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The authors used the meta-analytic approach to examine the effects of aerobic exercise on non-high-density lipoprotein cholesterol (non-HDL-C) in children and adolescents. Thirteen non-HDL-C outcomes in 404 males and females (221 exercise, 183 control) were available for pooling. Random-effects modeling yielded a nonstatistically significant exercise minus control group reduction of 0.61% in non-HDL-C ( ±SEM, -0.7±2.4 mg/dL, 95% confidence interval [CI], -5.4 to 5.0 mg/dL). A statistically significant decrease of 7% was found for percent body fat ( ±SEM, -2.1±0.5%, 95% CI, -3.0 to -1.2%) as well as an 8% increase in aerobic capacity ( ±SEM, 3.4±1.0 mL/kg/min, 95% CI, 1.4-5.3 mL/kg/min), both secondary outcomes of the study. It was concluded that aerobic exercise does not reduce non-HDL-C but does improve percent body fat and aerobic capacity in children and adolescents. However, a need exists for additional studies on this topic. [ABSTRACT FROM AUTHOR]

BACKGROUND: Osteoporosis and osteopenia are major public health problems. The purpose of this study was to conduct an individual patient data (IPD) meta-analysis to examine the efficacy of resistance exercise on lumbar spine and femoral neck bone mineral density (BMD) in premenopausal women. METHODS: Studies were retrieved via (1). computerized literature searches, (2). review of reference lists from previous studies, (3). hand searching selected journals, and (4). expert review of the reference list. Two x two analysis of covariance (ANCOVA) tests with repeated measures on one factor (time) and study as a covariate were used to analyze changes in BMD. RESULTS: One hundred forty-three subjects (74 exercise, 69 control) were included in the analysis. Changes in lumbar spine BMD averaged 0.006 +/- 0.035 g/cm(2) (0.64 +/- 2.99%) in the exercise group and 0.008 +/- 0.091 g/cm(2) (0.74 +/- 7.58%) in the control group, and changes in femoral neck BMD averaged 0.005 +/- 0.031 g/cm(2) (0.46 +/- 3.10%) in the exercise group and 0.003 +/- 0.031 g/cm(2) (0.31 +/- 2.97%) in the control group. No statistically significant differences in lumbar spine or femoral neck BMD were found within or between the exercise and control groups (p > 0.05). CONCLUSIONS: Based on existing evidence, our results do not support the efficacy of resistance exercise for increasing or maintaining lumbar spine and femoral neck BMD in premenopausal women. [ABSTRACT FROM AUTHOR]

Examine true inter-individual response differences (IIRD) as a result of resistance training on cardiorespiratory fitness in older adults. Data from a recent meta-analysis of 22 randomized controlled trials representing 552 men and women (292 resistance training, 260 control) ≥ 60 years of age were included. The primary outcome was cardiorespiratory fitness (VO 2max ) in ml . kg -1. min -1 . Using the inverse variance heterogeneity (IVhet) model, statistically significant treatment effect (resistance training minus control) increases in VO 2max in ml . kg -1. min -1 were found (mean, 1.8, 95% CI, 0.4 to 3.3 ml . kg -1. min -1 , p  = 0.01; Q = 82.8, p  < 0.001; I 2   = 74.6%, 95% CI, 61.6 to 83.3%; τ 2 =1.1). The 95% prediction interval (PI) was -0.8 to 4.5 ml . kg -1. min -1 . However, no statistically significant IIRD was observed (mean, 0.6, 95% CI, -1.1 to 1.4 ml . kg -1. min -1 ; τ 2 =1.5). The 95% PI was -1.8 to 2.0 ml . kg -1. min -1 . In conclusion, while progressive resistance training may increase VO 2max in ml . kg -1. min -1 , a lack of true resistance-training-associated IIRD exist., Competing Interests: Declaration of conflicting interestsThe author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Patient outcomes can improve when primary care and behavioral health providers use a collaborative system of care, but integrating these services is difficult. We tested the effectiveness of a practice intervention for improving patient outcomes by enhancing integrated behavioral health (IBH) activities., Methods: We conducted a pragmatic, cluster randomized controlled trial. The intervention combined practice redesign, quality improvement coaching, provider and staff education, and collaborative learning. At baseline and 2 years, staff at 42 primary care practices completed the Practice Integration Profile (PIP) as a measure of IBH. Adult patients with multiple chronic medical and behavioral conditions completed the Patient-Reported Outcomes Measurement Information System (PROMIS-29) survey. Primary outcomes were the change in 8 PROMIS-29 domain scores. Secondary outcomes included change in level of integration., Results: Intervention assignment had no effect on change in outcomes reported by 2,426 patients who completed both baseline and 2-year surveys. Practices assigned to the intervention improved PIP workflow scores but not PIP total scores. Baseline PIP total score was significantly associated with patient-reported function, independent of intervention. Active practices that completed intervention workbooks (n = 13) improved patient-reported outcomes and practice integration ( P ≤ .05) compared with other active practices (n = 7)., Conclusion: Intervention assignment had no effect on change in patient outcomes; however, we did observe improved patient outcomes among practices that entered the study with greater IBH. We also observed more improvement of integration and patient outcomes among active practices that completed the intervention compared to active practices that did not. Additional research is needed to understand how implementation efforts to enhance IBH can best reach patients., (© 2023 Annals of Family Medicine, Inc.)

Whether true inter-individual response differences (IIRD) occur as a result of resistance training on body weight and body composition in older adults with overweight and obesity is not known. To address this gap, data from a previous meta-analysis representing 587 men and women (333 resistance training, 254 control) ≥ 60 years of age nested in 15 randomized controlled trials of resistance training ≥ 8 weeks were included. Resistance training and control group change outcome standard deviations treated as point estimates for body weight and body composition (percent body fat, fat mass, body mass index in kg . m 2 , and lean body mass) were used to calculate true IIRD from each study. True IIRD as well as traditional pairwise comparisons were pooled using the inverse-variance (IVhet) model. Both 95% confidence intervals (CI) and prediction intervals (PI) were calculated. While statistically significant improvements were found for body weight and all body composition outcomes (p < 0.05 for all), no statistically significant IIRD was observed for any of the outcomes (p > 0.05 for all) and all 95% PIs overlapped. Conclusions: While resistance training is associated with improvements in body weight and body composition in older adults, the lack of true IIRD suggests that factors other than training response variation (random variation, physiological responses associated with behavioral changes that are not the result of resistance training) are responsible for the observed variation in body weight and body composition.

