement and utilise their role. Participants practised as IPPs in the management of minor ailments and some other conditions, such as respiratory and sexual health. The course and training for community IPPs was helpful, but there was a need to focus more on therapeutic and clinical examination skills. The main impact of the role was that it helped to improve communication between community pharmacies and general practices and relieved some pressure on general practices. The main barriers were the lack of appropriate funding by the Government to develop the role, lack of access to patients’ medical records, lack of support and high workload. “One of the areas identified as high risk is for pharmacy prescribers is the lack of access to clinical records. How can you [as community IPPs] make any sensible decisions with half the information?” IPP6 Facilitators included that some services were already in place and the drive from the 2030 vision. Conclusion This is the first study that explored the views of community IPPs regarding their prescribing role in community pharmacies in Wales. It provided an insight into this new role that can be considered by the Welsh Government to achieve the 2030 vision for this role. A limitation to this study was that the role is still new in community pharmacies, which may affect the views of the community IPPs. Many of them have obtained their prescribing qualification but have not started to utilise it yet. Further work is needed to explore a wider population of community IPPs’ experiences as the role develops. References 1. Wickware, C. 2019. All community pharmacies in Wales to have an independent prescriber as part of long-term plan for Welsh pharmacy. Available at: https://www.pharmaceutical-journal.com/news-and-analysis/news/all-community-pharmacies. 2. Welsh Pharmaceutical Committee. 2019. Pharmacy: Delivering a Healthier Wales. Available at: https://www.rpharms.com/Portals/0/RPS%2.

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Sexual and reproductive health services provided by community pharmacists: a scoping review

BMJ Open ◽

10.1136/bmjopen-2020-047034 ◽

2021 ◽

Vol 11 (7) ◽

pp. e047034

Author(s):

Javiera Navarrete ◽

Nese Yuksel ◽

Theresa J Schindel ◽

Christine A Hughes

Keyword(s):

Reproductive Health ◽

Scoping Review ◽

Sexual And Reproductive Health ◽

Community Pharmacists ◽

Cochrane Library ◽

Future Research ◽

Chlamydia Screening ◽

Community Pharmacies ◽

Pharmacy Services ◽

Reproductive Health Services

ObjectivesPharmacists are increasingly providing patient-focused services in community pharmacies, including in the area of sexual and reproductive health (SRH). Specific SRH areas have been the focus of research, but a broader perspective is needed to position pharmacists as SRH providers. This review explored research that described and evaluated professional pharmacy services across a broad range of SRH areas.DesignScoping reviewData sourcesMedline, EMBASE, CINAHL, Web of Science, Scopus and Cochrane Library (January 2007–July 2020).Study selectionStudies reporting on the description and evaluation of professional pharmacy SRH services provided by community pharmacists.Data extractionTwo investigators screened studies for eligibility, and one investigator extracted the data. Data were analysed to primarily describe professional pharmacy services and intervention outcomes.ResultsForty-one studies were included. The main SRH areas and professional pharmacy services reported were sexually transmitted and bloodborne infections (63%) and screening (39%), respectively. Findings showed that pharmacists’ delivery of SRH services was feasible, able to reach vulnerable and high-risk groups, and interventions were highly accepted and valued by users. However, integration into daily workflow, pharmacist remuneration, cost and reimbursement for patients, and policy regulations were some of the barriers identified to implementing SRH services. Studies were primarily in specific areas such as chlamydia screening or hormonal contraception prescribing, while studies in other areas (ie, medical abortion provision, long-acting reversible contraception prescribing and vaccine delivery in pregnant women) were lacking.ConclusionThis scoping review highlights the expansion of pharmacists’ roles beyond traditional product-focused services in a number of SRH areas. Given the potential feasibility, users’ acceptability and reach, pharmacists are ideally situated to enhance SRH care access. Future research describing implementation and evaluation of professional pharmacy services in all SRH areas is needed to promote access to these services through community pharmacies and position pharmacists as SRH providers worldwide.

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Effect of dose administration aids on adherence to self-administered medications: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2019-030536 ◽

2019 ◽

Vol 9 (10) ◽

pp. e030536

Author(s):

Kanika Chaudhri ◽

Madeleine Kearney ◽

Richard O Day ◽

Anthony Rodgers ◽

Emily Atkins

Keyword(s):

