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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.

Obesity affects approximately one-third of American adults. Recent evidence suggests that weight bias may be pervasive among both exercise and nutrition professionals working with adults who have obesity. However, the published literature on this topic is limited. This review aimed to (i) systematically review existing literature examining weight bias among exercise and nutrition professionals; (ii) discuss the implications of this evidence for exercise and nutrition professionals and their clients; (iii) address gaps and limitations of this literature; and (iv) identify future research directions. Of the 31 studies that met the criteria for this review, 20 examined weight bias among exercise professionals, of which 17 (85%) found evidence of weight bias among professionals practicing physical therapy (n = 4), physical education (n = 8) and personal/group fitness training (n = 5). Of 11 studies examining weight bias among nutrition professionals, eight (73%) found evidence of weight bias. These findings demonstrate fairly consistent evidence of weight bias among exercise and nutrition professionals. However, the majority of studies were cross-sectional (90%). Given that weight bias may compromise quality of care and potentially reinforce weight gain and associated negative health consequences in patients with obesity, it is imperative for future work to examine the causes and consequences of weight bias within exercise and nutrition professions using more rigorous study designs.

Background: Exercise is one of the best nonpharmacologic therapies to treat hypertension. The blood pressure (BP) response to exercise is heritable. Yet, the genetic basis for the antihypertensive effects of exercise remains elusive. Methods: To assemble a prioritized gene signature, we performed a systematic review with a series of Boolean searches in PubMed (including Medline) from earliest coverage. The inclusion criteria were human genes in major BP regulatory pathways reported to be associated with: (1) the BP response to exercise; (2) hypertension in genome-wide association studies (GWAS); (3) the BP response to pharmacotherapy; (4a) physical activity and/or obesity in GWAS; and (4b) BP, physical activity, and/or obesity in non-GWAS. Included GWAS reports disclosed the statistically significant thresholds used for multiple testing. Results: The search yielded 1422 reports. Of these, 57 trials qualified from which we extracted 11 genes under criteria 1, 18 genes under criteria 2, 28 genes under criteria 3, 27 genes under criteria 4a, and 29 genes under criteria 4b. We also included 41 genes identified from our previous work. Conclusions: Deep-sequencing the exons of this systematically assembled signature of genes represents a cost and time efficient approach to investigate the genomic basis for the antihypertensive effects of exercise.

Objective To investigate the efficacy of yoga as antihypertensive lifestyle therapy and identify moderators that account for variability in the blood pressure (BP) response to yoga. Methods We systematically searched 6 electronic databases from inception through June 4, 2018, for articles published in English language journals on trials of yoga interventions that involved adult participants, reported preintervention and postintervention BP, and had a nonexercise/nondiet control group. Our search yielded 49 qualifying controlled trials (56 interventions). We (1) evaluated the risk of bias and methodological study quality, (2) performed meta-regression analysis following random-effects assumptions, and (3) generated additive models that represented the largest possible clinically relevant BP reductions. Results On average, the 3517 trial participants were middle-aged (49.2±19.5 years), overweight (27.9±3.6 kg/m2) adults with high BP (systolic BP, 129.3±13.3 mm Hg; diastolic BP, 80.7±8.4 mm Hg). Yoga was practiced 4.8±3.4 sessions per week for 59.2±25.0 minutes per session for 13.2±7.5 weeks. On average, yoga elicited moderate reductions in systolic BP (weighted mean effect size, −0.47; 95% CI, −0.62-0.32, −5.0 mm Hg) and diastolic BP (weighted mean effect size, −0.47; 95% CI, −0.61 to −0.32; −3.9 mm Hg) compared with controls (P Conclusion Our results indicate that yoga is a viable antihypertensive lifestyle therapy that produces the greatest BP benefits when breathing techniques and meditation/mental relaxation are included.

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.

