Systematic Review and Meta-analyses of Effects of Phosphate-lowering Agents in Non-dialysis Chronic Kidney Disease

2021 ◽  
pp. ASN.2021040554
Author(s):  
Nicole Lioufas ◽  
Elaine Pascoe ◽  
Carmel Hawley ◽  
Grahame Elder ◽  
Sunil Badve ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Serum Phosphate ◽  
Risk Of Bias ◽  
Lowering Therapy ◽  
Mean Differences ◽  
Meta Analyses

Background: Benefits of phosphate-lowering interventions on clinical outcomes in patients with chronic kidney disease (CKD) are unclear; systematic reviews have predominantly involved dialysis patients. This study aimed to summarize evidence from randomized controlled trials (RCTs) concerning benefits and risks of non-calcium-based phosphate-lowering treatment in non-dialysis CKD. Methods: We conducted a systematic review and meta-analyses of RCTs involving noncalcium-based phosphate-lowering therapy compared to placebo, calcium-based binders, or no study medication, in adults with CKD not on dialysis or post-transplant. RCTs had ≥3 months follow up and outcomes included biomarkers of mineral metabolism, cardiovascular parameters, and adverse events. Outcomes were meta-analyzed using the Sidik-Jonkman method for random effects. Unstandardized mean differences were used as effect sizes for continuous outcomes, with common measurement units and Hedge's g standardized mean differences (SMD) otherwise. Odds ratios were used for binary outcomes. Cochrane risk of bias and GRADE assessment determined the certainty of evidence. Results: Twenty trials involving 2,498 participants (median sample size 120, median follow up 9 months) were eligible for inclusion. Overall, risk of bias was low. Compared with placebo, non calcium-based phosphate binders reduced serum phosphate (12 trials, weighted mean difference -0.37, 95% CI -0.58,-0.15 mg/dL, low certainty evidence) and urinary phosphate excretion (8 trials, SMD -0.61, 95% CI -0.90,-0.31, low certainty evidence), but resulted in increased constipation (9 trials, log odds ratio [OR] 0.93, 95% CI 0.02, 1.83, low certainty evidence) and greater vascular calcification score (3 trials, SMD 0.47, 95% CI 0.17, 0.77, very low certainty evidence). Data for effects of phosphate-lowering therapy on cardiovascular events (log OR 0.51 [95% CI -0.51, 1.17]) and death were scant. Conclusions: Non-calcium-based phosphate-lowering therapy reduced serum phosphate and urinary phosphate excretion, but there was an unclear effect on clinical outcomes and intermediate cardiovascular end-points. Adequately powered RCTs are required to evaluate benefits and risks of phosphate-lowering therapy on patient-centered outcomes.

scholarly journals Plasma natriuretic peptide level is an independent determinant of major clinical outcomes in atrial fibrillation patients without heart failure: the Fushimi AF Registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Hamatani ◽  
M Iguchi ◽  
Y Aono ◽  
K Ishigami ◽  
S Ikeda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Prognostic Marker ◽  
Oral Anticoagulants ◽  
Systemic Embolism ◽  
The Mean