The purpose of this study was to conduct a systematic review with meta-analysis to determine the representation of adults with rheumatoid arthritis (RA) according to sex, race, and ethnicity in exercise randomized controlled trials (RCTs) conducted in the USA. Exercise RCTs ≥ 4 weeks conducted in the USA in adults ≥ 18 years with RA were eligible. Studies were retrieved by searching six electronic databases, cross-referencing and searching a clinical trials registry. Dual, independent, study selection and data abstraction were conducted. The primary outcomes were the proportion of participants in each study according to sex as well as race/ethnicity. Results were pooled meta-analytically using the inverse-variance heterogeneity (IVhet) model after applying the double-arcsine transformation. Of the 1030 unique articles screened, five RCTs representing 353 participants with RA were included. The pooled participant prevalence was 83% (95% CI = 73 to 92%) for women and 17% (95% CI = 8 to 27%) for men, suggesting an over-representation of women and an under-representation of men by approximately 7.4% based on current prevalence US estimates for each. Qualitative examination for race and ethnicity demonstrated an under-representation of racial/ethnic minority groups. There is a lack of representation of men with RA in US-based randomized controlled exercise intervention studies. Additional US-based randomized controlled exercise trials, including greater inclusion and reporting of the racial/ethnic composition of participants, are also needed. Key Points • This systematic review with meta-analysis of US studies found an under-representation of men in randomized controlled trials examining the effects of exercise in those with rheumatoid arthritis (RA). • Qualitative examination according to race/ethnicity found both a lack of reporting as well as under-representation of selected racial/ethnic minorities in US-based randomized controlled exercise studies among adults with RA. • This study highlights the need for additional US-based randomized controlled trials of exercise in adults with RA that better represent the RA population in the USA., (© 2022. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Objective: To determine whether true interindividual response differences (IIRD) exist with respect to changes in anxiety because of aerobic exercise training in adults with fibromyalgia (FM)., Data Sources: Data from a previous meta-analytical database of randomized controlled trials of exercise in adults with arthritis and other rheumatic diseases., Study Selection: Randomized controlled trials limited to aerobic exercise training on anxiety in adults 18 years or older with FM were included., Data Extraction: Change outcome SDs treated as point estimates for anxiety were used to calculate true IIRD from each study. In addition, treatment effect data were extracted., Data Synthesis: The inverse variance heterogeneity model was used to pool all results. For the 5 studies and 321 participants in which results were pooled, statistically significant treatment effect reductions in anxiety were observed (mean, -0.77 points, 95% CI, -1.25 to -0.77). However, no significant IIRD were found (mean, 0.6 points, 95% CI, -1.2 to 1.5). The 95% prediction interval for true IIRD in a future study was -1.7 to 0.8. The percent chance, ie, probability, of a clinically meaningful difference in variability, was 61.5% (only possibly clinically important)., Conclusions: The results of the current study suggest that aerobic exercise is associated with reductions in anxiety among adults with fibromyalgia. However, there is currently a lack of convincing evidence to support the notion that true IIRD exist. Therefore, a search for potential mediators and moderators associated with aerobic exercise and changes in anxiety among adults with FM may not be warranted. However, additional research is needed before any true level of certainty can be established. This includes (1) the assessment of IIRD in future randomized controlled trials, (2) randomized controlled trials of longer duration, and (3) an increase in the proportion of men included in randomized controlled trials., (Copyright © 2022 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Conduct an ancillary meta-analysis to determine whether true inter-individual response differences (IIRD) exist with respect to the effects of qigong on resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) in adults., Methods: Data from a meta-analysis representing 370 participants (181 qigong, 189 control) from 7 randomized trials on qigong and resting SBP and DBP in men and women were included. Qigong and control group change outcome standard deviations treated as point estimates for both resting SBP and DBP were used to calculate true IIRD from each study. The inverse variance heterogeneity (IVhet) model was used to pool results., Results: For participants with essential hypertension, statistically significant and clinically important reductions in resting SBP (X̅, -18.2 mmHg, 95% CI, -21.3 to -15.2 mmHg) and DBP (X̅, -11.7 mmHg, 95% CI, -17.0 to -6.3 mmHg) were found. However, true IIRD were neither significant nor clinically important for either SBP (X̅, -6.0 mmHg, 95% CI, -9.1 to 3.5 mmHg) or DBP (X̅, 2.8 mmHg, 95% CI, -3.4 to 5.2 mmHg). The 95% prediction interval for true IIRD was - 11.9 to 8.4 mmHg for SBP and - 5.8 to 7.0 mmHg for DBP., Conclusions: While qigong is associated with reductions in resting SBP and DBP in adults with essential hypertension, a lack of true IIRD exists, suggesting that other external factors are responsible for any variation., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The clinical relevance of Tai Chi on pain, stiffness, and physical function in adults with knee osteoarthritis (KOA) has not been established. Therefore, the purpose of the current study was to address this gap. Eight randomized controlled trials from a recent meta-analysis representing 407 participants (216 Tai Chi, 191 control) in adults ≥18 years of age with KOA and included the assessment of pain, stiffness, and physical function using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were assessed. The inverse variance heterogeneity model (IVhet) was first used to pool standardized mean difference effect sizes (ES) for each outcome. Clinical relevance, i.e., number-needed-to treat (NNT) ≤10 and relative risk reduction (RRR) ≥25% was calculated across assumed controlled risks (ACR) ranging from 0.01 to 0.99. Statistically significant improvements were found for pain (ES, -0.75, 95% CI, -0.99, -0.51; Q = 8.9, p  = 0.26; I 2  = 21%), stiffness (ES, -0.70, 95% CI, -0.95, -0.46; Q = 9.6, p  = 0.21; I 2 = 27%), and physical function (ES, -0.91, 95% CI, -1.12, -0.70; Q = 7.2, p  = 0.40; I 2  = 3%). The intersection of results for a NNT ≤10 and RRR ≥25% yielded high evidence and clinically relevant improvements across a wide range of ACR for pain (0.15 to 0.88), stiffness (0.15 to 0.87), and physical function (0.13 to 0.97). These findings suggest that Tai Chi results in statistically significant as well as clinically important improvements in pain, stiffness, and physical function across a wide range of ACR in adults with KOA.

Conclusions: While walking is associated with reductions in resting SBP and DBP, a lack of true IIRD exists, suggesting that factors other than training response variation (random variation, physiological responses associated with behavioral changes that are not the result of walking) are responsible for the observed variation in resting SBP and DBP.

The aim of this systematic review and meta-analysis was to provide an updated analysis, including the use of more robust methods, on the effects of exercise on bone mineral density in men. Randomised Control Trials of > 24 weeks and published in English up to 01/05/20 were retrieved from 3 electronic databases, cross-referencing, and expert review. The primary outcome measures were changes in FN, LS, and lower limb BMD Standardised effect sizes were calculated from each study and pooled using the inverse heterogeneity model. A statistically significant benefit of exercise was observed on FN BMD [g = 0.21 (0.03, 0.40), Z = 2.23 p = 0.03], with no observed statistically significant benefit of exercise on LS BMD [g = 0.10 (- 0.07, 0.26), Z = 1.15 p = 0.25]. This analysis provided additional evidence to recommend ground- and/or joint-reaction force exercises for improving or maintaining FN, but not LS BMD. Additional well-designed RCTs are unlikely to alter this evidence, although interventions that include activities that directly load the lumbar spine are needed to ensure this is not a potential method of improving LS BMD., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Isometric exercise (IE) has been shown to reduce resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) in adults. However, no one to date has determined whether true inter-individual response differences (IIRD) versus random variability exist with respect to IE and resting SBP and DBP in adults ≥18 years of age. The purpose of the current study was to address this gap., Methods and Materials: Using the meta-analytic approach, randomised controlled trials from a recent meta-analysis that examined the effects of IE on resting SBP and DBP were included. Change outcome standard deviations for SBP and DBP from IE and control groups were used to calculate true IIRD from each study. The inverse variance heterogeneity (IVhet) model was used to pool results., Results: Pooled changes for true IIRD in SBP (16 studies, 411 participants) were 3.3 mmHg (95% confidence interval, -3.1 to 5.6 mmHg) while tau ( τ ) was 4.2. For DBP, true IIRD (16 studies, 411 participants) were 2.3 mmHg (95% confidence interval, -0.7 to 3.3 mmHg) while tau ( τ ) was 2.2. The 95% prediction interval for true IIRD in a future study was -5.8 to 7.4 mmHg for SBP and -2.7 to 4.2 mmHg for DBP. The percent chance, i.e. probability, of a clinically meaningful difference of 2 mmHg was 68% for SBP and 75% for DBP, both of which were only considered as 'possibly clinically important'., Conclusion: While IE reduces resting SBP and DBP in adults, the results of the current study suggest that random variability versus true IIRD account for any potential differences as a result of IE on changes in resting SBP and DBP in adults. Thus, a search for potential moderators and mediators, including potential genetic interactions associated with IE, may not be warranted.