BackgroundThere is a high prevalence of cardiovascular disease across diverse groups in the U.S. population, and increasing research has identified stigma as a potential barrier to cardiovascular disease prevention and treatment. This systematic review examines evidence linking discrimination and cardiovascular health among socially stigmatized groups.Study designSix databases were systematically reviewed from inception through February 2018 for studies with adult subjects, focusing on cardiovascular health indicators among social groups stigmatized because of their gender, race/ethnicity, age, body weight/obesity, or sexual orientation. The Newcastle-Ottawa Scale was used to evaluate the methodological quality and risk of bias for nonrandomized studies, and the Cochrane Collaboration 7-item domain for randomized controlled and experimental trials.ResultsThe search identified 84 eligible studies published between 1984 and 2017. Studies retrieved were categorized according to demonstrated links between stigma and cardiovascular disease risk factors including blood pressure (n = 45), heart rate variability (n = 6), blood/saliva cardiovascular biomarkers (n = 18), as well as other indicators of cardiovascular health (n = 15). Based on the findings from included studies, 86% concluded that there was a significant relationship among stigma or discrimination and cardiovascular health indicators among socially stigmatized groups. However, there were varying degrees of evidence supporting these relationships, depending on the type of discrimination and cardiovascular health indicator. The current evidence implies an association between perceived discrimination and cardiovascular health. However, a majority of these studies are cross-sectional (73%) and focus on racial discrimination (79%), while using a wide variety of measurements to assess social discrimination and cardiovascular health.ConclusionsFuture research should include longitudinal and randomized controlled trial designs, with larger and more diverse samples of individuals with stigmatized identities, using consistent measurement approaches to assess social discrimination and its relationship with cardiovascular health.

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...

Objectives To examine the effects of exercise training on cognitive function in individuals at risk of or diagnosed with Alzheimer's disease (AD). Design Meta‐analysis. Setting PubMed, Scopus, ClinicalTrials.gov, and ProQuest were searched from inception until August 1, 2017. Participants Nineteen studies with 23 interventions including 1,145 subjects with a mean age of 77.0 ± 7.5 were included. Most subjects were at risk of AD because they had mild cognitive impairment (64%) or a parent diagnosed with AD (1%), and 35% presented with AD. Intervention Controlled studies that included an exercise‐only intervention and a nondiet, nonexercise control group and reported pre‐ and post‐intervention cognitive function measurements. Measurements Cognitive function before and after the intervention and features of the exercise intervention. Results Exercise interventions were performed 3.4 ± 1.4 days per week at moderate intensity (3.7 ± 0.6 metabolic equivalents) for 45.2 ± 17.0 minutes per session for 18.6 ± 10.0 weeks and consisted primarily of aerobic exercise (65%). Overall, there was a modest favorable effect of exercise on cognitive function (d+ = 0.47, 95% confidence interval (CI) = 0.26–0.68). Within‐group analyses revealed that exercise improved cognitive function (d+w = 0.20, 95% CI = 0.11–0.28), whereas cognitive function declined in the control group (d+w = −0.18, 95% CI = −0.36 to 0.00). Aerobic exercise had a moderate favorable effect on cognitive function (d+w = 0.65, 95% CI = 0.35–0.95), but other exercise types did not (d+w = 0.19, 95% CI = −0.06–0.43). Conclusion Our findings suggest that exercise training may delay the decline in cognitive function that occurs in individuals who are at risk of or have AD, with aerobic exercise possibly having the most favorable effect. Additional randomized controlled clinical trials that include objective measurements of cognitive function are needed to confirm our findings.

Background Aerobic exercise ( AE ) is recommended as first‐line antihypertensive lifestyle therapy based on strong evidence showing that it lowers blood pressure ( BP ) 5 to 7 mm Hg among adults with hypertension. Because of weaker evidence showing that dynamic resistance training ( RT ) reduces BP 2 to 3 mm Hg among adults with hypertension, it is recommended as adjuvant lifestyle therapy to AE training. Yet, existing evidence suggests that dynamic RT can lower BP as much or more than AE . Methods and Results We meta‐analyzed 64 controlled studies (71 interventions) to determine the efficacy of dynamic RT as stand‐alone antihypertensive therapy. Participants (N=2344) were white (57%), middle‐aged (47.2±19.0 years), and overweight (26.8±3.4 kg/m 2 ) adults with prehypertension (126.7±10.3/76.8±8.7 mm Hg); 15% were on antihypertensive medication. Overall, moderate‐intensity dynamic RT was performed 2.8±0.6 days/week for 14.4±7.9 weeks and elicited small‐to‐moderate reductions in systolic BP ( SBP ; d + =−0.31; 95% CI s, −0.43, −0.19; −3.0 mm Hg) and diastolic BP ( DBP ; d + =−0.30; 95% CI s, −0.38, −0.18; −2.1 mm Hg) compared to controls ( P sBP reductions occurred among samples with higher resting SBP / DBP : ≈6/5 mm Hg for hypertension, ≈3/3 mm Hg for prehypertension, and ≈0/1 mm Hg for normal BP ( P sBP reductions that were approximately twice the magnitude of those previously reported following AE training (−14.3 mm Hg [95% CI s, −19.0, −9.4]/−10.3 mm Hg [95% CI s, −14.5, −6.2]). Conclusions Our results indicate that for nonwhite adult samples with hypertension, dynamic RT may elicit BP reductions that are comparable to or greater than those reportedly achieved with AE training. Dynamic RT should be further investigated as a viable stand‐alone therapeutic exercise option for adult populations with high BP .