Abstract Background Atrial fibrillation (AF) increases the risk of death, stroke/systemic embolism and heart failure (HF). Plasma natriuretic peptide (NP) level is an important prognostic marker in HF patients. However, little is known regarding the prognostic significance of plasma NP level in AF patients without HF. Purpose The aim of this study is to investigate the relationship between plasma NP level and clinical outcomes such as all-cause death, stroke/systemic embolism and HF hospitalization during follow-up period in AF patients without HF. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in our city. The inclusion criterion of the registry is the documentation of AF at 12-lead electrocardiogram or Holter monitoring at any time, and there are no exclusion criteria. We started to enroll patients from March 2011, and follow-up data were available for 4,466 patients by the end of November 2019. From the registry, we excluded 1,220 patients without a pre-existing HF (defined as having one of the following; prior hospitalization for HF, New York Heart Association class ≥2, or left ventricular ejection fraction <40%). Among 3,246 AF patients without HF, we investigated 1,189 patients with the data of plasma BNP (n=401) or N-terminal pro-BNP (n=788) level at the enrollment. We divided the patients according to the quartile of each plasma BNP or NT-pro BNP level and compared the backgrounds and outcomes between these 4 groups stratified by plasma NP level. Results Of 1,189 patients, the mean age was 72.1±10.2 years, 454 (38%) were female and 684 (58%) were paroxysmal AF. The mean CHADS2 and CHA2DS2-VASc score were 1.6±1.1 and 2.9±1.5, respectively. Oral anticoagulants were prescribed in 671 (56%) at baseline. The median (interquartile range) BNP and N-terminal pro-BNP level were 84 (38, 176) and 500 (155, 984) pg/ml, respectively. Patients with high plasma NP level were older, and demonstrated lower prevalence of paroxysmal AF, higher CHADS2 and CHA2DS2-VASc scores and higher prevalence of chronic kidney disease and oral anticoagulants prescription (all P<0.01). A total of 165 all-cause death, 114 stroke/systemic embolism and 103 HF hospitalization occurred during the median follow-up period of 5.0 years. Kaplan-Meier curves demonstrated that higher plasma NP level was significantly associated with the incidences of all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF (Figure 1A). Multivariable Cox regression analysis revealed that plasma NP level could stratify the risk of clinical outcomes even after adjustment by type of AF, CHA2DS2-VASc score, chronic kidney disease and oral anticoagulant prescription (Figure 1B). Conclusion Plasma NP level is a significant prognostic marker for all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF, suggesting the importance of measuring plasma NP level in AF patients even without HF. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Systematic review of the impact of non-alcoholic fatty liver disease on mortality and adverse clinical outcomes for individuals with chronic kidney disease

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e040970 ◽  
Author(s):  
Theresa Hydes ◽  
Ryan Buchanan ◽  
Oliver J Kennedy ◽  
Simon Fraser ◽  
Julie Parkes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Liver Disease ◽  
Kidney Disease ◽  
Fatty Liver ◽  
Clinical Outcomes ◽  
Fatty Liver Disease ◽  
Alcoholic Fatty Liver ◽  
All Cause Mortality ◽  
Alcoholic Fatty Liver Disease

ObjectivesTo investigate if non-alcoholic fatty liver disease (NAFLD) impacts mortality and adverse outcomes for individuals with chronic kidney disease (CKD).DesignSystematic review.Data sourcesPubMed, EMBASE and Web of Science were searched up to 1 February 2020 with no restriction on the earliest date.Eligibility criteria for selecting studiesObservational cohort studies that reported either the risk of all-cause mortality, incidence of non-fatal cardiovascular events (CVE) or progression of kidney disease among adults with established CKD who have NAFLD compared with those without.Data extraction and synthesisTwo reviewers extracted data and assessed bias independently.ResultsOf 2604 records identified, 3 studies were included (UK (n=852), South Korea (n=1525) and USA (n=1413)). All were judged to have a low or moderate risk of bias. Data were insufficient for meta-analysis. Two studies examined the influence of NAFLD on all-cause mortality. One reported a significant positive association for NAFLD with all-cause mortality for individuals with CKD (p<0.05) (cardiovascular-related mortality p=ns), which was lost following adjustment for metabolic risk factors; the second reported no effect in adjusted and unadjusted models. The latter was the only study to report outcomes for non-fatal CVEs and observed NAFLD to be an independent risk factor for this (propensity-matched HR=2.00, p=0.02). Two studies examined CKD progression; in one adjusted rate of percentage decline in estimated glomerular filtration rate per year was found to be increased in those with NAFLD (p=0.002), whereas the other found no significant difference.ConclusionsFew studies have examined the influence of NAFLD on prognosis and major adverse clinical outcomes within the CKD population. The studies identified were diverse in design and results were conflicting. This should be a focus for future research as both conditions continue to rise in prevalence and have end-stage events associated with significant health and economic costs.PROSPERO registration numberCRD42020166508.

scholarly journals Can nurses improve self-management among pediatric patients? A systematic review and meta-analysis

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Mele ◽  
A Nardi ◽  
G P Prencipe ◽  
G Migliara ◽  
A Massimi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Educational Intervention ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Educational Interventions ◽  
Risk Of Bias ◽  
Ed Visits ◽  
Meta Analyses ◽  
Almost All