Background: Provide national estimates of the number of US children and adolescents with overweight and obesity who could improve their percent body fat by exercising. Methods: Data were derived from (1) a previous meta-analysis, (2) 2015-2016 prevalence data from the National Health and Nutrition Examination Survey (NHANES), and (3) 2017 US Census population data. Multiplicative calculations were based on (1) number-needed-to treat data from a previous meta-analysis of the number of children with overweight and obesity who could reduce their percent body fat by participating in either aerobic, strength, or combined aerobic and strength training, (2) 2015-2016 NHANES data on the prevalence of children and adolescents with overweight or obesity, and (3) 2017 US Census population data on children and adolescents 2-19 years of age. Results: For both children and adolescents with overweight or obesity, the number who could improve their percent body fat was estimated at 4,388,273 [95% confidence interval (CI) 3,831,523-4,845,023] for either aerobic or strength exercise and 6,507,410 (95% CI 5,744,285-7,267,534) for combined aerobic and strength exercise. Conclusions: A large number of US children and adolescents with overweight and obesity could improve their percent body fat by exercising.

The purpose of this study was to examine the effects of exercise on cardiovascular disease (CVD) risk factors in children and adolescents with obesity. Randomized controlled trials (RCTs) of exercise ≥4 weeks in children and adolescents with obesity were included if one or more CVD risk factors were included as an outcome. Studies were retrieved by searching 7 electronic databases, cross-referencing, and expert review. Data were pooled using the inverse-variance heterogeneity (IVhet) model and strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. Thirty-nine studies representing 1548 participants (847 exercise, 701 control) met the inclusion criteria. Aerobic exercise improved 10 of 12 (83.3%) outcomes ( P < .05 for all) while combined aerobic and strength training improved 5 of 8 (62.5%) outcomes ( P < .05 for all). The strength of evidence ranged from "very low" to "moderate." It was concluded that aerobic exercise, as well as combined aerobic and strength training, is associated with improvements in multiple CVD risk factors among children and adolescents with obesity. However, the generally low strength of evidence suggests a need for future well-designed and conducted RCTs on the effects of exercise, especially strength training, in children and adolescents with obesity., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2021 The Author(s).)

Background: Exercise has been recommended as an important intervention for reducing adiposity in children and adolescents with overweight and obesity., Objective: Determine whether inter-individual differences exist in relation to exercise-induced changes in adiposity among children and adolescents with overweight and obesity., Methods: Meta-analysis of randomized controlled aerobic exercise trials and body mass index (BMI) in kg · m -2 . Change outcome standard deviations were pooled using the inverse-variance heterogeneity model., Results: Twenty-eight studies (1185 participants) were included. Inter-individual differences in BMI were -0.1 (95% compatibility interval, -0.7 to 0.7). The 95% prediction interval for inter-individual responses in a future study was -2.9 to 2.9. The probability of a clinically meaningful difference in variability was 29% (possibly clinically important) in favour of controls vs exercisers., Conclusions: Inter-individual differences for BMI in kg · m -2 were not observed as a result of aerobic exercise in children and adolescents with overweight and obesity., (© 2020 World Obesity Federation.)

Background: Provide robust and practically relevant information regarding the association between yoga, health-related quality-of-life (HRQOL), and mental well-being (MWB) in older adults., Methods: Data were derived from a recent meta-analysis of 12 randomized controlled yoga trials representing 752 adults ≥60 years of age. Standardized mean difference effect sizes (ESs) were pooled using the recently developed quality effects model and 95% compatibility intervals (CI). Small-study effects were examined using the Doi plot and Luis Furuya-Kanamori (LFK) index. Sensitivity and cumulative meta-analyses were conducted as well as percentile improvement, number needed to treat (NNT), and number to benefit. The grading of recommendations assessment, development, and evaluation (GRADE) instrument was used to assess the strength of the evidence., Results: Yoga was associated with improvements in both HRQOL (ES = 0.51, 95% CI, 0.25-0.77, I2 = 63.1%) and MWB (ES = 0.39, 95% CI, 0.15-0.63, I2 =56.2%). Percentile improvements were 19.5 for HRQOL and 15.3 for MWB whereas the NNT was 4 for HRQOL and 5 for MWB. An estimated 378,222 and 302,578 U.S. yoga-practicing adults ≥65 years of age could potentially improve their HRQOL and MWB, respectively. Major asymmetry suggestive of small-study effects was observed for MWB but not HRQOL. Further examination for asymmetry revealed that greater improvements in MWB were associated with more (151 vs. 68) minutes of yoga per week (p = .007). Overall strength of evidence was considered "high" for HRQOL and "moderate" for MWB., Conclusions: Yoga is associated with improvements in HRQOL and MWB among older adults, with approximately 150 minutes or more per week possibly optimal., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

We estimated the number of physically inactive US adults with arthritis by state and nationally who could improve their physical function and pain control by participating in an exercise program. Our calculations were based on number-needed-to-treat, arthritis prevalence, physical inactivity, and 2010 US Census data. Estimates were lowest in the District of Columbia (physical function, n = 4,412; pain, n = 2,451) and highest in Texas (physical function, n = 325,504; pain, n = 180,835). Overall estimates were 4,119,792 for physical function and 2,288,771 for pain control. State-level estimates are important for allocating resources, public health program planning, and future research.

Background: Determine whether inter-individual response differences exist with respect to changes in fat mass and percent body fat as a result of aerobic exercise training in overweight and obese children and adolescents. Methods: Using the meta-analytic approach, randomized controlled trials that examined the effects of aerobic exercise training on fat mass and percent body fat in overweight and obese children and adolescents were included. Change outcome standard deviations for fat mass and percent body fat were used to calculate true inter-individual differences from each study. The inverse variance heterogeneity model was used to pool results. Results: Pooled changes for inter-individual response differences in fat mass (16 studies, 575 participants) were 0.9 kg (95% confidence interval [CI], -1.4 to 1.8 kg) while tau ([Formula: see text]) was 2.9. For percent body fat, inter-individual differences (27 studies, 1035 participants) were 0.6% (95% CI, -0.6% to 1.0%, [Formula: see text] = 0.7). The 95% prediction interval for true inter-individual responses in a future study was -4.9 to 5.5 kg for fat mass and -0.7% to 1.7% for percent body fat. The percent chance, that is, probability, of a clinically meaningful difference in variability was 47% for fat mass and 26% for percent body fat, both of which were considered as only possibly clinically important. Conclusions: There is a lack of convincing evidence to suggest that true inter-individual response differences exist with respect to aerobic exercise training and changes in fat mass and percent body fat in overweight and obese children and adolescents.

