A Systematic Review of the Effects of Exercise Interventions on Body Composition in HIV+ Adults Home‐exercise Childhood Obesity Intervention: A Randomized Clinical Trial Comparing Print Versus Web‐based (Move It) Platforms Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Serum antimüllerian hormone in response to dietary management and/or physical exercise in overweight/obese women with polycystic ovary syndrome: secondary analysis of a randomized controlled trial. Physical activity as a treatment of non-alcoholic fatty liver disease: A systematic review. The effect of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women: a systematic review protocol Diet and exercise interventions reduce intrahepatic fat content and improve insulin sensitivity in obese older adults. Physical fitness of older adults in senior activity centres after 24-week silver yoga exercises. Children, parents, and pets exercising together (CPET) randomised controlled trial: study rationale, design, and methods Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Will older sedentary people with non-insulin-dependent diabetes mellitus start exercising? A health promotion model. A systematic review of randomized controlled trials on exercise parameters in the treatment of patellofemoral pain: what works? Effects of recreational soccer on physical fitness and health indices in sedentary healthy and unhealthy subjects Updated systematic review of exercise studies in breast cancer survivors: attention to the principles of exercise training Grading the strength of a body of evidence when assessing health care interventions: an EPC update. Effect of a Lifestyle Intervention Program With Energy-Restricted Mediterranean Diet and Exercise on Weight Loss and Cardiovascular Risk Factors: One-Year Results of the PREDIMED-Plus Trial Cardiorespiratory Fitness in Childhood and Adolescence Affects Future Cardiovascular Risk Factors: A Systematic Review of Longitudinal Studies Effect of long-term changes in diet and exercise on plasma leptin concentrations. Effect of calorie restriction with or without exercise on body composition and fat distribution. Effects of weight loss vs aerobic exercise training on risk factors for coronary disease in healthy, obese, middle-aged and older men. A randomized controlled trial. Preservation of fat-free mass after two distinct weight loss diets with and without progressive resistance exercise. Change in weight and body composition in obese subjects following a hypocaloric diet plus different training programs or physical activity recommendations. Effects of an ad libitum low-fat, high-carbohydrate diet on body weight, body composition, and fat distribution in older men and women: a randomized controlled trial.
Over the years , physical activity and exercise have been used to positively impact the health and quality of life of persons infected with HIV and , more recently , has been associated with a spectrum of body composition changes . The aim of this review was to examine the effects of various exercise interventions on body composition in HIV positive adults , using a search strategy of r and omized , controlled trials ( RCTs ) . A systematic review was performed by five independent review ers using a predetermined protocol adapted from previous research for assessing the articles for inclusion , the extracted data , and method ological quality . Eight RCTs involving 430 ( 26 % female ) HIV positive adults performing exercise a minimum of thrice weekly for at least six weeks were finally selected : Four were progressive resistance training ( PRT ) studies , three were aerobic training ( AT ) studies , and one involved yoga . In the PRT studies , there were significant increases in three anthropometric measures , namely , body mass , sum of skinfolds and sum of limb girths . In the AT studies , significant decreases were found in seven anthropometric measures , namely , body mass index , waist-hip ratio , body mass , triceps skinfold , waist circumference and sum of skinfolds . With yoga , the changes were non-significant . Exercise contributes to improved body composition and , when applied safely , appears to be beneficial for adults living with HIV/AIDS . However , these findings should be interpreted cautiously due to the relatively few RCTs published to date . Future studies would benefit from increased attention to sample size , female participants , participant follow-up , complete statistical analysis and intention-to-treat analysis Purpose : To compare the impact of adhering to a Mediterranean diet plus mixed physical exercise program ( Move‐It ) implemented by means of printed instructions or via a web‐platform ( with or without e‐mail support ) on body composition , physical fitness , and blood pressure . Design and Methods : R and omized clinical trial . Fifty‐two overweight or obese Spanish children and adolescents were r and omly assigned to the print‐based ( n = 18 ) , Move‐It ( n = 18 ) , or Move‐It plus support ( n = 16 ) intervention groups . Two‐way mixed ANOVA tests were used to compare any changes between the groups in terms of percentage body fat , physical fitness ( VO2peak ) , h and grip strength , and systolic