Abstract Background Few studies report educational interventions for pediatric patients with asthma or diabetes type 1 as a fundamental instrument to engage them and improve their health. The aim of this systematic review and meta-analysis was to synthesize evidence about behavioral changes in life style, disease management and clinical outcome in pediatric patients after a structured educational intervention delivered by nurses. Methods A systematic review of the literature was carried out in MEDLINE, Scopus and CINHAL including only RCTs. Methodological quality of the studies was assessed using Cochrane tool. Meta-analyses on HbA1c reduction for diabetes and hospitalization, emergency department (ED) visits and medication for asthma were carried-out. Results Of the 3559 papers initially retrieved, 5 regarding diabetes and 19 asthma met the inclusion criteria for the systematic review and 14 for the meta-analyses. Included studies were highly heterogeneous in terms of type of intervention and follow-up duration. Almost all the studies showed an improvement but only few were statistically significant. All studies regarding diabetes showed a low risk of bias (only one RCTs had a high risk of bias in one domain), while almost all RCTs on asthma showed a high risk of bias. The pooled mean differences in favor of the experimental groups were: HBA1c -0.02 (IC95%: -0.26 - 0.22), Hospitalization 0.58 (IC95%: 0.19 - 1.78), Medication -0.10 (IC95%: -0.43 - 0.23), ED Visits 0.82 (IC95%: 0.44 - 1.54). Conclusions There is a general agreement about the central role of educational intervention delivered by nurses to pediatric patients and the assessment of the behavioral changes after educational interventions is strongly recommended in pediatric population. However, more efforts are requested in designing studies on patients with asthma and to program more appropriate follow-up and periodic recall in order to engage pediatric patients in the management of their own chronic disease. Key messages educational intervention delivered by nurses to pediatric patients with asthma or diabetes type 1 as a fundamental instrument to engage them. more efforts are requested in designing studies on patients with asthma and to program more appropriate follow-up and periodic recall in order to engage pediatric patients.

P0670DIFFUSIONAL KURTOSIS IMAGING PREDICTS THE PROGNOSIS OF CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yan Liu ◽  
Gu-mu-yang Zhang ◽  
Xiaoyan Peng ◽  
Xuemei Li ◽  
Hao Sun ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Iga Nephropathy ◽  
Clinical Outcomes ◽  
Renal Fibrosis ◽  
Prognostic Value ◽  
Mean Value ◽  
Non Invasive ◽  
The Mean

Abstract Background and Aims Renal fibrosis is the strongest prognosis predictor of ESRD in chronic kidney disease (CKD), but non-invasive and repeatable imaging markers are missing. Magnetic resonance imaging (MRI) has wide range of applications in renal parenchymal diseases, and diffusional kurtosis imaging (DKI) is a new promising noninvasive method of MRI which can provide more information about non-Gaussian diffusion using a polynomial model. We had successfully used DKI to assess renal fibrosis in IgA nephropathy in our previous work. This study aimed to evaluate the prognostic value of DKI in CKD. Method We prospectively enrolled forty-two CKD patients in our study in Jan. 2017. On recruitment, the basic clinical data were documented, and DKI was performed on a clinical 3T MR scanner. Region-of-interest (ROI) measurements were performed to determine apparent diffusion coefficient (ADC), kurtosis (K) and diffusivity (D) of the cortex of the kidneys. We had followed up these patients for 3 years, and collected all the clinical data and outcomes. The prognostic value of DKI metrics and clinical parameters were investigated. Results Forty-two patients consisted of 26 males and 16 females with mean age of 41.3±15.4 years. The most common etiology was IgA nephropathy (25/42, 59.5%). At baseline, the mean value of serum creatinine (SCr) was 224.4±156.2μmol/L. Among them, 18 patients had eGFR≥45ml/min and 24 patients had eGFR&lt;45ml/min. According to the etiology and CKD classification, all the patients had received appropriate treatment. Besides supportive treatment and management of CKD complications, 21 patients (50%) had received corticosteroid and/or immunosuppressants treatment. After 36 months follow up, 12 patients had progressed to end stage renal disease (ESRD), and the mean value of SCr of the remaining 30 patients was 153.0±78.8umol/L. The Kaplan-Meyer survival regression showed that the patients with eGFR&lt;45ml/min had worse clinical outcomes (p=0.0006). ROC analysis and Kaplan-Meyer survival regression showed that DKI metrics (K≥0.66 or ADC&lt;1.35) not only predicted severe renal fibrosis, but also had worse clinical outcomes (p=0.01 and p&lt;0.0001) (Figure 1). According to the COX regression analysis, both K (K≥0.66, HR 4.676, 95%CI 1.262-17.325) and ADC (ADC&lt;1.35, HR 13.118, 95%CI 3.499-49.178) values, but not age, gender and eGFR group (cut-off value: 45ml/min), were the independent risk factors for the progression to ESRD. Conclusion Renal ADC and K values obtained from DKI showed significant predictive value for the prognosis of CKD, could be a promising non-invasive technique in patients follow-up.