This study used the inverse variance heterogeneity (IVhet) model to conduct a reanalysis of a recent meta-analysis that reported a positive association, based on the random-effects (RE) model, between obesity and the incidence of type 2 diabetes and coronary heart disease, but not all-cause stroke, in adults. Data emanated from a recent meta-analysis of five Mendelian randomization studies representing 881,692 adults. Results were pooled using the IVhet model and reported as OR's and 95% CI. Small-study effects were examined using the Doi plot and Luis Furuya-Kanamori (LFK) index. Influence analysis was also conducted. The association between obesity and type 2 diabetes, coronary heart disease, and all-cause stroke was, respectively, 1.38 (95% CI 1.00 to 1.90, p=0.05, I 2 =93%), 1.10 (95% CI 0.90 to 1.35, p=0.35, I 2 =87%), and 1.02 (95% CI 0.95 to 1.09, p=0.64, I 2 =0%). Compared with the original RE model, results were similar for all-cause stroke, but point estimates for type 2 diabetes and coronary heart disease were smaller (29.3% and 9.8%) with wider (7.0% and 14.7%), overlapping CI. Major asymmetry suggestive of small-study effects was observed (LFK=3.59). With the exception of one study for type 2 diabetes, results remained uncertain (overlapping 95% CI) when each study was deleted from the model once. A lack of certainty exists regarding the association between obesity and the incidence of type 2 diabetes, coronary heart disease, and all-cause stroke in adults., Competing Interests: Competing interests: None declared., (© American Federation for Medical Research 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Provide state-level estimates of the number of physically inactive adults in the United States with arthritis and other rheumatic and musculoskeletal diseases (RMDs) who could improve their anxiety and depression by exercising., Methods: Utilizing 1) number-needed-to treat (NNT) data from two prior meta-analyses of randomized controlled trials addressing the effects of exercise on anxiety and depression in adults with arthritis and other RMDs, 2) recent state-level prevalence estimates on arthritis and physical inactivity in adults with arthritis and other RMDs, and 3) state-level 2010 US Census population data, the number of physically inactive adults with arthritis and other RMDs who could improve their anxiety and depression by exercising was estimated., Results: Across all states and the District of Columbia, the number of adults with arthritis and other RMDs who could improve their anxiety and depression by starting an exercise program was estimated at 3 433 167 (95% confidence interval [CI] = 3 171 000-3 703 522) for anxiety and 2 942 706 (95% CI = 2 718 000-3 174 438) for depression. For anxiety, numbers ranged from 3677 (95% CI = 3235-4154) in the District of Columbia to 271 253 (95% CI = 243 998-298 508) in Texas. For depression, numbers ranged from 3151 (95% CI = 2773-3561) in the District of Columbia to 232 502 (95% CI = 209 140-255 863) in Texas., Conclusion: These state-specific data suggest that a large number of physically inactive US adults with arthritis and other RMDs could improve their anxiety and depression by starting and maintaining a regular exercise program., (© 2020 The Authors. ACR Open Rheumatology published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.)

There exists an ever-increasing number of systematic reviews, with or without meta-analysis, in the field of nutrition. Concomitant with this increase is the increased use of such to guide future research as well as both practice and policy-based decisions. Given this increased production and consumption, a need exists to educate both producers and consumers of systematic reviews, with or without meta-analysis, on how to conduct and evaluate high-quality reviews of this nature in nutrition. The purpose of this paper is to try and address this gap. In the present manuscript, the different types of systematic reviews, with or without meta-analyses, are described as well as the description of the major elements, including methodology and interpretation, with a focus on nutrition. It is hoped that this non-technical information will be helpful to producers, reviewers and consumers of systematic reviews, with or without meta-analysis, in the field of nutrition.

Objectives: Determine both the effects and hierarchy of effectiveness for exercise interventions (aerobic, strength training or both) on selected measures of adiposity (body mass index (BMI) in kg/m 2 , fat mass and per cent body fat) in overweight and obese children and adolescents., Design: Network meta-analysis of randomised exercise intervention trials., Setting: Any setting where a randomised trial could be conducted., Participants: Overweight and obese male and/or female children and adolescents 2-18 years of age., Interventions: Randomised exercise intervention trials > 4 weeks, published between 1 January 1973 and 22 August 2018, and which included direct and/or indirect evidence for aerobic, strength training or combined aerobic and strength training., Primary Outcomes: Changes in BMI in kg/m 2 , fat mass and per cent body fat., Results: Fifty-seven studies representing 127 groups (73 exercise, 54 control) and 2792 participants (1667 exercise, 1125 control) met the criteria for inclusion. Length of training ([Formula: see text] ± SD) averaged 14.1±6.2 weeks, frequency, 3.3±1.1 days per week and duration 42.0±21.0 min per session. Significant and clinically important reductions in BMI, fat mass and per cent body fat were observed in aerobic versus control comparisons (BMI, mean, 95% CI -1.0, 1.4 to -0.6; fat mass -2.1, -3.3 to -1.0 kg; per cent fat -1.5, -2.2 to -0.9%) and combined aerobic and strength versus control comparisons (BMI -0.7, -1.4 to -0.1; fat mass -2.5, -4.1 to -1.0 kg; per cent fat, -2.2, -3.2 to -1.2%). A significant reduction in per cent fat was also found for strength vs control comparisons (-1.3,-2.5 to -0.1%). Combined aerobic and strength training was ranked first for improving both fat mass (kg) and per cent body fat while aerobic exercise was ranked first for improving BMI., Conclusions: Aerobic and combined aerobic and strength training are associated with improvements in adiposity outcomes in overweight and obese children and adolescents., Prospero Registration Number: CRD42017073103., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Given the plethora of studies today on the same topic, clinicians in rheumatology as well as others increasingly rely on systematic reviews, with or without meta-analysis, to aid in their evidence-based decision-making. However, given time constraints, staying up-to-date on current methods for conducting systematic reviews and meta-analyses as well as interpreting the results of these reviews for application in clinical practice can be challenging. The purpose of this paper is to try and address this gap. In this paper, a description of the different types of systematic reviews and meta-analyses is provided as well as a description of the major elements, including methodology and interpretation of systematic reviews with meta-analyses. Included is a broad, five-question checklist to aid clinicians in rheumatology for making decisions about the utility of a systematic review. It is the hopes that this paper will aid clinicians in rheumatology as well as other consumers of systematic reviews and meta-analyses with the information necessary for judging the utility of systematic reviews and meta-analyses in their own work.

Objective: Apply more robust and additional analyses to a previous meta-analysis that reported statistically significant associations between leisure time physical activity (LTPA) and stroke., Methods: A reanalysis of a previous meta-analysis that included nine prospective cohort studies representing 269,594 men and women 25-84 years of age and in which the association between LTPA and incident stroke was examined. Follow-up periods ranged from 7.7 to 32.0 years. Relative risks (RR) from each study were pooled using the inverse-heterogeneity model. Heterogeneity was examined using the Q statistic, inconsistency using I 2 , and small-study effects using Doi plots and the LFK index. Influence and cumulative meta-analysis were also conducted., Results: Using low LTPA as the reference, moderate LTPA was associated with a statistically significant reduction in the risk for stroke in men (RR = 0.79, 95% CI = 0.65 to 0.95) and a trend in women (RR = 0.88, 95% CI = 0.78 to 1.0). High LTPA was associated with a statistically significant reduction in the risk for stroke in both men (RR = 0.72, 95% CI = 0.60 to 0.86) and women (RR = 0.78, 95% CI = 0.66 to 0.92). No statistically significant heterogeneity was observed and inconsistency was low. However, potential small-study effects were observed. With each study deleted once, results remained statistically significant. Cumulative meta-analysis demonstrated stability in results since at least 2005., Conclusions: Leisure time physical activity is associated with a reduced risk of stroke in both men and women. However, the small-study effects observed suggest the possibility that results may be exaggerated.

