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Highlights • First study that directly compared Tai Ji Quan trials published in English and Chinese with meta-regression analysis in the largest sample to date • In trials published in English, Tai Ji Quan reduces systolic blood pressure by 10 mm Hg and diastolic blood pressure 4 mm Hg among adults with hypertension • In trials published in Chinese, Tai Ji Quan reduces systolic pressure by 19 mm Hg and diastolic pressure by 9 mm Hg among adults with hypertension • More confidence should be placed in Tai Ji Quan trials published in English due to their higher methodological quality compared to trials published in Chinese, Background Professional health organizations are not currently recommending Tai Ji Quan alongside aerobic exercise to treat hypertension. We aimed to examine the efficacy of Tai Ji Quan as antihypertensive lifestyle therapy. Methods Tai Ji Quan interventions published in English and Chinese were included when they involved healthy adults, reported pre- and post-intervention blood pressure (BP), and had a non-exercise/non-diet control group. We systematically searched 11 electronic databases for studies published through July 31, 2018, yielding 31 qualifying controlled trials. We (1) evaluated the risk of bias and methodological study quality, (2) performed meta-regression analyses following random-effects assumptions, and (3) generated additive models representing the largest possible clinically relevant BP reductions. Results Participants (n = 3223) were middle-aged (56.6 ± 15.1 years of age, mean ± SD) adults with prehypertension (systolic BP (SBP) = 136.9 ± 15.2 mmHg, diastolic BP (DBP) = 83.4 ± 8.7 mmHg). Tai Ji Quan was practiced 4.0 ± 1.4 sessions/week for 54.0 ± 10.6 min/session for 22.3 ± 20.2 weeks. Overall, Tai Ji Quan elicited significant reductions in SBP (–11.3 mmHg, 95%CI: –14.6 to –8.0; d+ = –0.75) and DBP (–4.8 mmHg, 95%CI: –6.4 to –3.1; d+ = –0.53) vs. control (p < 0.001). Controlling for publication bias among samples with hypertension, Tai Ji Quan trials published in English elicited SBP reductions of 10.4 mmHg and DBP reductions of 4.0 mmHg, which was half the magnitude of trials published in Chinese (SBP reductions of 18.6 mmHg and DBP reductions of 8.8 mmHg). Conclusion Our results indicate that Tai Ji Quan is a viable antihypertensive lifestyle therapy that produces clinically meaningful BP reductions (i.e., 10.4 mmHg and 4.0 mmHg of SBP and DBP reductions, respectively) among individuals with hypertension. Such magnitude of BP reductions can lower the incidence of cardiovascular disease by up to 40%., Graphical Abstract Image, graphical abstract

Background: Exercise in pregnancy favorably affects maternal and fetal outcomes, yet only 50% of women receive exercise guidance during prenatal care and 15% are told to stop exercising. Reasons for clinician reluctance to recommend exercise include safety concerns and ambiguity of recommendations. To better inform clinicians, this systematic review assembled a consensus exercise prescription (ExRx) for healthy pregnant women framed by the Frequency, Intensity, Time, and Type (FITT) principle. Methods: In April 2021, PubMed, Scopus, SPORTDiscus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane databases were searched. Reports were eligible if: (1) targeted healthy pregnant women, (2) framed the ExRx by the FITT, and (3) published by a professional society from 2000 to 2021 in English. The Appraisal of Guidelines for Research and Evaluation II tool assessed risk of bias. Results: Twelve reports of poor to good quality were included. Nine societies conducted systematic reviews, but only three provided a detailed, transparent description of the review conducted. Although the FITT varied, the most common was most days of the week, moderate intensity, 30 minutes/session to accumulate 150 minutes/week, and aerobic, resistance, and flexibility exercise with three societies advising neuromotor exercise. All professional societies specified activities to avoid and eight societies included contraindications to exercise. Conclusions: This systematic review produced a consensus ExRx for healthy pregnant women to better inform clinicians about advising their patients to exercise during pregnancy. Future research is needed to determine the upper limits of exercise while pregnant and provide better informed guidance relating to safety concerns for women who are pregnant.