scholarly journals Reliability of Mouse Behavioural Tests of Anxiety: a Systematic Review and Meta-Analysis on the Effects of Anxiolytics.

2021 ◽  
Author(s):  
Marianna Rosso ◽  
Robin Wirz ◽  
Ariane Vera Loretan ◽  
Nicole Alessandra Sutter ◽  
Charlène Tatiana Pereira da Cunha ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Control Treatment ◽  
Test Results ◽  
Animal Models Of Anxiety ◽  
Mean Differences ◽  
Behavioural Tests ◽  
Meta Analyses ◽  
Quality Checklist

Animal research on anxiety and anxiety disorders relies on valid animal models of anxiety. However, the validity of widely used rodent behavioural tests of anxiety has repeatedly been questioned, as they often fail to produce consistent results across independent replicate studies using different study populations or different anxiolytic compounds. In this study, we assessed the sensitivity of behavioural tests of anxiety in mice to detect anxiolytic effects of drugs prescribed to treat anxiety in humans. To this end, we conducted a pre-registered systematic review of studies reporting tests of anxiolytic compounds against a control treatment using common behavioural tests of anxiety in mice. PubMed and EMBASE were searched on August 21 st 2019 for studies published in English and 814 papers were identified for inclusion. Risk of bias was assessed based on Syrcle’s risk of bias tool and the Camarades study quality checklist on a randomly selected subsample of 180 papers. Meta-analyses on effect sizes of treatments using standardized mean differences (Hedges’ g) showed that only two of 17 test measures reliably detected effects of anxiolytic compounds other than diazepam. Further, we report considerable variation in both direction and size of effects of most anxiolytics on most outcome variables, indicating poor replicability of test results. This was corroborated by high heterogeneity in most test measures. Finally, we found an overall high risk of bias. Our findings indicate a general lack of sensitivity of common behavioural tests of anxiety in mice to anxiolytic compounds and cast serious doubt on both construct and predictive validity of most of those tests. The use of animals to model human conditions can be justified only if the expected results are informative, reproducible, and translatable. In view of scientifically valid and ethically responsible research, we call for a revision of behavioural tests of anxiety in mice and the development of more predictive tests .

scholarly journals Fibroblast Growth factor 23 and α-Klotho protein are associated with adverse clinical outcomes in non dialysis chronic kidney disease stage 1-5 patients

2019 ◽  
Author(s):  
Eleni Manou ◽  
Elias Thodis ◽  
George Arsos ◽  
Ploumis Pasadakis ◽  
Stylianos Panagoutsos ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Growth Factor ◽  
Kidney Disease ◽  
Fibroblast Growth Factor 23 ◽  
Serum Phosphate ◽  
Fibroblast Growth ◽  
Fgf 23 ◽  
Stage 1

