Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials

Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years. Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12 th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups. Results: The systematic review included 81 RCTs, with 69 meeting eligibility for the network meta-analysis ( n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges' g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges' g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges' g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges' g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment. Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults, irrespective of severity. Registration: PROSPERO CRD42018115866 (23/11/2018). © 2020 Miller KJ et al

Limited evidence exists on the effectiveness of education and training interventions on trial recruitment; a systematic review

Objective: To examine the effectiveness of education and training interventions on recruitment to randomised and non-randomised trials. Study Design and Setting: A systematic review of the effectiveness of education and training interventions for recruiters to trials. The review included randomised and non-randomised controlled trials of any type of education and training intervention for recruiters to trials, within any healthcare field. The primary outcome was recruitment rates, and secondary outcomes were: quality of informed consent, recruiter self-confidence, understanding/knowledge of trial information, numbers of potential trial participants approached, satisfaction with training, retention rates. Results: Of the 19 records reviewed at full text level, six met the inclusion criteria for our review. Due to heterogeneity of outcomes and methods between the included studies, meta-analysis was not possible for the primary outcome. Of the three studies that reported recruitment rates, one favoured the education and training intervention for increased recruitment; the remaining two found no differences between the groups. Of the reported secondary outcomes, quality of informed consent was improved, but no differences between groups in understanding/knowledge of trial information were found. Conclusion: There is limited evidence of effectiveness on the impact of education and training interventions on trial recruitment. Further work on developing a substantial evidence base around the effectiveness of education and training interventions for recruiters to trials is required. Keywords: trial recruitment, educational intervention, training intervention, systematic revie

Exploring the effects of perioperative and preoperative exercise therapy for prostate, colorectal and breast cancer patients

Cancer is a prevalent disease with significant morbidity and mortality rates. Exercise interventions implemented before, during, or after cancer-based surgeries have shown promising benefits in improving fitness, postoperative complications, and quality of life. This thesis comprises three original research chapters aimed at investigating the effect of perioperative and preoperative 'prehabilitation' exercise in breast, colorectal, and prostate cancer patients. The first study focused on exploring exercise therapy interventions and their impact on cardio-respiratory fitness and 30-day postoperative outcomes in colorectal cancer patients. The systematic review and meta-analysis (N= 411 intervention and N= 368 control) revealed a small but significant improvement in cardio-respiratory fitness (SMD = 0.18; 95% CI = 0.03, 0.32; p < 0.05) with exercise interventions, although no significant impact on 30-day postoperative outcomes was observed. In the second study, various exercise types, including aerobic, resistance, flexibility, and mind-body exercises (alone or in combination), were compared in terms of their effect on cardio-respiratory fitness and 30-day postoperative outcomes in colorectal cancer patients (N= 411 intervention and N= 368 control). The network meta-analysis findings indicated that engaging in aerobic exercise alone (SMD = 0.30) or a combination of aerobic, resistance, and flexibility exercises (SMD = 0.57) yielded the most significant improvements in cardio-respiratory fitness. The final study examined the efficacy of pre-surgical aerobic exercise (prehabilitation) therapy in relation to post-operative cardio-respiratory fitness, quality of life, and 30-day postoperative outcomes in the Grampians Region of Victoria. The prehabilitation (PREHAB) group included a supervised aerobic based program which would see patients exercise every two/three days for a minimum of 2 weeks. A total of 11 PREHAB and 9 usual care (UCARE) patients were enrolled and analysed. The study showed that a prehabilitation exercise program resulted in small clinical improvements in some markers of cardio-respiratory fitness (+1.5% and +1.2% for absolute and relative V̇O2peak, respectively) and is safe and feasible. However, no significant improvements were observed in quality of life and 30-day postoperative outcomes. While the overall findings demonstrate some positive effects of perioperative and specifically prehabilitation exercise, it is important to consider the magnitude of these effects and any specific factors contributing to their success, if applicable. Further research is needed to fully understand the potential benefits and limitations of exercise before, during and after surgery in this patient population.Doctor of Philosoph

