scholarly journals Are exercise referral schemes associated with an increase in physical activity? Observational findings using individual patient data meta-analysis from The National Referral database

2019 ◽  
Author(s):  
Nikita Rowley ◽  
James Steele ◽  
Matthew Wade ◽  
Robert J. Copeland ◽  
Steven Mann ◽  
...  
Keyword(s):  
Physical Activity ◽  
Random Effects ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Activity Levels ◽  
Random Effects Model ◽  
Physical Activity Levels ◽  
The Impact ◽  
Exercise Referral

Background: Exercise referral schemes (ERSs) within clinical populations offer inactive individuals the opportunity to increase physical activity levels over the length of scheme. Schemes are also intended to support the treatment of specific health conditions of medically referred individuals through increased physical activity behaviours. The extant literature concerning the impact of exercise referral on physical activity levels is inconsistent. It is of interest researchers, policy makers, commissioners and practitioners to to consider broadly whether meaningful change in physical activity levels are observed in people who undergo exercise referral, to identify potential effective policy actions in supporting active living. Purpose: To examine if ERSs increase physical activity levels in a large cohort of individuals throughout England, Scotland and Wales from The National Referral Database. Method: Data were obtained from 5246 participants from 12 different referral schemes. Average age was 53±15 years and, 68% of participants were female. Participants self-reported International Physical Activity Questionnaire (IPAQ) scores pre- and post- scheme, to determine if exercise referral had any impact on change in physical activity levels. Two stage individual patient data meta-analysis was performed on the both pre-ERS, and change scores, (i.e. post- minus pre-ERS scores) for MET-minutes/week calculated from IPAQ. Analyses were conducted on the continuous data collected using the IPAQ. Results: For pre-ERS MET-minutes/week the estimate and 95%CI from random effects model was 676 MET-minutes/week [539 to 812 minutes]. For change in MET-minutes/week the estimate and 95%CI from random effects model for was an increase of 540 MET-minutes/week [396 to 684 minutes]. Significant heterogeneity was evident among the schemes (I2 > 80%). Changes in total PA levels occurred as a result of increases in vigorous activity of 17 minutes [95%CI 9 to 24 minutes], increases in moderate activity of 29 minutes [95%CI 22 to 36 minutes], and reductions in sitting of -61 minutes [95%CI -78 to -43 minutes], though little change in walking (-5 minutes [95%CI -14 to 5 minutes]). Conclusion: Observation of participants undergoing ERSs suggests that most are already ‘moderately active’ upon entering an ERS. Changes in physical activity behaviour associated with ERS participation were varied and primarily facilitated by increased moderate-to-vigorous physical activity and reduced sitting. However, this was not sufficient to result in IPAQ categorical change and participants where thus on average still classed as ‘moderately active’. Further work is required to ensure ERSs are implemented to targeting the appropriate populations where they may result in the greatest benefit.

scholarly journals The effect of exercise referral schemes upon health and wellbeing: Initial observational insights using individual patient data meta-analysis from The National Referral database

2019 ◽  
Author(s):  
Matthew Wade ◽  
Steven Mann ◽  
Robert J. Copeland ◽  
James Steele
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Body Mass Index ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Activity Levels ◽  
Resting Heart Rate ◽  
Health And Wellbeing ◽  
Physical Activity Levels ◽  
Exercise Referral