and diastolic blood pressure . The measurements were taken before and after a three‐month mixed‐exercise ( aerobic and resistance ) and Mediterranean‐diet program which was either implemented by means of printed instructions or via a web‐platform ( with or without e‐mail support ) . Results : No statistical differences were found between groups . However , the results highlighted significant improvements in body fat percentage metrics over time for all three groups ( print‐based : −1.8 % , 95%CI −3.3 % to −0.3 % ; Move‐It : −1.8 % , 95%CI −3.3 % to −0.3 % ; Move‐It plus support : −2.0 % , 95%CI −3.7 % to −0.4 % , P < 0.05 ) . We also observed a tendency towards improvement in the VO2peak , h and grip strength , and blood pressure variable values 10 min after the exercise‐stress test in these three groups . Conclusions : The program improved the body composition , regardless of the way it is implemented . Practice Implication s : A mixed physical exercise program lasting for three months , combined with a Mediterranean diet , improves the body composition of children and adolescents with overweight/obesity . Highlights : Move‐It improves the body composition in three months . Move‐It improves the body composition , regardless of the way it is implemented . Move‐It shows a tendency towards improvement in physical fitness and blood pressure Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made OBJECTIVE To investigate whether r and omized diet and /or physical exercise influence serum levels of antimüllerian hormone ( AMH ) in obese women with polycystic ovary syndrome ( PCOS ) . DESIGN R and omized , 4-month trial with three interventions . SETTING Women 's health clinical research unit at a university hospital . PATIENT(S ) Fifty-seven overweight/obese women with PCOS . INTERVENTION(S ) Diet , physical exercise , or both , using programs individually adapted and supervised by a dietician and /or a physiotherapist . MAIN OUTCOME MEASURE(S ) Serum AMH levels before and after the interventions and correlations to reproductive function , body composition , and endocrine and metabolic variables . RESULT ( S ) After intervention , serum levels of AMH were significantly decreased only in the diet group , and the levels were significantly lower than in the exercise group . The strongest predictor of decreased AMH was a decrease in free T , whereas weight loss had no significant influence . Normalized levels of AMH were associated with improvements in menstrual cyclicity and hyper and rogenism but not in metabolic variables . CONCLUSION ( S ) This r and omized study supports that diet reduces serum AMH in association with decreased and rogen levels in obese women with PCOS . Increased serum AMH may be used as a marker of ovulatory dysfunction and hyper and rogenism but not as a marker of insulin resistance . CLINICAL TRIAL REGISTRY NUMBER IS RCT N48342048 AIM To review the effectiveness of exercise as a therapy for nonalcoholic fatty liver disease ( NAFLD ) and potential benefits in treating insulin resistance and atherosclerosis . METHODS Medline ( EBSCOhost ) and PubMed were search ed for English- language r and omized controlled trials and prospect i ve cohort studies in human adults aged ≥ 18 which investigated the various effects of exercise alone , a combination of exercise and diet , or exercise and diet coupled with behavioral modification on NAFLD from 2010 to Feburary 2015 . RESULTS Eighteen of 2298 available studies were chosen for critical review , which included 6925 patients . Nine ( 50 % ) studies were r and omized controlled trials . Five ( 27.8 % ) studies utilized biopsy to examine the effects of physical activity on hepatic histology . The most commonly employed imaging modality to determine change in hepatic steatosis was hydrogen-magnetic resonance spectroscopy . Only two studies examined the effects of low impact physical activity for patients with significant mobility limitations and one compared the efficacy of aerobic and resistance exercise . No studies examined the exact duration of exercise required for hepatic and metabolic improvement in NAFLD . CONCLUSION  While exercise improved hepatic steatosis and underlying metabolic abnormalities in NAFLD , more studies are needed to define the most beneficial form and duration of exercise treatment Review question / objective What are the effects of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women ? The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aim ed at limiting gestational weight gain and postpartum weight retention in women . The second objective of this systematic review is to investigate included intervention components with respect to effect on weight‐related outcomes . This may include , but is not limited to : length of intervention , use of face‐to‐face counselling , group or individual consultations , use of other interventions components including exercise , use of goals and use of support tools like food diaries , coaching , including email or text message support . Background Around half of all women of reproductive age are either overweight or obese,1,2,3 with women aged 25‐34 years having a greater risk of substantial weight gain compared