Background: Practice guidelines do not specify which test recordings are best for assessing dichotic deficit or interaural asymmetry. Dichotic Digits and SCAN-3 Competing Words Free Recall are among the most widely used dichotic tests, but it is not known if the choice of test results in important differences in the identification of children with deficits or if they can be used interchangeably., Purpose: To determine whether two commonly used dichotic tests, SCAN-3 Competing Words Free Recall (CW) and Musiek's Dichotic Digits (DD), agree on interaural asymmetry and dichotic deficit in children., Research Design: CW and DD tests were administered to all participants. Each participant had a single study visit., Study Sample: Sixty volunteers aged 7-14 years with normal hearing sensitivity participated in the study., Data Collection and Analysis: Hearing sensitivity, CW, and DD performance were measured at a single study visit. We used Spearman's rho (ρ) to assess associations between rank ordering of participants by each test and the kappa statistic (κ) to assess decision consistency between tests., Results: Participants were rank-ordered similarly by CW and DD for the right ear (ρ = 0.58), left ear (ρ = 0.51), and total (ρ = 0.73) scores, but not for interaural asymmetry (ρ =0.18). They agreed no better than chance on direction of ear advantage (κ = 0.01, p = 0.93) and had poor agreement on which children scored below cut-scores (κ = 0.22, p < 0.01). DD identified significantly more participants with deficits (n = 18) than CW (n = 3) (p < 0.001)., Conclusions: Although children with high scores on one test tend to have high scores on the other, CW and DD do not agree on ear advantage or the presence of deficit. They are not interchangeable for clinical use. Additional research is needed to determine whether either is appropriate for identifying children who would benefit from treatment for dichotic listening deficits., (American Academy of Audiology.)

Purpose The objective of the study was to compare test-retest reliability of three dichotic listening tests: SCAN-3 Competing Words Test (Words; Keith, 2009a , 2009b ), Double Dichotic Digits Test (Digits; Musiek, 1983a ), and Bergen Dichotic Listening Test With Consonant-Vowel Syllables (Syllables; Hugdahl & Hammar, 1997 ). Method Sixty English-speaking children, 7-14 years old with normal hearing, had a single study visit during which each test was administered twice. Changes on retest were summarized by within-subject standard deviation ( S w ), compared among tests, and compared with binomial model predictions. Correlates of variance were explored. Results Scores based on 40 items were more precise ( S w = 5%) than those based on 20-30 items ( S w = 6%-8%). All 3 tests had reliability within bounds predicted by binomial model. Changes on retest for Words and Digits Test were weakly associated with age, but this is confounded by the trend for older children to have higher Words and Digits scores. Conclusions Digits Right, Digits Left, and Words Total scores-each based on 40 items-had the best reliability among the clinically used scores. Scores based on fewer items were less precise. Poor precision may contribute to misdiagnosis in clinic and to nondifferential misclassification in research. More precise estimates of dichotic listening ability require longer tests.

Objective: To use the minimal important difference (MID) versus the standardized mean difference (SMD) approach in order to provide more robust and clinically relevant information regarding the association between land-based aerobic exercise and changes in self-reported fatigue among adults with rheumatoid arthritis (RA)., Methods: Data from a previous meta-analysis of 5 randomized controlled trials that represented up to 298 participants per study were utilized to calculate 9 effect sizes, using the MID approach. Data used to obtain the MID were derived from previously reported anchor-based values specific to each fatigue instrument in adults with RA. Results were pooled using a random-effects model., Results: Aerobic exercise resulted in statistically significant reductions in self-reported fatigue (MID effect size -0.34 [95% confidence interval (95% CI) -0.58, -0.10]; P = 0.006). Results were similar when effect sizes were collapsed so that only 1 effect size represented each study (MID effect size -0.39 [95% CI -0.76, -0.03]; P = 0.04)., Conclusion: Land-based aerobic exercise is associated with statistically significant reductions in fatigue; however, based on previous cut points, it may be unlikely that a substantial number of participants with RA could obtain clinically relevant reductions in fatigue. Additional studies are needed, especially in those individuals with RA who have elevated levels of fatigue., (© 2018, American College of Rheumatology.)

Background/objectives: Raised blood pressure is a major problem in older adults. Using a random-effects model, a recent meta-analysis reported statistically significant reductions in both resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) as a result of aerobic, resistance, and combined aerobic and resistance exercise in adults ≥65 years. To provide more objective information regarding this nonpharmacologic approach, this study applied more robust methods to this data., Design: Meta-analysis of 41 randomized controlled trials representing 96 groups (52 exercise; 44 control)., Setting: Any location where a randomized controlled trial could be conducted., Participants: Adults ≥65 years., Intervention: Trials ≥2 weeks that included aerobic, resistance, and/or combined aerobic and resistance exercise as the intervention., Measurements: The recently developed inverse heterogeneity model (IVhet) was used to pool findings and the Doi plot was used to examine for small-study effects. Absolute and relative differences between the IVhet and random-effects model were also calculated. Data were reported using the mean difference (exercise minus control) with nonoverlapping 95% confidence intervals considered statistically significant., Results: Statistically significant reductions in resting blood pressure were found as a result of aerobic exercise (SBP, -4.7 mmHg, 95% CI, -7.7 to -1.8; DBP, -2.0 mmHg, 95% CI -3.13 to -0.9), SBP but not DBP for resistance training (SBP, -7.0 mmHg, 95% CI, -10.5 to -3.4; DBP, -1.2 mmHg, 95% CI -2.7 to 0.3), and both SBP and DBP for combined aerobic and resistance training (SBP, -5.5 mmHg, 95% CI, -8.3 to -2.7; DBP, -3.7 mmHg, 95% CI -4.8 to -2.7)., Conclusions: Exclusive of changes in DBP congruent with resistance training, exercise (aerobic, resistance, and combined aerobic and resistance) reduces resting SBP and DBP in older adults. These findings have practical implications when considering exercise for the prevention and treatment of raised blood pressure in older adults.

Objective: Given the high prevalence of anxiety in adults with arthritis and other rheumatic diseases (AORD) and the subsequent need for interventions to reduce anxiety, this brief report sought to determine if evidential value exists to support the role of exercise for reducing anxiety in adults with AORD., Methods: Utilizing data from a prior meta-analysis, a recently developed approach, P -curve, was used to determine evidential value by assessing for publication bias and p -hacking. Binomial tests as well as the more robust Stouffer's test were used to examine for evidential value. To examine the influence of selected studies on p- curve results, findings were also examined by dropping the highest and lowest p values from the analysis., Results: The binomial test for evidential value was not statistically significant ( p = 0.11) while the more robust Stouffer's test satisfied both conditions for evidential value ( p = 0.002). Power analyses suggested a good fit for the observed p -curve. Results were generally robust when the least and most extreme values were excluded., Conclusions: The results of this study provide evidential support for the benefits of exercise on anxiety in adults with AORD.

A recent meta-analysis reported statistically significant improvements in anxiety as a result of exercise in adults with arthritis and other rheumatic diseases (AORD) using the traditional standardized mean difference (SMD) effect size (ES). The objective of this study was to use the more recently developed and clinically relevant minimal important difference (MID) approach to examine this association. Data from a previous meta-analysis of 14 randomized controlled trials representing 926 initially enrolled adults ≥ 18 years of age (539 exercise, 387 control) was used to calculate the ES using the MID approach. Minimal important difference data were derived from previously reported anchor-based values that represented the different instruments used to assess anxiety. Effect sizes were pooled using the inverse heterogeneity (IVhet) model. Overall, exercise resulted in a mean ES reduction in anxiety of - 0.80 (95% CI, - 1.60 to 0.001, p = 0.05; Q = 92.1, p < 0.001, I 2  = 83.7%, 95% CI, 74.9%, 89.5%), suggesting that overall, exercise may benefit an appreciable number of patients. Nonetheless, this effect spanned the range from many patients gaining important benefits to no patients improving. The clinically relevant effects of exercise on anxiety in adults with AORD are varied. However, these results should be interpreted with caution given the absence of anchor-based MID data specific to the instruments and questions used to assess anxiety in adults with AORD. A need exists for future research to establish instrument-specific, anchor-based MID values for questions assessing anxiety in adults with AORD.