Objectives We performed a systematic review and meta-analysis to examine the effect of body fat on thermoregulatory responses to exercise in the heat. Design Systematic Review and Meta-analysis. Methods We systematically searched databases (N = 8) for studies that included: healthy participants; an aerobic exercise intervention under heat stress; a measure of body fat by a high and low body fat group; pre- and post-exercise internal temperature, and/or post-exercise mean skin temperature and whole body sweat loss. Criteria to distinguish high body fat and low body fat were determined by each qualifying study. Out of 1222 potential studies, 10 qualified. Robust variance estimation models were utilized to determine the pooled effect size (ES, 95% CI) for interventions that performed unbias comparisons between groups. Results Participants (n = 211) were mostly male (70%) and young (19.3 ± 7.1 years) with a maximal oxygen consumption of 50.42 ± 9.3 ml∙kg-1∙min-1 by high body fat (36.7 ± 11.8%) and low body fat (17.8 ± 5.7%). Exercise duration was between 30 and 60 min at moderate-high intensity (44.1-71.4% VO2max) at 28-40.3 °C and 26-50% humidity. Of the 7 interventions that normalized metabolic heat production to body mass and 5 interventions that normalized to external workload, there were no differences in any of the three outcome variables between groups. Conclusions Many of the included studies did not control for confounding factors that may affect the relationship between body fat and thermoregulation during exercise in the heat such as metabolic heat production and body mass. Given the small number of interventions included, future work must make unbiased comparisons to appropriately assess the independent influence of body fat.

Aerobic exercise training and, to a lesser degree, dynamic resistance training, are recommended to lower blood pressure (BP) among adults with hypertension. Yet the combined influence of these exercise modalities, termed concurrent exercise training (CET), on resting BP is unclear.This study aimed to meta-analyze the literature to determine the efficacy of CET as antihypertensive therapy.Electronic databases were searched for trials that included the following: adults (19 yr), controlled CET interventions, and BP measured pre- and postintervention. Study quality was assessed with a modified Downs and Black Checklist. Analyses incorporated random-effects assumptions.Sixty-eight trials yielded 76 interventions. Subjects (N = 4110) were middle- to older-age (55.8 ± 14.4 yr), were overweight (28.0 ± 3.6 kg·m), and had prehypertension (systolic BP [SBP]/diastolic BP [DBP] = 134.6 ± 10.9/80.7 ± 7.5 mm Hg). CET was performed at moderate intensity (aerobic = 55% maximal oxygen consumption, resistance = 60% one-repetition maximum), 2.9 ± 0.7 d·wk for 58.3 ± 20.1 min per session for 19.7 ± 17.8 wk. Studies were of moderate quality, satisfying 60.7% ± 9.4% of quality items. Overall, CET moderately reduced SBP (db = -0.32, 95% confidence interval [CI] = -0.44 to -0.20, -3.2 mm Hg) and DBP (db = -0.35, 95% CI = -0.47 to -0.22, -2.5 mm Hg) versus control (P0.01). However, greater SBP/DBP reductions were observed among samples with hypertension in trials of higher study quality that also examined BP as the primary outcome (-9.2 mm Hg [95% CI = -12.0 to -8.0]/-7.7 mm Hg [95% CI = -14.0 to -8.0]).Among samples with hypertension in trials of higher study quality, CET rivals aerobic exercise training as antihypertensive therapy. Because of the moderate quality of this literature, additional randomized controlled CET trials that examine BP as a primary outcome among samples with hypertension are warranted to confirm our promising findings.

ObjectiveTo compare the blood pressure (BP) effects of exercise alone (EXalone), medication alone (MEDSalone) and combined (EX+MEDScombined) among adults with hypertension.Data sourcesPubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Cochrane Library.Eligibility criteriaRandomised controlled trails (RCTs) or meta-analyses (MAs) of controlled trials that: (1) involved healthy adults>18 year with hypertension; (2) investigated exercise and BP; (3) reported preintervention and postintervention BP and (4) were published in English. RCTs had an EX+MEDScombined arm; and an EXalone arm and/or an MEDSalone arm; and MAs performed moderator analyses.DesignA systematic network MA and meta-review with the evidence graded using the Physical Activity Guidelines for Americans Advisory Committee system.OutcomeThe BP response for EXalone, MEDSalone and EX+MEDScombined and compared with each other.ResultsTwelve RCTs qualified with 342 subjects (60% women) who were mostly physically inactive, middle-aged to older adults. There were 13 qualifying MAs with 28 468 participants (~50% women) who were mostly Caucasian or Asian. Most RCTs were aerobic (83.3%), while the MAs involved traditional (46%) and alternative (54%) exercise types. Strong evidence demonstrates EXalone, MEDSalone and EX+MEDScombined reduce BP and EX+MEDScombined elicit BP reductions less than the sum of their parts. Strong evidence indicates EX+MEDScombined potentiate the BP effects of MEDSalone. Although the evidence is stronger for alternative than traditional types of exercise, EXaloneelicits greater BP reductions than MEDSalone.ConclusionsThe combined BP effects of exercise and medications are not additive or synergistic, but when combined they bolster the antihypertensive effects of MEDSalone.PROSPERO registration numberThe protocol is registered at PROSPERO CRD42020181754.