Abstract Background: Fibroblast Growth Factor 23 (FGF-23) and α-Klotho contribute to the patho-genesis of chronic kidney disease - mineral and bone disorders (CKD-MBD). The aim of our study was to evaluate the association of FGF-23 and α-Klotho levels with CKD-MBD parameters, as well as with renal prognosis and mortality, in CKD patients stage 1-5, not in renal replacement therapy (RRT). Methods: 128 patients were included. At enrollment GFR was measured (mGFR) and plasma levels of carboxyl terminal FGF-23 (cFGF-23) and soluble α-Klotho (sKlotho) were determined by ELISA. Abdominal aorta calcification (AAC) score was assessed in lateral abdominal X ray. The composite end point (event) was initiation of RRT or death. Follow-up was five years (median 36, range 2-60 months). Results: mGFR significantly correlated with cFGF-23 and sKlotho negatively and posi-tievely respectively (p<0.0001 for both). Multiple regression analysis showed an inde-pendent correlation of cFGF-23 with mGFR, 25-OH vitamin D, presence of diabetes melli-tus and AAC score, of sKlotho with mGFR and phosphate and of AAC score with sKlotho and cFGF-23. Multivariate regression tree analysis, led to the formation of three regression groups (A, B, C) based on two “cut off” values: mGFR levels of 60.85 ml/min/1.73m2 and serum phosphate levels of 3.7 mg/dl. These groups significantly correlated with the five CKD stages and additionally cFGF-23 and sKlotho plasma levels (p<0.0001 for both). During follow-up, 40 out of the 128 patients, (31.2%) either initiated RRT or died (31 and 9 respectively). Kaplan Meier survival analysis showed that groups of patients with cFGF-23 levels less than median and those with sKlotho more than median value showing a more favorable course, regarding outcome (p=0.0003 for cFGF-23, p=0.004 for s-Klotho). In Cox regression analysis the association of cFGF-23 (p=0.04), sKlotho (p=0.008) and AAC score (p=0.01) with the presence of “event” remained significant after adjustment for traditional and CKD- related covariates. Conclusions: In CKD patients stage 1-5, cFGF-23 and sKlotho levels are associated with adverse clinical outcomes. mGFR and serum phosphate, in association with sKlotho lev-els, may provide a “new classification” of CKD patients, which appears to be predictive of outcome.

scholarly journals Diagnostic performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation at estimating glomerular filtration rate in adults with diabetes mellitus: a systematic review and meta-analysis protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e031558 ◽  
Author(s):  
Neda Zafari ◽  
Leonid Churilov ◽  
Richard J MacIsaac ◽  
Niloufar Torkamani ◽  
Helen Baxter ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Diagnostic Accuracy ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Risk Of Bias ◽  
Index Test ◽  
Disease Epidemiology

IntroductionTimely detection leading to the implementation of reno-protective measures reduces the progression of diabetic kidney disease. Estimated glomerular filtration rate (eGFR) is a major surrogate of kidney function. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Equation is a tool to estimate GFR. This protocol outlines a systematic-review, assessing the diagnostic accuracy of the CKD-EPI equation in adults with diabetes.Methods and analysisMEDLINE, Embase, Cochrane Central Register of Controlled Trials and grey literature will be searched for publications in English, Farsi, Dutch and Chinese from 2009 (when CKD-EPI was first introduced) to January 2019. Bridging searches will be conducted to capture literature published from January 2019 until final review publication. The inclusion criteria will be (1) study participants with diabetes; (2) age ≥18 years; (3) creatinine-based CKD-EPI eGFR as index test; (4) measured GFR using the clearance/plasma disappearance of inulin, iohexol, iothalamate, diethylenetriamine-pentaacetic acid (DTPA) or chromium labelled ethylenediaminetetraacetic acid (Cr-EDTA) as reference test; (5) report of the diagnostic accuracy of the index test. Exclusion criteria will be participants with renal transplant, chronic use of corticosteroids, chronic inflammatory diseases, pregnancy, non-diabetes related kidney disease, thalassaemia, heart failure, pregnancy and potential kidney donors as well as critically ill patients. Screening, eligibility check, risk of bias assessment and data extraction will be carried out by two independent reviewers. Any discrepancies will be discussed, and third-party opinion will be sought. The risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies−2 tool. A quantitative synthesis of the aggregated-data will be used if the included studies are homogenous.Ethics and disseminationNo ethics approval is required. The outcome will be published in a peer-reviewed journal. The results will help researchers and clinicians evaluate the diagnostic accuracy of the creatinine-based CKD-EPI eGFR in adults with diabetes.PROSPERO registration numberCRD42018108776

scholarly journals Association of Body Mass Index with Clinical Outcomes in Non-Dialysis-Dependent Chronic Kidney Disease: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 6 (1) ◽  
pp. 37-49 ◽  
Author(s):  
Seyed-Foad Ahmadi ◽  
Golara Zahmatkesh ◽  
Emad Ahmadi ◽  
Elani Streja ◽  
Connie M. Rhee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Body Mass Index ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Disease Progression ◽  
Body Mass ◽  
Meta Analysis ◽  
Risk Of Death ◽  
Kidney Disease Progression ◽  
Meta Analyses