Background: Physical activity is widely considered to be effective in the prevention, management, and treatment of many chronic health disorders. Yet, population physical activity levels are relatively low and have changed little in recent years. Sufficient physical activity levels for health and wellbeing often do not arise as result of typical activities of daily living. As such, specific exercise has been argued to be necessary for many, and one approach to providing this has been through exercise referral schemes (ERS). Schemes are aimed at increasing physical activity levels in sedentary individuals with chronic disease, however, evidence is currently lacking as to whether ERSs are effective as currently implemented. Thus, it is of interest to consider broadly whether meaningful changes in health and wellbeing outcomes are observed in people undergoing and ERS. Purpose: To examine if ERSs are associated with meaningful changes in health and wellbeing in a large cohort of individuals throughout England, Scotland and Wales from The National Referral Database. Method: Data were obtained from 23731 participants from 13 different ERSs. Average age was 51±15 years and, 68% of participants were female. Health and wellbeing outcomes were examined including body mass index, blood pressure, resting heart rate, short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), World Health Organization Well-Being Index (WHO-5), Exercise Related Quality of Life scale (ERQoL), and Exercise Self-Efficacy Scale (ESES). Two stage individual patient data random effects meta-analysis was performed on the change scores, (i.e. post- minus pre-ERS scores) and interval estimates were compared to null intervals for meaningfulness. Results: Estimates and 95%CIs revealed that statistically significant changes occurred when compared to point nulls of zero for body mass index (-0.55 kg.m2 [-0.69 to -0.41]), systolic blood pressure (-2.95 mmHg [-3.97 to -1.92]), SWEMWBS (2.99 pts [1.61 to 4.36]), WHO-5 (8.78 pts [6.84 to 10.63]), ERQoL (15.26 pts [4.71 to 25.82]), ESES (2.58 pts [1.76 to 3.40]), but not resting heart rate (0.22 fc [-1.57 to 1.12]), diastolic blood pressure (-0.93 mmHg [-1.51 to -0.35]). However, comparisons of estimates and intervals against null intervals for meaningfulness of changes suggested that the majority of outcomes may not improve meaningfully. Conclusion: The analyses performed here were with the intention of considering broadly; do we observe a meaningful effect in people who are undergoing ERSs? With respect to this broad question the present results demonstrate that, although many health and wellbeing outcome changes are statistically significant when compared to point null estimates (i.e. they differ from a change of zero) our analysis revealed there may be a general lack of meaningful change over time in participants undergoing ERSs, though results varied widely across different schemes. These findings suggest the need to consider the implementation of ERSs more critically in order to discern how best to maximize their effectiveness such that it reflects the efficacy often evidence in the literature.

scholarly journals Are Exercise Referral Schemes Associated With an Increase in Physical Activity? Observational Findings Using Individual Patient Data Meta-Analysis From the National Referral Database

2020 ◽  
Vol 17 (6) ◽  
pp. 621-631 ◽  
Author(s):  
Nikita Rowley ◽  
James Steele ◽  
Matthew Wade ◽  
Robert James Copeland ◽  
Steve Mann ◽  
...  
Keyword(s):  
Physical Activity ◽  
International Physical Activity Questionnaire ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Moderate Activity ◽  
Metabolic Equivalent ◽  
Physical Activity Questionnaire ◽  
Exercise Referral ◽  
Activity Questionnaire

Objectives: To examine if exercise referral schemes (ERSs) are associated with meaningful changes in physical activity in a large cohort of individuals throughout England, Scotland, and Wales from The National Referral Database. Methods: Data were obtained from 5246 participants from 12 different ERSs, lasting 6–12 weeks. The preexercise referral scheme and changes from the preexercise to the postexercise referral scheme in self-reported International Physical Activity Questionnaire scores were examined. A 2-stage individual patient data meta-analysis was used to generate the effect estimates. Results: For the pre-ERS metabolic equivalent (MET) minutes per week, the estimate (95% confidence interval [CI]) was 676 MET minutes per week (539 to 812). For the change in MET minutes per week, the estimate (95% CI) was an increase of 540 MET minutes per week (396 to 684). Changes in the total PA levels occurred as a result of increases in vigorous activity of 17 minutes (95% CI, 9 to 24), increases in moderate activity of 29 minutes (95% CI, 22 to 36), and reductions in sitting of −61 minutes (95% CI, −78 to −43), though little change in walking (−5 min; 95% CI, −14 to 5) was found. Conclusions: Most participants undergoing ERSs are already “moderately active.” Changes in PA behavior associated with participation are through increased moderate to vigorous PA and reduced sitting. However, this was insufficient to change the International Physical Activity Questionnaire category, and the participants were still “moderately active.”