Purpose: The aim of the study was to evaluate the evidence of clinical utility for dichotic speech tests of binaural integration used to assess auditory processing in English-speaking children 6-14 years old., Method: Dichotic speech test recordings and pertinent research studies were identified from iterative searches of the Internet and bibliographic databases, as well as communication with colleagues and test publishers. Test documentation and peer-reviewed literature were evaluated for evidence of reliability, accuracy, usefulness, and value., Results: Eleven dichotic tests of binaural integration were identified for children. Evidence of test-retest reliability was found for 5 tests and demonstrated moderate to good correlation between results on repeated administration (r = .59-.92). Evidence of accuracy was identified for 5 tests but was either inconsistent with accurate performance or was not generalizable due to significant limitations in study design. No evidence was found to either support or dispute claims of usefulness or value., Conclusions: A medical diagnostic framework is useful for evaluating dichotic tests. Although dichotic procedures show moderate reliability, the absence of a widely accepted gold standard reference test limits our ability to assess their value. Overall, the data available at the time of this review do not support the routine use of dichotic tests of binaural integration for clinical evaluation of children.

Systematic reviews, with or without meta-analysis, play an important role today in synthesizing cancer research and are frequently used to guide decision-making. However, there is now an increase in the number of systematic reviews on the same topic, thereby necessitating a systematic review of previous systematic reviews. With a focus on cancer, the purpose of this article is to provide a practical, stepwise approach for systematically reviewing the literature and publishing the results. This starts with the registration of a protocol for a systematic review of previous systematic reviews and ends with the publication of an original or updated systematic review, with or without meta-analysis, in a peer-reviewed journal. Future directions as well as potential limitations of the approach are also discussed. It is hoped that the stepwise approach presented in this article will be helpful to both producers and consumers of cancer-related systematic reviews and will contribute to the ultimate goal of preventing and treating cancer.

Background/purpose: Given conflicting findings, the purpose of this study was to use the meta-analytic approach to examine the effects of exercise (aerobic, strength training or both) on anxiety in adults with arthritis and other rheumatic diseases (AORD)., Methods: Randomised controlled exercise intervention trials ≥4weeks in adults ≥18 years of age with osteoarthritis, rheumatoid arthritis or fibromyalgia were included. Studies were located by searching eight electronic databases, cross-referencing and expert review. Dual selection and data abstraction of studies were performed. Hedge's standardised effect size (ES) was calculated for each result and pooled using the recently developed inverse heterogeneity model. Two-tailed z -alpha values ≤0.05 and non-overlapping 95% CI were considered statistically significant. Heterogeneity was estimated using Q and I 2 with alpha values ≤0.10 for Q considered statistically significant. Small-study effects were examined using funnel plots and Egger's regression test. In addition, the number needed to treat (NNT), percentile improvement and meta-regression were conducted., Results: Of the 639 citations screened, 14 studies representing 926 initially enrolled participants (539 exercise, 387 control) met the criteria for inclusion. Length of training (mean±SD) averaged 15.8±6.7 weeks, frequency 3.3±1.3 times per week and duration 28.8±14.3 min per session. Overall, statistically significant reductions in anxiety were found (exercise minus control changes ES=-0.40, 95% CI -0.65 to -0.15, tau 2 =0.14; Q=40.3, P=0.0004; I 2 =62.8%). The NNT was 6 with a percentile improvement of 15.5% and an estimated 5.3 million inactive US adults with AORD improving their anxiety if they started exercising regularly. Statistically significant small-study effects were observed (P<0.0001)., Conclusions: Exercise is associated with reductions in anxiety among adults with selected types of AORD. However, a need exists for additional, well-designed, randomised controlled trials on this topic., Prospero Registration Number: CRD42016048728., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: Using the traditional random-effects model, a recently reported standardized effect size (g) reduction of -0.42 (95% CI, -0.58 to -0.27) was observed in depressive symptoms as a result of community-deliverable exercise in adults with arthritis and other rheumatic diseases. However, a recently proposed alternative model (IVhet) has been shown to have superior coverage probability to the random-effects model. The purpose of this brief report was to compare these previous random-effects results with the IVhet model., Methods: Based on a previous meta-analysis of 35 g's representing 2449 participants, results for depressive symptoms were pooled using the IVhet model. Influence analysis, number needed-to-treat, percentile improvement, and gross estimates of the number of inactive adults with arthritis who could benefit from exercise were also calculated., Results: The IVhet model yielded statistically significant reductions in depressive symptoms (g = -0.30, 95% CI, -0.49 to -0.11), a difference that was -0.12 (28.7%) smaller than the random-effects model. With each study deleted from the model once, results remained statistically significant, ranging from -0.28 to -0.34. The percentile improvement, number needed-to-treat, and estimated number of people with arthritis in the United States who could improve their depressive symptoms by participating in a regular exercise program were, respectively, 11.8% (95% CI, 4.5% to 18.8%), 8 (95% CI, 5 to 23), and 2.7 million (95% CI, 1.0 to 4.4 million)., Conclusions: These findings provide more conservative and accurate evidence that community-deliverable exercise improves depressive symptoms in adults with arthritis and other rheumatic diseases. Future meta-analyses may want to consider using the IVhet versus traditional random-effects model., (© 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.)

Introduction: Overweight and obesity is a worldwide public health problem among children and adolescents. However, the magnitude of effect, as well as hierarchy of exercise interventions (aerobic, strength training or both), on selected measures of adiposity is not well established despite numerous trials on this issue. The primary purposes of this study are to use the network meta-analytical approach to determine the effects and hierarchy of exercise interventions on selected measures of adiposity in overweight and obese children and adolescents., Methods and Analysis: Randomised exercise intervention trials >4 weeks, available in any language up to 31 August 2017 and which include direct and/or indirect evidence, will be included. Studies will be located by searching seven electronic databases, cross-referencing and expert review. Dual selection and abstraction of data will occur. The primary outcomes will be changes in body mass index (in kg/m 2 ), fat mass and percent body fat. Risk of bias will be assessed using the Cochrane Risk of Bias assessment instrument while confidence in the cumulative evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation instrument for network meta-analysis. Network meta-analysis will be performed using multivariate random-effects meta-regression models. The surface under the cumulative ranking curve will be used to provide a hierarchy of exercise treatments (aerobic, strength or both)., Ethics and Dissemination: This study does not require ethics approval. Findings will be presented at a professional conference and published in a peer-reviewed journal., Prospero Registration Number: CRD 42017073103 ., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Conduct a systematic review of previous systematic reviews with meta-analysis to determine the effects of exercise (aerobic, strength or both) on cancer-related-fatigue (CRF) in adults with any type of cancer., Methods: Systematic reviews with meta-analyses of previous randomized controlled trials published through July of 2016 were included by searching six electronic databases and cross-referencing. Dual-selection and data abstraction were conducted. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Standardized mean differences (SMD) that were pooled using random-effects models were included as the effect size. In addition, 95% prediction intervals (PI), number needed-to-treat (NNT) and percentile improvements were calculated., Results: Sixteen studies representing 2 to 48 SMD effect sizes per analysis (mean ± SD, 7 ± 8, median = 5) and 37 to 3254 participants (mean ± SD, 633 ± 690, median = 400) were included. Length of training lasted from 3 to 52 weeks (mean ± SD, 14.6 ± 3.1, median = 14), frequency from 1 to 10 times per week (mean ± SD, 3.4 ± 0.8, median = 3), and duration from 10 to 120 min per session (mean ± SD, 44.3 ± 5.5, median = 45). Adjusted AMSTAR scores ranged from 44.4% to 80.0% (mean ± SD, 68.8% ± 12.0%, median = 72.5%). Overall, mean SMD improvements in CRF ranged from -1.05 to -0.01, with 22 of 55 meta-analytic results (52.7%) statistically significant (non-overlapping 95% CI). When PI were calculated for results with non-overlapping 95% CI, only 3 of 25 (12%) yielded non-overlapping 95% PI favoring reductions in CRF. Number needed-to-treat and percentile improvements ranged from 3 to 16 and 4.4 to 26.4, respectively., Conclusions: A lack of certainty exists regarding the benefits of exercise on CRF in adults. However, exercise does not appear to increase CRF in adults., Trial Registration: PROSPERO Registration # CRD42016045405 .

