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Background: As a mind-body exercise, Tai Chi (TC) may have a positive impact on physical function and psychological well-being in patients with breast cancer (BC). The aim of this current overview of systematic reviews (SRs) and meta-analyses (MAs) was to identify and summarize the existing evidence regarding the effectiveness of TC in patients with BC.Methods: A computerized search of electronic databases was performed to identify relevant SRs/MAs of TC related to BC from inception to June 2020. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklists were used to assess the methodological quality and reporting quality of SRs and MAs, respectively. The Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the evidence quality of outcome measures.Results: Six SRs/MAs in which quantitative synthesis was used to assess various outcomes of TC related to BC were included in this overview. The quality of the SRs/MAs and the evidence quality of the outcome measures were generally unsatisfactory. The limitations of the past SRs/MAs were the lack of a protocol and registration, a list of excluded studies, or inadequately reported computational details of meta-analyses. The critical problems were that the qualitative data synthesis relied on the trials with small sample sizes and of critical low quality.Conclusions: TC is possibly beneficial to BC treatment. However, further rigorous and comprehensive studies are required to provide robust evidence for definitive conclusions. [ABSTRACT FROM AUTHOR]

• Supervised therapeutic exercise has a beneficial effect in patients with knee osteoarthritis. • Active video game playing had the same effect as therapeutic exercise for pain. • Active video game playing improved balance, physical functional performance and physical health as compared with therapeutic exercise. • Active video game playing may be an alternative supplementary therapy to therapeutic exercise. Active video games (AVGs) have become popular and have been investigated for their therapeutic purposes. However, the effect of AVGs on patients with knee osteoarthritis (OA) remains uncertain. We aimed to compare the effects of AVGs with those of traditional therapeutic exercise on patients with knee OA. This was a prospective single-blind, randomized controlled trial. Participants (n = 80) with knee OA were allocated to the AVGs group (n = 40) or therapeutic exercise group (n = 40). Both groups received treatment 3 times a week for 4 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and secondary outcome measures were the World Health Organization Quality of Life-Brief Vision, Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, physical functional performance (including time for 10-m walking and for ascending and descending stairs), Biodex Stability System, Chronic Pain Grade Questionnaire, and Work Ability Index. The patients were evaluated at baseline, 2 and 4 weeks after treatment, and 1 and 3 months after treatment completion. Both groups showed significant time effect in the pain subcategory of the WOMAC (P = 0.047). However, we found no significant group × time interaction effect between the groups at any follow-up assessments for pain (P = 0.066), stiffness (P = 0.284), or physical function (P = 0.179) for the WOMAC. Among the secondary outcomes, we found significant group × time effects favoring the AVG group in dynamic balance (P = 0.020), and physical functional performance including 10-m walking time (P = 0.002) and stair ascent time (P = 0.005), and the physical domain of health (P = 0.032). Therapeutic exercises and playing AVGs similarly improved the pain of patients with knee OA; however, playing AVGs improved dynamic balance, physical functional performance, and physical health more than therapeutic exercises did. [ABSTRACT FROM AUTHOR]

• The content of comparator groups in knee OA exercise therapy RCTs varied greatly. • Effect estimates of exercise for knee OA varied depending on comparator interventions. • Participant and intervention characteristics did not impact the effect estimates Systematic reviews of exercise therapy for knee osteoarthritis (OA) have largely ignored the variability in comparator interventions. To assess how effect estimates of exercise therapy for knee OA as reported in randomized controlled trials vary depending on the comparator interventions. We followed the Cochrane Handbook and PRISMA guidance to conduct and report this meta-epidemiological study. Randomised controlled trials (RCTs) were identified from systematic reviews published in 2015 or later and reference lists of included studies. Exercise therapy RCTs testing interventions that adhered to the American College of Sports Medicine (ACSM) guidelines compared to any comparator intervention in people with knee OA and reporting outcomes of knee pain, physical function and/or quadriceps strength at the end of intervention were included. Thirty-five RCTs with 2412 participants were included. Comparator interventions included no intervention, non-ACSM compliant exercise therapy, education/self-management, and passive modalities. For pain, standardized mean difference (SMD) for ACSM compliant exercise therapy compared to passive modalities was 1.76 (95% CI 0.49, 3.04), no intervention 0.93 (95% CI 0.50; 1.36), education/self-management 0.27 (95% CI 0.07, 0.47), and non-ACSM compliant exercise therapy 0.09 (95% CI -0.06, 0.23). For physical function, SMD for ACSM compliant exercise therapy compared to passive modalities was 1.29 (95% CI 0.41, 2.17), no intervention 0.76 (95% CI 0.15, 1.36), non-ACSM compliant exercise therapy 0.25 (95% CI -0.00, 0.51) and education/self-management 0.21 (95% CI -0.14, 0.55). For quadriceps strength, SMD for ACSM compliant exercise therapy compared to no intervention was 0.69 (95% CI 0.42, 0.96), non-ACSM compliant exercise therapy 0.23 (95% CI -0.01, 0.46), education/self-management -0.02 (95% CI -0.45, 0.42) and passive modalities 0.80 (95% CI -0.10, 1.71). The effect of exercise therapy for knee OA varies significantly depending on the comparator intervention. This variability should be assessed routinely in systematic reviews. [ABSTRACT FROM AUTHOR]