Meta-Analysis of Physical Activity Levels in Youth With and Without Disabilities

2018 ◽  
Vol 35 (4) ◽  
pp. 381-402 ◽  
Author(s):  
Jaehun Jung ◽  
Willie Leung ◽  
Bridgette Marie Schram ◽  
Joonkoo Yun
Keyword(s):  
Physical Activity ◽  
Meta Analysis ◽  
Activity Level ◽  
Activity Levels ◽  
Random Effects Model ◽  
Q Value ◽  
Youth With Disabilities ◽  
Physical Activity Levels ◽  
Intensity Physical Activity ◽  
Vigorous Intensity

The purpose of this study was to explore the current levels of physical activity among youth with disabilities using meta-analysis. The search identified 11 publications including 729 participants (age 4–20 yr). The overall effect size for 11 studies was Hedges g = 0.60 (SE = 0.18, 95% confidence interval [CI] [0.24, 0.96], p < .05, k = 11) using a random-effects model. The findings suggest that differences in physical activity levels between youth with and without disabilities are complex. Results indicated that youth without disabilities engaged in higher levels of physical activity of moderate to vigorous intensity (g = 0.66, SE = 0.18, p < .05). However, no differences were found in light-intensity physical activity (g = −0.03, SE = 0.16, p > .85). Results also suggested that the differences in physical activity between youth with and without disabilities were affected by age (<12 yr, g = 0.83, SE = 0.24, 95% CI [0.37, 1.29], p < .05, and >13 yr, g = 0.37, SE = 0.10, 95% CI [0.18, 0.57], p < .05; Q value = 3.20, df = 1, p < .05), with children with disabilities engaging in less physical activity than children without disabilities in younger ages. Differences in physical activity level between youth with and without disabilities are functions of intensity of physical activity and age but may not be of type of disability (Q value = 0.22, df = 1, p > .6).

scholarly journals When does the use of individual patient data in network meta-analysis make a difference? A simulation study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Steve Kanters ◽  
Mohammad Ehsanul Karim ◽  
Kristian Thorlund ◽  
Aslam Anis ◽  
Nick Bansback
Keyword(s):  
Simulation Study ◽  
Treatment Effect ◽  
Mean Squared Error ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Model Performance ◽  
Patient Data ◽  
Meta Regression ◽  
Treatment Comparisons ◽  
The Impact

Abstract Background The use of individual patient data (IPD) in network meta-analyses (NMA) is rapidly growing. This study aimed to determine, through simulations, the impact of select factors on the validity and precision of NMA estimates when combining IPD and aggregate data (AgD) relative to using AgD only. Methods Three analysis strategies were compared via simulations: 1) AgD NMA without adjustments (AgD-NMA); 2) AgD NMA with meta-regression (AgD-NMA-MR); and 3) IPD-AgD NMA with meta-regression (IPD-NMA). We compared 108 parameter permutations: number of network nodes (3, 5 or 10); proportion of treatment comparisons informed by IPD (low, medium or high); equal size trials (2-armed with 200 patients per arm) or larger IPD trials (500 patients per arm); sparse or well-populated networks; and type of effect-modification (none, constant across treatment comparisons, or exchangeable). Data were generated over 200 simulations for each combination of parameters, each using linear regression with Normal distributions. To assess model performance and estimate validity, the mean squared error (MSE) and bias of treatment-effect and covariate estimates were collected. Standard errors (SE) and percentiles were used to compare estimate precision. Results Overall, IPD-NMA performed best in terms of validity and precision. The median MSE was lower in the IPD-NMA in 88 of 108 scenarios (similar results otherwise). On average, the IPD-NMA median MSE was 0.54 times the median using AgD-NMA-MR. Similarly, the SEs of the IPD-NMA treatment-effect estimates were 1/5 the size of AgD-NMA-MR SEs. The magnitude of superior validity and precision of using IPD-NMA varied across scenarios and was associated with the amount of IPD. Using IPD in small or sparse networks consistently led to improved validity and precision; however, in large/dense networks IPD tended to have negligible impact if too few IPD were included. Similar results also apply to the meta-regression coefficient estimates. Conclusions Our simulation study suggests that the use of IPD in NMA will considerably improve the validity and precision of estimates of treatment effect and regression coefficients in the most NMA IPD data-scenarios. However, IPD may not add meaningful validity and precision to NMAs of large and dense treatment networks when negligible IPD are used.

scholarly journals Accelerometer-Measured Physical Activity and Its Impact on Sleep Quality in Persons Suffering From Restless Legs Syndrome

2020 ◽  
Author(s):  
Anne Reimers ◽  
Verena Heidenreich ◽  
Hans-Joachim Bittermann ◽  
Guido Knapp ◽  
Carl-Detlev Reimers
Keyword(s):  
Physical Activity ◽  
Sleep Quality ◽  
Negative Correlation ◽  
Restless Legs Syndrome ◽  
Quality Parameters ◽  
Moderate Physical Activity ◽  
Activity Levels ◽  
Restless Legs ◽  
Physical Activity Levels ◽  
The Impact