Background: Previous studies have not shown a consistent link between body mass index (BMI) and outcomes such as mortality and kidney disease progression in non-dialysis-dependent chronic kidney disease (CKD) patients. Therefore, we aimed to complete a systematic review and meta-analysis study on this subject. Methods: We searched MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL), and screened 7,123 retrieved studies for inclusion. Two investigators independently selected the studies using predefined criteria and assessed each study's quality using the Newcastle-Ottawa quality assessment scale. We meta-analyzed the results based on the BMI classification system by the WHO. Results: We included 10 studies (with a total sample size of 484,906) in the systematic review and 4 studies in the meta-analyses. The study results were generally heterogeneous. However, following reanalysis of the largest reported study and our meta-analyses, we observed that in stage 3-5 CKD, being underweight was associated with a higher risk of death while being overweight or obese class I was associated with a lower risk of death; however, obesity classes II and III were not associated with risk of death. In addition, reanalysis of the largest available study showed that a higher BMI was associated with an incrementally higher risk of kidney disease progression; however, this association was attenuated in our pooled results. For earlier stages of CKD, we could not complete meta-analyses as the studies were sparse and had heterogeneous BMI classifications and/or referent BMI groups. Conclusion: Among the group of patients with stage 3-5 CKD, we found a differential association between obesity classes I-III and mortality compared to the general population, indicating an obesity paradox in the CKD population.

scholarly journals Effectiveness of adult community-based physical activity interventions with objective physical activity measurements and long-term follow-up: a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e034541
Author(s):  
Charlotte Wahlich ◽  
Umar A R Chaudhry ◽  
Rebecca Fortescue ◽  
Derek G Cook ◽  
Shashivadan Hirani ◽  
...  
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Community Based ◽  
Intervention Effects ◽  
Meta Analyses

ObjectiveTo identify randomised controlled trials (RCTs) of physical activity (PA) interventions with objective PA outcomes in adults and to evaluate whether intervention effects were sustained beyond 12 months.DesignSystematic review and meta-analysis.Data sourcesSeven databases (Medline, Embase, PsycINFO, Web of Science, Cochrane library, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and ASSIA (Applied Social Sciences Index and Abstracts)) were searched from January 2000 until December 2019.Eligibility criteriaRCTs reporting objective PA outcomes beyond 12 months with community-based participants aged ≥18 years were included; those where controls received active interventions, including advice to increase PA levels, were excluded.Data extraction and synthesisTwo independent reviewers completed extraction of aggregate data and assessed risk of bias. Meta-analyses used random-effects models at different follow-up points. Primary outcomes were daily steps and weekly minutes of moderate-to-vigorous PA (MVPA).ResultsOf 33 282 records identified, nine studies (at generally low risk of bias) were included, five in meta-analyses with 12 months to 4 year follow-up. We observed 12 month increases for intervention vs control participants in steps/day (mean difference (MD)=554 (95% CIs: 384 to 724) p<0.0001, I2=0%; 2446 participants; four studies) and weekly MVPA minutes (MD=35 (95% CI: 27 to 43) p<0.0001, I2=0%; 2647 participants; four studies). Effects were sustained up to 4 years for steps/day (MD=494 (95% CI: 251 to 738) p<0.0001, I2=0%; 1944 participants; four studies) and weekly MVPA minutes (MD=25 (95% CI: 13 to 37) p<0.0001, I2=0%; 1458 participants; three studies).ConclusionsThere are few PA interventions with objective follow-up beyond 12 months, more studies are needed. However, this review provided evidence of PA intervention effects beyond 12 months and sustained up to 4 years for both steps/day and MVPA. These findings have important implications for potential long-term health benefits.PROSPERO registration numberCRD42017075753.

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