with men of all ages.1,4 Excessive gestational weight gain ( GWG ) and postpartum weight retention ( PPWR ) may play a significant role in long term obesity . Having one child doubles the five‐ and 10‐year obesity incidence for women , with many women who gain excessive weight during pregnancy remaining obese permanently.5 Excessive GWG and /or PPWR can also significantly contribute to short‐ and long‐term adverse health outcomes for mother , baby and future pregnancies.6,7 Maternal obesity increases the risk of pregnancy related complications such as pre‐eclampsia , gestational diabetes mellitus , stillbirth and the rate of caesarean section.8 Childhood obesity is a further long term complication of maternal obesity for offspring , which may persist in to adulthood.9 Excess GWG is also a risk factor for PPWR both in the short and long‐term.10,11 Nehring et al. conducted a meta‐ analysis with over 65,000 women showing that , compared to women who gained weight within recommendations during pregnancy , women with GWG above Institute of Medicine weight gain recommendations , 12 retained an additional 3.1 kg and 4.7 kg after three and greater than or equal to 15 years postpartum , respectively.13 The health risk associated with PPWR is highlighted in a study of 151,025 Swedish women followed between 1992 and 2001.The study identified the risk of adverse pregnancy outcomes for those who gained three or more units of Body Mass Index ( kg/m2 ) between consecutive pregnancies ( an average of two years ) was much higher compared with women whose BMI changed from ‐1.0 and 0.9 units.14 Long‐term chronic disease risk may also be affected by PPWR as weight retention at the end of the first year post‐partum has been found to be a predictor of maternal overweight 15 years later.15With around 14‐20 % of women retaining 5 kg or more 12 months postpartum,16,5 the risk of developing conditions like diabetes , metabolic syndrome and cardiovascular disease may be increased.17 It becomes evident that interventions which aim to support attainment of healthy weight both in the antenatal and postpartum periods are key health priorities for women during this life stage . Lifestyle factors of overweight , having poor diet quality , and not undertaking enough moderate‐to‐vigorous physical activity are amongst the top five predictors of mortality in women.18 Additionally it is noted that , for many women , pregnancy and the postpartum period are associated with a reduction in physical activity.19 It is known that a combination of poor dietary choices , an increase in sedentary time and reduction in physical activity are all contributors to the development of overweight and obesity . With this in mind , current research has focused on lifestyle interventions to limit GWG and PPWR . Thangaratinam et al. review ed 44 r and omized controlled trials ( 7278 women ) where interventions including diet , physical activity or both were evaluated for their influence on maternal weight during  pregnancy.20 Results indicate that all were significantly effective in reducing GWG compared with the control group . More specifically , dietary interventions were the most effective in reducing weight gain , with a mean weight loss of ‐3.84 kg compared with ‐0.72 kg and ‐1.06 kg for physical activity and the mixed ( diet plus physical activity ) approach , respectively.20 This finding is supported by Hill and colleagues ' recent systematic review of theory based interventions to limit GWG.21 Included studies in this review reported an underpinning theory base and were classified as adopting a dietary , physical activity or mixed approach . Hill et al. concluded that studies which included a diet intervention were significantly more effective at limiting GWG.21 In 2011 Tanentsapf et al. review ed the effect of dietary interventions alone for reducing GWG in normal weight , overweight and obese pregnant women.22 This review analysed 13 r and omized controlled trials and quasi‐r and omized controlled trials with a dietary intervention to prevent excessive GWG in women . The review concluded that dietary interventions during pregnancy were effective in reducing GWG with an effect of ‐1.92 kg ( n=1434 ) compared with the control group.22 Tanentsapf et al. identified that trials differed in the conduct of the interventions with various diet and non‐diet related components utilised . Dietary approaches were highly variable with some trials focusing only on calorie restriction and others included additional target macronutrient distribution for intake . Some trials further provided feedback based on maternal weight gain guidelines .12 Interventions also varied in delivery method with a variety of modes used , including face‐to‐face , individual or group consultations and /or written correspondence . The frequency of communication , despite the type or mix , also changed from trial to trial with additional methods via telephone , posted material s , feedback or food diaries utilised . The inclusion of physical activity in addition to diet intervention was also common . Whilst the recent review by Tanentsapf et al.22 identified that dietary interventions are effective in reducing GWG , the review did not investigate the impact that different intervention components , delivery methods or dietary counselling approaches had on gestational weight management . It remains unclear as to which intervention components optimize GWG in women . The impact of lifestyle interventions has also been investigated in the postpartum period . The recent systematic review from van der Pligt et al. reported seven of 11 studies review ed were successful in limiting PPWR.23 As with studies aim ed at limiting GWG , interventions included in van der Pligt et al. 