Abstract Background: Main symptoms of the restless legs syndrome (RLS) are sleep onset insomnia and difficulty to maintain sleep. Previous studies showed that regular physical activity can reduce the risk of developing RLS. However, the relationships of physical activity on sleep quality parameters in subjects suffering from RLS have not been investigated by applying accelerometry. Thus, the present study investigates the impact of physical activity during the day (7-12 h, 12-18 h, 18-23 h) on sleep quality in subject suffering from idiopathic RLS as well as their intensity and extent of physical activity by applying a real-time approach.Methods: In a sample of 47 participants suffering from idiopathic RLS, physical activity and sleep quality were captured over one week by using accelerometers. For data analysis physical activity levels and step counts during three periods of a day (morning, afternoon, evening) were correlated with sleep quality parameters of the following night.Results: In this observational study, significant correlations of physical activity with the sleep parameters were rarely confirmed (exception: negative correlation of steps in the morning with periodic leg movements in sleep and negative correlation of physical activity in the evening and total sleep period). However, the physical activity levels of the participants were unexpectedly high compared to population-level data and variance in physical activity was low. The average activity was 13,817 (SD=4,086) steps and 347 (SD=117) minutes of moderate physical activity per day in females and 10,636 (SD=3,748) steps and 269 (SD=69) minutes of moderate physical activity in males, respectively. However, the participants conducted no vigorous physical activity.Conclusions: To investigate the effects of daily physical activity and RLS symptoms interventional studies with different intensities of physical activities at different points of time during the day are needed.

scholarly journals Is the impact of adiposity on taste perceptions moderated by chronic physical activity? An overview of the data from NHANES 2013-2014.

2021 ◽  
Author(s):  
Alexandre-Charles Gauthier ◽  
Marie-Eve Mathieu
Keyword(s):  
Physical Activity ◽  
Body Fat ◽  
Activity Level ◽  
Body Fat Percentage ◽  
Activity Levels ◽  
Fat Percentage ◽  
Active Lifestyle ◽  
Physical Activity Levels ◽  
Tip Test ◽  
The Impact

Introduction Taste is a key sensory modulator of eating behaviour and thus energy intake. The effects of acute exercise has recently been confirmed especially regarding sweet and salty tastes. Physical activity is a safe and effective countermeasure to certain types of chemosensory losses, especially in older populations. Knowing that taste can be impaired with increased adiposity, it is unknown if the adoption of an active lifestyle on a regular basis can mitigate such impairments. Methods Data were extracted from NHANES 2013-2014 database. Perception of salt and bitter tastes for Tongue Tip Test and Whole Mouth Test, physical activity levels over an 8-9-day period and adiposity were analyzed. Moderation analyses were used to study the impact of adiposity on taste perceptions, with physical activity level as the moderator. Results The 197 participants (130 males) included in this project had a mean+/-standard deviation age of 49.1+/-5.2 years, a mean body fat percentage of 31.7+/-7.6% and mean daily physical activity levels of 11 084+/-3531 Monitor-Independent Movement Summary unit (MIMS). The positive association between adiposity and both bitter Tongue Tip Test and overall result (salt+bitter) of Tongue Tip Test were moderated by the adoption of an active lifestyle, with better taste scores observed in individuals achieving higher physical activity levels. When moderation analysis were stratified by gender, the effect of physical activity was no longer significant. Perspectives This study is the first to evaluate the influence of an active lifestyle on the preservation of some taste perceptions across a wide range of adiposity levels. While differences in taste can be observed regarding body fat percentage, physical activity moderates that relation only when men and women are analysed together.

Exploring the Relationship Between Fundamental Motor Skill Interventions and Physical Activity Levels in Children: A Systematic Review and Meta-analysis

2018 ◽  
Vol 48 (8) ◽  
pp. 1845-1857 ◽  
Author(s):  
Alexander C. Engel ◽  
Carolyn R. Broderick ◽  
Nancy van Doorn ◽  
Louise L. Hardy ◽  
Belinda J. Parmenter
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Motor Skill ◽  
Meta Analysis ◽  
Activity Levels ◽  
Physical Activity Levels ◽  
The Relationship
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