Anti-Viral Pattern Recognition Receptors as Therapeutic Targets

Pattern recognition receptors (PRRs) play a central role in the inflammation that ensues following microbial infection by their recognition of molecular patterns present in invading microorganisms but also following tissue damage by recognising molecules released during disease states. Such receptors are expressed in a variety of cells and in various compartments of these cells. PRR binding of molecular patterns results in an intracellular signalling cascade and the eventual activation of transcription factors and the release of cytokines, chemokines, and vasoactive molecules. PRRs and their accessory molecules are subject to tight regulation in these cells so as to not overreact or react in unnecessary circumstances. They are also key to reacting to infection and in stimulating the immune system when needed. Therefore, targeting PRRs offers a potential therapeutic approach for chronic inflammatory disease, infections and as vaccine adjuvants. In this review, the current knowledge on anti-viral PRRs and their signalling pathways is reviewed. Finally, compounds that target PRRs and that have been tested in clinical trials for chronic infections and as adjuvants in vaccine trials are discussed

An Examination of the Volatile Nature of Grass Production in Ireland

Grass production provides Irish dairy farmers with a competitive advantage over many of their mainland European counterparts by providing a cheap feed source. The temperate climate in Ireland favours the production of grass, however production is highly seasonal with little growth over the winter period. This seasonal pattern of grass production in turn has resulted in predominantly spring calving dairy herds and has limited the development of the dairy product portfolio in Ireland which has created a reliance on dairy commodities. As Ireland exports approximately 80% of its dairy output, recent substantial increases in market price volatility has resulted in increased price volatility at farm level. The increased price volatility at market and farm level has been well documented; however the volatility of farm inputs has received little attention to date. In this paper the seasonal and volatile nature of grass production is presented and compared with other Irish crops. As Irish dairy and beef farmers expand production in the post quota environment the optimal use of grass as a feed source will be central to their competitive position. The volatile nature of this resource will require improved pasture management along with improved risk management tools. A number of possible tools are discussed in the latter part of this paper

Coconut water : a sports drink alternative?

Coconut water is used as an alternative to conventional sports drinks for hydration during endurance cycling; however, evidence supporting its use is limited. This study determined if drinking coconut water compared to a sports drink altered cycling performance and physiology. In a randomized crossover trial, 19 experienced male (n = 15) and female (n = 4) cyclists (age 30 ± 9 years, body mass 79 ± 11 kg, (Formula presented.) O2 peak 55 ± 8 mL·k

A systematic review of clinical practice guidelines for recurrent miscarriage

The aim of this systematic review is to identify, appraise and describe published CPGs for the management, investigation and/or follow-up of RM within high-income countries

Comparative effectiveness of three exercise types to treat clinical depression in older adults: A systematic review and network meta-analysis of randomised controlled trials

Background: Few studies have directly compared the effects of different exercise therapies on clinical depression in older adults. Thus, we conducted a systematic review and network meta-analysis of current evidence from randomised controlled trials (RCTs) to compare the effectiveness of three major exercise types (aerobic, resistance, and mind-body exercise) in clinically depressed older adults. Methods: We followed PRISMA-NMA guidelines and searched databases for eligible RCTs (inception – September 12th, 2019). RCTs were eligible if they included clinically depressed adults aged >65 years, implemented one or more exercise therapy arms using aerobic, resistance, or mind-body exercise, and assessed depressive symptoms at baseline and follow-up using a validated clinical questionnaire. Results: A network meta-analysis was performed on 15 eligible RCTs comprising 596 participants (321 treatment and 275 controls), including aerobic (n = 6), resistance (n = 5), and mind-body (n = 4) exercise trials. Compared with controls, mind-body exercise showed the largest improvement on depressive symptoms (g = −0.87 to −1.38), followed by aerobic exercise (g = −0.51 to −1.02), and resistance exercise (g = −0.41 to −0.92). Notably, there were no statistically significant differences between exercise types: aerobic versus resistance (g = −0.10, PrI = −2.23, 2.03), mind-body versus aerobic (g = −0.36, PrI = −2.69, 1.97), or mind-body versus resistance (g = −0.46, PrI = −2.75, 1.83). Conclusions: These findings should guide optimal exercise prescription for allied health professionals and stakeholders in clinical geriatrics. Notably, clinically depressed older adults may be encouraged to self-select their preferred exercise type in order to achieve therapeutic benefit on symptoms of depression. In coalition with high levels of compliance, these data provide encouraging evidence for the antidepressant effect of either aerobic, resistance, or mind-body exercise as effective treatment adjucts for older adults presenting with clinical depression. © 201

Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials [version 2; peer review: 2 approved, 1 approved with reservations]

Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years. Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups. Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis (n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges’ g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges’ g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges’ g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges’ g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment. Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults. Registration: PROSPERO CRD42018115866 (23/11/2018)