Background:Anteriorly flexed posture is a common impairment with negative consequences for individuals with Parkinson's disease (PD). Identification of objective non-radiologic procedures for measuring flexed trunk posture is therefore important.Objective:Summarise available information on objective non-radiologic procedures for measuring anterior trunk flexion in PD.Methods:A systematic review using six relevant databases was conducted. Two reviewers independently examined the search output using strict inclusion and exclusion criteria. Articles determined to be relevant were abstracted for participant characteristics, measurement technique, test position and findings and were graded using a critical appraisal checklist.Results:Seventeen studies revealed information on objective, non-radiologic procedures for measuring sagittal plane-flexed posture in PD. Participants were primarily older adults with Hoehn and Yahr scale scores of 1–5. Five different measures were reported: linear distance betwee...

I read with interest the article by Williams et al. [1] titled ‘‘Concussion recovery time among high school and collegiate athletes: a systematic review and meta-analysis’’. Though the authors followed the reporting standards set forth in the PRISMA guidelines [2], they (like many other authors of systematic reviews) fell short in conducting a comprehensive review of the literature and reporting a reproducible search strategy. Expertly devised search methods for identifying relevant published and unpublished studies are the bedrock upon which the validity of the entire review is dependent; as in order for a systematic review to perform its function as a reliable resource for clinical decision making, it must include all relevant clinical studies. The shortcomings within this systematic review are commonplace. Though an electronic search strategy for one database was presented, the search as reported is not reproducible. The authors state that their search was run in PubMed from database inception to December 2013, yet a large discrepancy exists between the 141 citations the authors state were found and the 1913 citations that result when the following strategy is run through December 31, 2013: (athletes or sports) and (concussion or mild traumatic brain injury) and (recovery or symptoms or cognition). Further, the search fails to qualify as a comprehensive literature search; these searches are innately sensitive and complex. The strategy used in this study does not use controlled vocabulary or proper syntax, nor does it provide an inclusive concatenation of those terms published on sports, athletes, concussions, recovery, symptoms, or cognition. Exhaustive searches that form the foundation of systematic reviews reflect an intimate understanding of the variability of keywords and database-specific indexing. They also take advantage of database-specific limiters/filters. For example, many studies written about concussions are sport specific. A search that only includes general terms for athletes or sports will miss some studies conducted on single sport athletes, such as football or soccer players. A comprehensive PubMed search for the concept of athletes or sports follows: (‘‘Sports’’[Mesh] OR ‘‘Athletes’’[Mesh] OR sport OR sports OR athlete* OR rugby OR football OR soccer OR lacrosse OR wrestling OR swimming OR hockey OR skiing OR skiers). Additional sports could be added, as appropriate. By improving syntax use and expanding upon the comprehensiveness of terms, the authors would have found several hundred additional articles in PubMed alone. Including other databases such as PsycINFO, Web of Science, Scopus, the Cochrane Library, and clinical trial registers would yield dozens more. Databases are designed so that all searches harvest results; however, only trained and experienced searchers have the capability to conduct the exhaustive searches required for systematic reviews. This is recognized in the Institute of Medicine’s ‘‘Recommended Standards for Finding and Assessing Individual Studies’’, which stipulate that authors of systematic reviews ‘‘Work with a librarian or other information specialist trained in performing systematic reviews (SRs) to plan the search strategy’’ and ‘‘Use an independent librarian or other information specialist to peer review the search strategy’’ [3]. The expertise of a medical librarian will ensure the comprehensive collection and examination of relevant studies. Additionally, owing to their intimate knowledge of literature in the & Jill Livingston jill.livingston@uconn.edu