Systematic Review ◽

Health Outcomes ◽

Meta Analysis ◽

Study Participant ◽

Risk Of Bias ◽

Cochrane Library ◽

Secondary Outcome ◽

Dose Administration ◽

Common Solution ◽

The Impact

IntroductionForgetting to take a medication is the most common reason for non-adherence to self-administered medication. Dose administration aids (DAAs) are a simple and common solution to improve unintentional non-adherence for oral tablets. DAAs can be in the form of compartmentalised pill boxes, automated medication dispensing devices, blister packs and sachets packets. This protocol aims to outline the methods that will be used in a systematic review of the current literature to assess the impact of DAAs on adherence to medications and health outcomes.Methods and analysisRandomised controlled trials will be identified through electronic searches in databases including EMBASE, MEDLINE, CINAHL and the Cochrane Library, from the beginning of each database until January 2020. Two reviewers will independently screen studies and extract data using the standardised forms. Data extracted will include general study information, characteristics of the study, participant characteristics, intervention characteristics and outcomes. Primary outcome is to assess the effects of DAAs on medication adherence. Secondary outcome is to evaluate the changes in health outcomes. The risk of bias will be ascertained by two reviewers in parallel using The Cochrane Risk of Bias Tool. A meta-analysis will be performed if data are homogenous.Ethics and disseminationEthics approval will not be required for this study. The results of the review described within this protocol will be disseminated through publication in a peer-reviewed journal and relevant conference presentations.PROSPERO registration numberCRD42018096087

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Effect of Food Environment Interventions on Anthropometric Outcomes in School-Aged Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Current Developments in Nutrition ◽

10.1093/cdn/nzaa098 ◽

2020 ◽

Vol 4 (7) ◽

Cited By ~ 1

Author(s):

Bianca Carducci ◽

Christina Oh ◽

Emily C Keats ◽

Daniel E Roth ◽

Zulfiqar A Bhutta

Keyword(s):

Health Outcomes ◽

Food Environment ◽

Cochrane Library ◽

Free Text ◽

Environmental Interventions ◽

Middle Income ◽

Middle Income Countries ◽

School Aged Children ◽

The Impact ◽

Low And Middle Income

ABSTRACT Food environments may promote access to unhealthy foods, contributing to noncommunicable diseases in low- and middle- income countries (LMICs). This review assessed published evidence on the effects of food environment interventions on anthropometric (BMI and weight status) outcomes in school-aged children (5–9 y) and adolescents (10–19 y) (SACA) in LMICs. We summarized randomized controlled trials (RCTs) and quasi-experimental studies (QES) published since 2000 to August 2019 in the peer-reviewed and gray literature that assessed the effects of food-related behavioral and environmental interventions on diet-related health outcomes in SACA in LMICs. Electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Library) were searched using appropriate keywords, Medical Subject Headings, and free text terms. Eleven RCTs and 6 QES met the inclusion criteria, testing multicomponent behavioral and environmental interventions in schools. Analysis of 6 RCTs (n = 17,054) suggested an overall effect on change in BMI [mean difference (MD): −0.11, 95% CI: −0.19 , −0.03], whereas there was no observed effect in 5 studies using endline BMI (n = 17,371) (MD: 0.05, 95% CI: −0.32, 0.21). There was no significant pooled effect among the 3 QES (n = 5,023) that reported differences in change in BMI or endline (MD: −0.37, 95% CI: −0.95, 0.22). There is limited evidence to support the modification of diet-related health outcomes through school-based food environment interventions in SACA in LMICs. Further studies are needed to understand the impact of school and community-based food environment interventions on nutritional status in this population.

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Mobile health interventions to promote physical activity and reduce sedentary behaviour in the workplace: A systematic review

Digital Health ◽

10.1177/2055207619839883 ◽

2019 ◽

Vol 5 ◽

pp. 205520761983988 ◽

Cited By ~ 24

Author(s):