Background: While a recent meta-analysis of observational studies reported a statistically significant association between sarcopenia and both all-cause mortality and functional decline, a recently developed inverse heterogeneity (IVhet) model has been shown to be more valid than the traditional random-effects model used., Objective: The objective of this short report was to use a previous meta-analysis to compare the two approaches., Methods: Aggregate data meta-analysis of prospective observational studies conducted in any setting. Men and women 60years of age and older in which all-cause mortality (12 studies, 14,169 participants) or functional decline (6 studies, 8561 participants) was assessed. Using the IVhet model, pooling of previous studies regarding the association between sarcopenia and all-cause mortality as well as functional decline. Absolute and relative differences between IVhet and random-effects results were also calculated as well as influence analysis with each study deleted once. Non-overlapping 95% confidence intervals (CI) for odds ratios (OR) were considered statistically significant., Results: Sarcopenia was associated with an increased risk for all-cause mortality (OR=3.64, 95% CI=2.94 to 4.51) and functional decline (OR=2.58, 95% CI=1.33 to 4.99). Compared to the random-effects model, the OR was slightly higher (0.04 or 1.1%) but with wider CI (0.16 or 11.3%) for all-cause mortality and 0.45 (14.9%) lower with a CI that was 0.34 (10.2%) wider for functional decline. With each study deleted from the model once, results remained statistically significant for both all-cause mortality and functional decline., Conclusion: These results provide additional and more accurate evidence in support of an association between sarcopenia and an increased risk for both all-cause mortality and functional decline., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aim: Examine the effects of selected types of exercise (aerobic, strength training, both) on BMI z-score in overweight and obese children and adolescents., Methods: Randomized exercise intervention trials ≥ 4 weeks were included. Studies were retrieved by searching six electronic databases, cross-referencing and expert review. Dual selection and abstraction occurred. Risk of bias and confidence in cumulative evidence were assessed. Network meta-analysis was performed using multivariate random-effects meta-regression models while surface under the cumulative ranking curves were used to calculate a hierarchy of exercise treatments. The number needed to treat (NNT) and percentile improvement (U 3 ) were also calculated., Results: Thirty-four studies representing 2,239 participants were included. Median exercise occurred 3 times per week, 50 minutes per session over a 12-week period. Statistically significant reductions in BMI z-score were found for aerobic exercise and combined aerobic and strength exercise, but not strength training alone (M±SD, 95% CI: aerobic, -0.10, -0.15 to -0.05; aerobic and strength, -0.11, -0.19 to -0.03; strength, 0.04, -0.07 to 0.15). Combined aerobic and strength training was ranked best, followed by aerobic exercise and strength training. The NNT was 2 for both aerobic exercise and combined aerobic exercise and strength training. Percentile improvements were 28.8% for aerobic exercise and 31.5% for combined aerobic exercise and strength training. Confidence in effect estimates was ranked as low for aerobic exercise and very low for combined aerobic and strength training as well as strength training., Conclusions: Aerobic exercise and combined aerobic exercise and strength training are associated with reductions in BMI z-score., (© 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.)

Introduction: While anxiety is a major public health problem in adults with arthritis and other rheumatic diseases (AORD), the effects of exercise on anxiety in adults are not well established despite numerous studies on this topic. The purpose of this study is to conduct a systematic review with an aggregate data meta-analysis to determine the effects of community-deliverable exercise interventions (aerobic, strength training or both) on anxiety in adults with AORD., Methods and Analysis: Randomised controlled exercise intervention trials ≥4 weeks and published in any language up to 31 December 2016 will be included. Studies will be retrieved by searching 8 electronic databases, cross-referencing and expert review. Dual selection and abstraction of data will occur. The primary outcome will be changes in anxiety. Risk of bias will be assessed using the Cochrane risk of bias assessment instrument while confidence in the cumulative evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. Standardised effect sizes for anxiety will be calculated from each study and then pooled using the inverse variance heterogeneity (IVhet) model. Meta-regression based on the IVhet model will be used to examine the relationship between changes in anxiety and selected covariates., Dissemination: The results of this study will be presented at a professional conference and published in a peer-reviewed journal., Trial Registration Number: CRD42016048728., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Background: Although the results of a recent meta-analysis using the traditional random effects model yielded a statistically significant standardized mean difference (SMD) reduction in cancer-related fatigue (CRF) as a result of aerobic exercise, a recently developed inverse heterogeneity (IVhet) model has been shown to be more valid than the traditional random effects model. The purpose of this study was to compare these previous meta-analytic results using the IVhet model., Methods: Using data from a previous meta-analysis that included 36 SMD effect sizes (ES) representing 2,830 adults (1,426 exercise, 1,404 control), results were pooled using the IVhet model. Absolute and relative differences between the IVhet and random effects results for CRF were also calculated as well as influence analysis with each SMD ES deleted from the IVhet model. Nonoverlapping 95% confidence intervals (CI) were considered statistically significant., Results: A statistically nonsignificant reduction in CRF fatigue was found as a result of aerobic exercise using the IVhet model (SMD, -0.08; 95% CI, -0.31-0.14; P = 0.46). The IVhet model yielded a SMD ES that was 0.14 (63.6%) smaller than the random effects model. With each study deleted from the IVhet model once, results remained statistically nonsignificant with SMD ESs ranging from -0.11 (95% CI, -0.33-0.11) to -0.06 (95% CI, -0.28-0.16)., Conclusions: Insufficient evidence currently exists to support the use of aerobic exercise for reducing CRF in adults., Impact: Additional studies are needed to determine the certainty of aerobic exercise on CRF in adults. Cancer Epidemiol Biomarkers Prev; 26(2); 281-3. ©2016 AACR., Competing Interests: The authors declare no potential conflicts of interest., (©2016 American Association for Cancer Research.)

Objective: Conduct a systematic review of previous meta-analyses on exercise and sleep outcomes in adults and a meta-analysis of studies nested within these meta-analyses., Methods: Meta-analyses of randomized controlled exercise interventions were included by searching nine electronic databases and cross-referencing. Dual-selection and data abstraction were conducted. Methodological quality of meta-analyses was assessed using AMSTAR and quality of evidence using GRADE. Random-effects models were used to pool results from the individual studies included in each meta-analysis., Results: Three meta-analyses representing 950 adults were included. Methodological quality ranged from 36% to 64% while quality of evidence was very low to low. Statistically significant improvements (P ≤ 0.05) were observed for the apnea-hypopnea index (AHI), overall sleep quality, global score, subjective sleep, and sleep latency. The number-needed-to-treat (NNT) and percentile improvements ranged from 4 to 7 and from 18.1 to 26.5, respectively. When overall sleep quality results from individual studies nested within different meta-analyses were pooled, statistically significant standardized mean difference (SMD) improvements were observed (-0.50, 95% CI -0.72 to -0.28). The NNT and percentile improvement were 7 and 19, respectively., Conclusions: Exercise improves selected sleep outcomes in adults. To increase public health reach, a large, well-designed, and more inclusive meta-analysis is needed., (© 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.)