During fiscal year 2006, the University of Connecticut Libraries spent almost two-thirds of its collection budget on electronic resources, making it essential that students, faculty, and staff can find and access these resources without assistance from librarians. To address ease-of-use issues, a cross-functional task team spent a year assessing the libraries’ database locator and worked to create a more functional system. This iterative process of usability testing and design included three sets of usability tests, several design sessions, and revision of database descriptions. The new design now enables users to successfully and quickly find databases without mediation.

Open URL link resolvers are emerging technological tools designed to increase use of library collections by automating the process of locating and accessing library holdings. This study examines the system architecture and capabilities of commercially available OpenURL link resolvers to assess viable options for the University of Connecticut Libraries. Data for the study, largely experiential feedback received from libraries employing OpenURL link resolvers, were gathered through a series of evaluative activities. These included a preliminary literature review, Web survey, follow-up e-mail survey, and on-site visits to libraries. Results were analyzed within the context of the University of Connecticut Libraries' resources and needs. Analysis revealed wide variation in library experiences with and perception of product functionality and performance, as well as requisite staff and financial investments.

Library liaison programs are commonly used and provide a successful framework for communication in academic libraries. Liaison programs, whereby librarians are formally designated as the primary contact between the library and one or more departmental or administrative units, are proven to improve the transfer of information between the library and users, to improve the quality of collections and services, and to enhance the library's image. Previously published literature on liaison programs is primarily devoted to large-scale liaison programs in academic settings, the market where this model is commonly employed. Small hospital and other smaller libraries are nearly absent in the literature, reflecting the low level of liaison use in the smaller library setting. This article invites hospital and other smaller libraries to explore the liaison model by presenting common liaison goals and activities that are not only pertinent to, but also scalable, adaptable, and adoptable by smaller and larger libraries alike.

A systematic literature review from 1966 to 2000 revealed 2,730 English-language publications on the role of bacteria in human primary dental caries in vivo. The most pertinent 313 papers were analyzed in evidence tables accessible online (http://www.nidcr.nih.gov). The search targeted all bacterial types implicated previously in caries and asked two questions. First, what is the association of specific bacteria with tooth decay and can causation be attributed to any of those bacteria? Retrieved studies were categorized as randomized-blinded-interventional, longitudinal, case-control, and cross-sectional and were weighted in descending order in terms of significance. Although many studies, due to ethical requirements, had confounding variables, they still indicate strongly: 1) the central role of the mutans streptococci in initiation of caries of smooth surfaces and fissures of crowns of teeth and suggests their potent role in induction of root surface caries; and 2) that lactobacilli are implicated as important contributory bacteria in tooth decay, but their role in induction of lesions is not well supported. Second, what is the source of infection by cariogenic bacteria? Molecular/genetic studies of implicated bacteria isolated from humans, randomized-blinded-interventional, and longitudinal studies indicate that mutans streptococci are spread vertically among humans, mostly from mothers to their children. Implications of these conclusions are briefly discussed. The most significant problems of literature interpretation include the benefits/shortcomings of salivary and plaque monitoring of the flora, the role of sugar(s) in decay as it influences the flora, and modeling strategies to predict lesion score increments as distinct from determination of the etiological role of specific bacteria. Future directions for microbiological clinical caries research are suggested, and the use of the term "caries" to describe the disease, not its lesions, is urged.

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