Sarah Ann Buckingham ◽

Andrew James Williams ◽

Karyn Morrissey ◽

Lisa Price ◽

John Harrison

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Sedentary Behaviour ◽

Mobile Health ◽

Technology Use ◽

Methodological Quality ◽

Experimental Studies ◽

Cochrane Library ◽

Behaviour Change Techniques ◽

The Impact

Objective This systematic review aimed to assess the effectiveness, feasibility and acceptability of mobile health (mHealth) technology (including wearable activity monitors and smartphone applications) for promoting physical activity (PA) and reducing sedentary behaviour (SB) in workplace settings. Methods Systematic searches were conducted in seven electronic databases (MEDLINE, SPORTDiscus, Scopus, EMBASE, PsycINFO, Web of Science and the Cochrane library). Studies were included if mHealth was a major intervention component, PA/SB was a primary outcome, and participants were recruited and/or the intervention was delivered in the workplace. Study quality was assessed using the Effective Public Health Practice Project (EPHPP) tool. Interventions were coded for behaviour change techniques (BCTs) using the Coventry, Aberdeen and London – Refined (CALO-RE) taxonomy. Results Twenty-five experimental and quasi-experimental studies were included. Studies were highly heterogeneous and only one was rated as ‘strong’ methodological quality. Common BCTs included self-monitoring, feedback, goal-setting and social comparison. A total of 14/25 (56%) studies reported a significant increase in PA, and 4/10 (40%) reported a significant reduction in sedentary time; 11/16 (69%) studies reported a significant impact on secondary outcomes including reductions in weight, systolic blood pressure and total cholesterol. While overall acceptability was high, a large decline in technology use and engagement was observed over time. Conclusions While methodological quality was generally weak, there is reasonable evidence for mHealth in a workplace context as a feasible, acceptable and effective tool to promote PA. The impact in the longer term and on SB is less clear. Higher quality, mixed methods studies are needed to explore the reasons for decline in engagement with time and the longer-term potential of mHealth in workplace interventions. Protocol registration: The review protocol was registered with PROSPERO: CRD42017058856

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Advice-giving in Community Pharmacies in the UK

Journal of Health Services Research & Policy ◽

10.1177/135581969700200109 ◽

1997 ◽

Vol 2 (1) ◽

pp. 38-50 ◽

Cited By ~ 33

Author(s):

Mary P. Tully ◽

Karen Hassell ◽

Peter R. Noyce

Keyword(s):

Pharmacy Practice ◽

Community Pharmacists ◽

Subjective Assessment ◽

Community Pharmacies ◽

Common Definition ◽

Advice Giving ◽

Published Evidence ◽

Design Consistency ◽

The Uk ◽

The Impact

Objectives: To review (1) the published evidence on the information provided with prescribed and purchased medicines by pharmacists and pharmacy assistants, (2) clients' expectations of advice about medicines from community pharmacies and their experience and use of it, and (3) appropriateness and rigour of study methods used. Methods: Papers, published between 1980 and 1995 inclusively, were identified based on searches of on-line databases, a published literature index, key pharmacy practice journals and cited references in the bibliographies of published papers. Those papers selected reported research findings on any aspect of medicines-related communications and the provision of advice about medicines to members of the public who visited pharmacies in the UK. The comparatively small volume of work and lack of design consistency meant that a subjective assessment, rather than a criteria-based objective review, was deemed appropriate. Results: Forty-two suitable studies were identified and are reviewed. No common definition of ‘advice’ has emerged. Most studies reported were quantitative, concentrating on the frequency of advice-giving in community pharmacies and only one study considered the impact of advice on outcome. The quality of advice given was judged highly variable, although pharmacists' referrals, where made, were considered appropriate. Given that pharmacy assistants appear to make most of the medicine sales, remarkably few studies addressed their contribution to advicegiving. The review can provide little insight into what determines when advice is provided, but it does illuminate the disparity between the advice that clients say they want and what they actually seek. Conclusions: Where there appears to be a consensus that advice-giving in community pharmacies is wanted, this review reveals a lack of shared understanding between consumer bodies and the pharmacy profession about who needs advice and when and how it should be given. The need for unsolicited advice-giving associated with the sale of medicines is particularly contentious. With the current programme of deregulation of medicines, this is an increasingly important issue to resolve. The authors suggest a need for a consensus-building forum to generate guidelines that meet shared expectations between clients, community pharmacists, government and the pharmaceutical industry.

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Effectiveness of feeding supplementation in preterm infants: an overview of systematic reviews

BMC Pediatrics ◽

10.1186/s12887-021-03052-w ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Keqin Liu ◽

Jiaxin Tao ◽

Jixin Yang ◽

Yufeng Li ◽

Yanwei Su ◽

...

Keyword(s):

Health Outcomes ◽

Preterm Infants ◽

Systematic Reviews ◽

Methodological Quality ◽

Data Extraction ◽

Cochrane Library ◽

Qualitative Synthesis ◽

Term Infants ◽

Online Library

Abstract Background Preterm infants have higher nutrition needs than term infants. The effectiveness of various feeding supplementation was assessed by the improvement of health outcomes in single specific systematic reviews (SRs). The aim of this review was to comprehensively describe the effectiveness of feeding supplementation in promoting health outcomes of preterm infants. Methods A literature search was conducted in the PUBMED, EMBASE, Science Direct, Cochrane library, Web of Science, and Wiley online library. SRs selection followed clear inclusion and exclusion criteria. Pairs of reviewers independently applied the criteria to both titles/abstracts and full texts. Screening and data extraction were performed by using the advanced tables. The methodological quality of SRs and the quality of the evidence were carried out according to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool and the Grades of Recommendation, Assessment, Development, and Evaluation guidelines (GRADE) respectively. A qualitative synthesis of evidence is presented. Results Seventeen SRs were included in the review. Fifteen kinds of feeding supplementation were reported in the SRs. In preterm infants, the effectiveness of feeding supplementation in addition to regular breast-feeding was mainly shown in six aspects: physical health, neurodevelopment, biochemical outcomes, other health outcomes, morbidity and all-cause mortality. And the effectiveness of the interventions on health outcomes in preterm infants was found by most systematic reviews. The methodological quality of all the included SRs was high, and most of the evidences was of low or very low quality. Conclusions Our results will allow a better understanding of the feeding supplementation in preterm infants. Although the feeling supplements may improve the health outcomes of in preterm infants, the existing evidence is uncertain. Therefore, the clinical use of these supplements should be considered cautiously and more well-designed RCTs are still needed to further address the unsolved problems of the included SRs.