• Intensive exercise in the early postoperative rehabilitation after hip fracture (up to 3 months postoperatively) is beneficial to the recovery of physical function in older adults. • Intensive exercise with more load lead to greater improvements in muscle strength, balance, and functional ability. • Older adults with cognitive impairment were not included in the studies selected for this review, conclusions about the training results may not be extended to this population. Individuals commonly experience age-related systemic decreases in skeletal muscle strength, physical function, and mobility, leading to falls and potential associated hip fractures. To evaluate whether intensive exercise can improve physical function, mobility, and independence in activities of daily living (ADL) and shorten the length of hospital stay in older adults after hip fracture surgery. This systematic review was conducted under the PRISMA guidelines. Searches were performed on January 5, 2022 in eight databases. Randomized controlled trials (RCTs) were included. The participants included older adults with hip fracture, and the intervention studied was intensive exercise. The outcomes were physical function, mobility, ADLs, and the length of hospital stay. Meta-analyses were conducted using RevMan 5.3. Fifteen studies were included in this review. After hip fracture surgery, intensive exercise improved participants' physical function to a greater extent than regular or no exercise (standardized mean difference [SMD] = 0.74; 95% CI: 0.25, 1.23). Intensive exercise was particularly more effective for gait speed (SMD = 0.15, 95% CI: 0.01, 0.30), the timed up-and-go test results (mean difference [MD] = -4.34, 95%CI: -6.74, -1.94), balance (SMD =0.42, 95% CI: 0.38, 0.89), and ADLs (SMD = 0.55, 95% CI: 0.24, 0.87). The quality of the evidence was low due to risk of bias, inconsistency, and imprecision. Intensive exercise early post-operation provides potential additional benefits compared to no or regular exercises on older adults after hip fracture surgery. [ABSTRACT FROM AUTHOR]

Effects of exercise in patients with breast cancer have been thoroughly investigated. The aim was to explore differences in effects regarding type, delivery mode and extensiveness (e.g. intensity; volume) of the interventions. We searched for randomised controlled trials including patients with breast cancer receiving systemic treatment, exercise-based interventions, and measures on patient reported- and objectively measured outcomes. Exercise showed significant and moderate effects on the primary outcomes quality of life and physical function, Standardised Mean Difference: 0.52 (95 % CI 0.38–0.65) and 0.52 (95 % CI 0.38–0.66), respectively. Type of exercise had little influence on the effects, however combined aerobic- and resistance exercise seemed superior for increasing physical function, compared to aerobic or resistance exercise. Supervised interventions were superior to partly and unsupervised. Extensiveness of the intervention only influenced physical function. Supervised interventions, more than type or extensiveness of interventions, seem to increase effects. [Display omitted] • Exercise effectively increases quality of life, irrespective of exercise type. • Supervised exercise interventions are most effective. • Extensiveness of exercise interventions has very little influence on the effects. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, new challenges are presented in clinical research settings to increase exercise levels, particularly in vulnerable populations such as cancer survivors. While in-person supervised exercise is an effective format to improve patient-reported outcomes and physical function for cancer survivors, the COVID-19 pandemic limited this form of exercise as a feasible option within research and cancer care. As such, exercise oncology interventions were adapted to home-based instruction. In this review, we examine the current evidence of exercise interventions in cancer populations during and beyond the COVID-19 pandemic. We identified that group-based virtually supervised home-based exercise was the most used format among exercise oncology interventions during the pandemic. Preliminary results support feasibility and effectiveness of this emerging exercise setting in cancer survivors; however, it needs to be further investigated in adequately designed larger trials. Additionally, we provide recommendations and perspective for the implementation of virtually supervised home-based exercise. [Display omitted] • The COVID-19 pandemic resulted in a transition to home-based exercise interventions in cancer survivors. • Virtually supervised group-based exercise interventions were the most common format among exercise oncology interventions during COVID-19. • Preliminary results suggest feasibility, safety, and effectiveness of virtually supervised exercise. • We provide recommendations and perspectives for the implementation of virtually supervised exercise in future exercise oncology trials. • There is a need to develop high-quality research in exercise oncology to support cancer survivors beyond the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