Aim: To determine whether evidential value exists that exercise reduces depression in adults with arthritis and other rheumatic conditions., Methods: Utilizing data derived from a prior meta-analysis of 29 randomized controlled trials comprising 2449 participants (1470 exercise, 979 control) with fibromyalgia, osteoarthritis, rheumatoid arthritis or systemic lupus erythematosus, a new method, P -curve, was utilized to assess for evidentiary worth as well as dismiss the possibility of discriminating reporting of statistically significant results regarding exercise and depression in adults with arthritis and other rheumatic conditions. Using the method of Stouffer, Z -scores were calculated to examine selective-reporting bias. An alpha ( P ) value < 0.05 was deemed statistically significant. In addition, average power of the tests included in P -curve, adjusted for publication bias, was calculated., Results: Fifteen of 29 studies (51.7%) with exercise and depression results were statistically significant ( P < 0.05) while none of the results were statistically significant with respect to exercise increasing depression in adults with arthritis and other rheumatic conditions. Right-skew to dismiss selective reporting was identified ( Z = -5.28, P < 0.0001). In addition, the included studies did not lack evidential value ( Z = 2.39, P = 0.99), nor did they lack evidential value and were P -hacked ( Z = 5.28, P > 0.99). The relative frequencies of P -values were 66.7% at 0.01, 6.7% each at 0.02 and 0.03, 13.3% at 0.04 and 6.7% at 0.05. The average power of the tests included in P -curve, corrected for publication bias, was 69%. Diagnostic plot results revealed that the observed power estimate was a better fit than the alternatives., Conclusion: Evidential value results provide additional support that exercise reduces depression in adults with arthritis and other rheumatic conditions.

Introduction: While overweight and obesity in children and adolescents is a major global health problem, the effects of exercise on overweight and obesity in children and adolescents are not well established despite numerous studies on this topic. The purpose of this study is to use the network meta-analytic approach to determine the effects of exercise (aerobic, strength training or both) on body mass index (BMI) z-score in overweight and obese children and adolescents., Methods and Analysis: Randomised exercise intervention trials >4 weeks, published in any language between 1 January 1990 and 31 September 2015, and which include direct and/or indirect evidence, will be included. Studies will be retrieved by searching 6 electronic databases, cross-referencing and expert review. Dual abstraction of data will occur. The primary outcome will be changes in BMI z-score while the secondary outcome will be changes in body weight in kilograms (kg). Risk of bias will be assessed using the Cochrane risk of bias assessment instrument while confidence in the cumulative evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument for network meta-analysis. Network meta-analysis will be performed using multivariate random-effects meta-regression models. The surface under the cumulative ranking curve will be used to provide a hierarchy of exercise treatments (aerobic, strength training or both)., Dissemination: The results of this study will be presented at a professional conference and published in a peer-reviewed journal., Trial Registration Number: CRD42015026377., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Purpose: While individual participant data (IPD) meta-analyses are considered the gold standard for meta-analysis, the feasibility of obtaining IPD may be problematic., Methods: Using data from a previous meta-analysis of 29 studies on exercise in adults with arthritis and other rheumatic diseases, the percentage of studies in which useable IPD was provided was calculated., Results: Eight of 29 authors (28%, 95% CI = 11% to 44%) provided IPD. Using logistic regression, neither year of publication (odds ratio = 1.05, 95% CI = 0.90 to 1.27, p = 0.58) nor country (odds ratio = 1.36, 95% CI = 0.20 to 10.9, p = 1.00) was significantly associated with the obtainment of IPD., Conclusions: The retrieval of IPD for exercise meta-analyses may not be worth the time and effort. However, further research is needed before any final recommendations can be made.

Poor health-related quality-of-life (HRQOL) is a significant public health issue while the use of meditative movement therapies has been increasing. The purpose of this investigation was to carry out a systematic review of previous meta-analyses that examined the effects of meditative movement therapies (yoga, tai chi and qigong) on HRQOL in adults. Previous meta-analyses of randomized controlled trials published up through February, 2014 were included by searching nine electronic databases and cross-referencing. Dual-selection and data abstraction occurred. The Assessment of Multiple Systematic Reviews Instrument (AMSTAR) was used to assess methodological quality. Standardized mean differences that were pooled using random-effects models were included. In addition, 95% prediction intervals were calculated as well as the number needed-to-treat and percentile improvements. Of the 510 citations screened, 10 meta-analyses representing a median of 3 standardized mean differences in 82 to 528 participants (median = 270) with breast cancer, schizophrenia, low back pain, heart failure and diabetes, were included. Median methodological quality was 70%. Median length, frequency and duration of the meditative movement therapies were 12 weeks, 3 times per week, for 71 minutes per session. The majority of results (78.9%) favored statistically significant improvements (non-overlapping 95% confidence intervals) in HRQOL, with standardized mean differences ranging from 0.18 to 2.28. More than half of the results yielded statistically significant heterogeneity (Q ≤ 0.10) and large or very large inconsistency (I2 ≥ 50%). All 95% prediction intervals included zero. The number-needed-to-treat ranged from 2 to 10 while percentile improvements ranged from 9.9 to 48.9. The results of this study suggest that meditative movement therapies may improve HRQOL in adults with selected conditions. However, a need exists for a large, more inclusive meta-analysis (PROSPERO Registration #CRD42014014576).

Introduction: Previous randomized controlled trials have led to conflicting findings regarding the effects of exercise on depressive symptoms in adults with arthritis and other rheumatic conditions (AORC). The purpose of this study was to use the meta-analytic approach to resolve these discrepancies., Methods: The inclusion criteria were: (1) randomized controlled trials, (2) exercise (aerobic, strength training, or both) ≥4 weeks, (3) comparative control group, (4) adults with osteoarthritis, rheumatoid arthritis, fibromyalgia or systemic lupus erythematosus, (5) published studies in any language since January 1, 1981 and (6) depressive symptoms assessed. Studies were located by searching 10 electronic databases, cross-referencing, hand searching and expert review. Dual-selection of studies and data abstraction was performed. Hedge's standardized mean difference effect size (g) was calculated for each result and pooled using random-effects models, an approach that accounts for heterogeneity. Non-overlapping 95% confidence intervals (CI) were considered statistically significant. Heterogeneity based on fixed-effect models was estimated using Q and I (2) with alpha values ≤0.10 for Q considered statistically significant., Results: Of the 500 citations reviewed, 2,449 participants (1,470 exercise, 979 control) nested within 29 studies were included. Length of training, reported as mean ± standard deviation (±SD) was 19 ± 16 weeks, frequency 4 ± 2 times per week and duration 34 ± 17 minutes per session. Overall, statistically significant exercise minus control group reductions were found for depressive symptoms (g = -0.42, 95% CI, -0.58, -0.26, Q = 126.9, P <0.0001, I(2) = 73.2%). The number needed-to-treat was 7 (95% CI, 6 to 11) with an estimated 3.1 million (95% CI, 2.0 to 3.7) United States adults not currently meeting physical activity guidelines improving their depressive symptoms if they began and maintained a regular exercise program. Using Cohen's U3 Index, the percentile reduction was 16.4% (95% CI, 10.4% to 21.9%). All studies were considered to be at high risk of bias with respect to blinding of participants and personnel to group assignment., Conclusions: Exercise is associated with reductions in depressive symptoms among selected adults with AORC. A need exists for additional, well-designed and reported studies on this topic.