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The impact of clinical pharmacist services on patient health outcomes in Pakistan: a systematic review

BMC Health Services Research ◽

10.1186/s12913-021-06897-0 ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Ali Ahmed ◽

Muhammad Saqlain ◽

Maria Tanveer ◽

Ali Qais Blebil ◽

Juman Abdulelah Dujaili ◽

...

Keyword(s):

Systematic Review ◽

Health Outcomes ◽

Clinical Pharmacist ◽

Risk Of Bias ◽

Economic Outcomes ◽

Cochrane Library ◽

Clinical Pharmacists ◽

Pharmacist Interventions ◽

Patient Health ◽

Pharmacist Services

Abstract Background The pharmacist’s role shifts from dispensing to bedside care, resulting in better patient health outcomes. Pharmacists in developed countries ensure rational drug use, improve clinical outcomes, and promote health status by working as part of a multidisciplinary team of healthcare professionals. However, clinical pharmacist services on healthcare utilization in low-and middle-income countries (LMICs) like Pakistan are unclear. As a result, we aim to systematically review pharmacists’ clinical roles in improving Pakistani patients’ therapeutic, safety, humanistic, and economic outcomes. Methods We searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed. Results The literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions. Conclusions The findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients’ health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed.

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Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews

BMC Public Health ◽

10.1186/s12889-020-09855-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Pawel Posadzki ◽

Dawid Pieper ◽

Ram Bajpai ◽

Hubert Makaruk ◽

Nadja Könsgen ◽

...

Keyword(s):

Physical Activity ◽

Health Outcomes ◽

Systematic Reviews ◽

Effect Size ◽

Methodological Quality ◽

Prediction Interval ◽

Mortality Rates ◽

Noncommunicable Diseases ◽

Cochrane Library

Abstract Background Sedentary lifestyle is a major risk factor for noncommunicable diseases such as cardiovascular diseases, cancer and diabetes. It has been estimated that approximately 3.2 million deaths each year are attributable to insufficient levels of physical activity. We evaluated the available evidence from Cochrane systematic reviews (CSRs) on the effectiveness of exercise/physical activity for various health outcomes. Methods Overview and meta-analysis. The Cochrane Library was searched from 01.01.2000 to issue 1, 2019. No language restrictions were imposed. Only CSRs of randomised controlled trials (RCTs) were included. Both healthy individuals, those at risk of a disease, and medically compromised patients of any age and gender were eligible. We evaluated any type of exercise or physical activity interventions; against any types of controls; and measuring any type of health-related outcome measures. The AMSTAR-2 tool for assessing the methodological quality of the included studies was utilised. Results Hundred and fifty CSRs met the inclusion criteria. There were 54 different conditions. Majority of CSRs were of high methodological quality. Hundred and thirty CSRs employed meta-analytic techniques and 20 did not. Limitations for studies were the most common reasons for downgrading the quality of the evidence. Based on 10 CSRs and 187 RCTs with 27,671 participants, there was a 13% reduction in mortality rates risk ratio (RR) 0.87 [95% confidence intervals (CI) 0.78 to 0.96]; I2 = 26.6%, [prediction interval (PI) 0.70, 1.07], median effect size (MES) = 0.93 [interquartile range (IQR) 0.81, 1.00]. Data from 15 CSRs and 408 RCTs with 32,984 participants showed a small improvement in quality of life (QOL) standardised mean difference (SMD) 0.18 [95% CI 0.08, 0.28]; I2 = 74.3%; PI -0.18, 0.53], MES = 0.20 [IQR 0.07, 0.39]. Subgroup analyses by the type of condition showed that the magnitude of effect size was the largest among patients with mental health conditions. Conclusion There is a plethora of CSRs evaluating the effectiveness of physical activity/exercise. The evidence suggests that physical activity/exercise reduces mortality rates and improves QOL with minimal or no safety concerns. Trial registration Registered in PROSPERO (CRD42019120295) on 10th January 2019.

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