[Display omitted] • Coexistence of atrial fibrillation (AF) and heart failure (HF) causes poor outcomes. • We examined the impact of AF on response to exercise training in older individuals with HF. • AF in older HF individuals was correlated with lower physical function at the baseline. • AF was not associated with response to exercise-based cardiac rehabilitation. • Positive response of physical function was associated with better prognosis even with AF. Although the coexistence of heart failure (HF) with atrial fibrillation (AF) exhibits poor outcomes, the correlation between AF status and outcomes after exercise-based cardiac rehabilitation (CR) remains unclear in older individuals with HF. This retrospective study aimed to investigate the impact of AF on changes in physical function and prognosis after CR in older individuals with HF. We enrolled consecutive individuals with HF who were ≥ 60 years old who received 5-month CR. Exercise-based CR involved moderate-intensity aerobic exercises tailored to each participant. Isometric quadriceps strength (QS) and 6-min walk distance (6MWD) were measured as physical function, at baseline and 5 months thereafter. We compared QS and 6MWD changes from baseline to the 5-month observation period (▪QS and ▪6MWD) between sinus rhythm and AF. We examined composite incidence of all-cause death or unplanned readmission after 5-month CR and analysed the association of ▪QS and ▪6MWD with clinical events, estimating adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Of the 764 participants, 476 (62%) had sinus rhythm, and 288 (38%) had AF. AF was associated with lower QS and 6MWD at baseline. The 2 groups did not differ in ▪QS and ▪6MWD after adjusting for clinical confounders. With sinus rhythm, greater change in QS and 6MWD was significantly associated with reduced incidence of clinical events (▪QS tertile: aHR 0.75 [95% CI 0.60–0.92]; ▪6MWD tertile: aHR 0.59 [95% CI 0.46–0.76]); however, with AF, this association was observed for only 6MWD and not QS (▪QS: aHR 0.92 [95% CI 0.72–1.17]; ▪6MWD: aHR 0.73 [95% CI 0.54–0.98]). AF in older individuals with HF is associated with reduced physical function at baseline but not response to exercise-based CR. Furthermore, positive response of physical function after CR is associated with better prognosis regardless of AF, which suggests that exercise-based CR is potentially effective in older individuals with HF and AF. [ABSTRACT FROM AUTHOR]

Treatments for early breast cancer have side effects that affect quality of life (QoL) and cause deconditioning. Physical exercise might have a supportive and coadjuvant role in the rehabilitation of breast cancer survivors. We aimed to analyse the preliminary results of a community-based supervised exercise training program on QoL and muscle strength in breast cancer survivors. Twenty breast cancer female survivors were recruited to a single-arm clinical trial consisting of sequential 16 weeks (wk) of control phase (CP) and 16 wk intervention phase (IP). Four evaluations were carried out: M1 (8 wk on CP), M2 (immediately previous IP), M3 (8 wk CP) and M4 (16 wk IP). The IP consisted of 3 sessions per week of combined aerobic and strength exercise (60min) at moderate to vigorous exercise (65-85% of maximum heart rate or 6-8 points on OMNI scale). The primary endpoint was QoL, which was evaluated by EORTC QLQ-C30 questionnaire. Secondary endpoints included handgrip strength and sit-to-stand (STS) test. Of the 20 recruited women, 19 initiated and 15 concluded the program, with a mean compliance to the exercise intervention of 63.6%. The median age was 59 years old (39-72). All but 3 were diagnosed with invasive carcinoma. After surgery, 13 (62%) underwent radiotherapy, 15 (71%) chemotherapy and 18 (86%) were under hormonotherapy. During the control phase, no significant differences were observed in the efficacy variables. There was no changes over time for any domain of QoL, except for physical functioning scale (p = 0.038), where it was observed a trend to increase between M2 and M3 (77.3±14.0 to 85.3±10.1, p = 0.051). A significant increase in handgrip strength of non-operated (22.2±3.9 to 25.6±5.3 kg.f, p = 0.004) and operated limb (22.6±4.7 to 26.9±6.6 kg.f, p = 0.001) was shown after exercise training. Similar results were also observed for STS test [12 (11-13.5) to 17 (13-21) repetitions, p = 0.002]. An exercise program appears to be beneficial for QoL, particularly in the physical functioning of breast cancer survivors. Moreover, it seems to have an important role on strength levels. Associação de Investigação e Cuidados de Suporte em Oncologia. Liga Portuguesa Contra o Cancro. All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]