's review differed greatly in their conduct . Six of these seven studies included both dietary and physical activity components for the intervention , with the final successful study including a diet only intervention . Five of the successful studies recruited overweight or obese women only . Intervention time varied considerably in successful studies with some running for as little at ten days , and others up to six months . Bertz et al. demonstrated that their 12‐week behavior modification intervention which targeted diet alone or diet and exercise , including two individual sessions with a dietitian and physical therapist , provision of scales for weight self‐monitoring and bi‐weekly text messages was successful in achieving significant weight loss following the intervention , and sustained at one year.24 The diet intervention and the diet and exercise intervention  yielded significant weight loss compared to the control . Following 12 weeks a reduction of ‐8.3 + /‐ 4.2 kg for diet intervention and ‐6.9 + /‐ 3.0 kg for diet and exercise was observed . Additionally after one year , the diet intervention showed ‐10.2 + /‐ 5.7 kg reduction and ‐7.3 + /‐ 6.3 kg for the diet and exercise intervention (p<0.001).24 Colleran et al. also found significant weight change results by implementing a 16‐week intervention which consisted of weekly individual sessions with a dietitian regarding calorie restriction , two additional home visits regarding exercise , weekly food diary completion and email support.25 The intervention group had greater weight loss compared to the control group ( ‐5.8 kg + /‐ 3.5 kg vs ‐1.6 kg + /‐ 5.4 kg ) . It can be seen that various methods have been utilized in investigating the impact of diet and physical activity interventions on PPWR . The review by van der Pligt et al.23 highlights the impact successful lifestyle interventions can have on postpartum weight change . However , this review did not investigate the different intervention strategies utilized . It remains unclear as to the optimal setting , delivery method , diet strategy , contact frequency or intervention length to limit PPWR . Previous systematic review s for both GWG and PPWR have focused on the effectiveness of lifestyle interventions as a whole for weight management in pregnant and postpartum women.20,23 And despite Tanentsapf et al. 's focus on dietary interventions for GWG,22 much is still unknown about the effectiveness of differing diet interventions over the antenatal and postpartum period . Specifically , the impact of differing diet intervention strategies on maternal weight gain is not known . Firstly , this systematic review will focus on whether  weight management interventions which include a dietary component  are effective in pregnant and postpartum women . In addition to this , this review will investigate the different intervention strategies utilized and their effectiveness in maternal weight management . A search of systematic review protocol data bases has shown that there is no current review underway for this topic Both obesity and aging increase intrahepatic fat ( IHF ) content , which leads to nonalcoholic fatty liver disease ( NAFLD ) and metabolic abnormalities such as insulin resistance . We evaluated the effects of diet and diet in conjunction with exercise on IHF content and associated metabolic abnormalities in obese older adults . Eighteen obese ( BMI > or=30 kg/m(2 ) ) older ( > or=65 years old ) adults completed a 6-month clinical trial . Participants were r and omized to diet ( D group ; n = 9 ) or diet + exercise ( D+E group ; n = 9 ) . Primary outcome was IHF quantified by magnetic resonance spectroscopy ( MRS ) . Secondary outcomes included insulin sensitivity ( assessed by oral glucose tolerance ) , body composition ( assessed by dual-energy X-ray absorptiometry ) , physical function ( VO(2 peak ) and strength ) , glucose , lipids , and blood pressure ( BP ) . Body weight ( D : -9 + /- 1 % , D+E : -10 + /- 2 % , both P < 0.05 ) and fat mass ( D : -13 + /- 3 % , D+E -16 + /- 3 % , both P < 0.05 ) decreased in both groups but there was no difference between groups . IHF decreased to a similar extent in both groups ( D : -46 + /- 11 % , D+E : -45 + /- 8 % , both P < 0.05 ) , which was accompanied by comparable improvements in insulin sensitivity ( D : 66 + /- 25 % , D+E : 68 + /- 28 % , both P < 0.05 ) . The relative decreases in IHF correlated directly with relative increases in insulin sensitivity index ( ISI ) ( r = -0.52 ; P < 0.05 ) . Improvements in VO(2 peak ) , strength , plasma triglyceride ( TG ) , and low-density lipoprotein-cholesterol concentration , and diastolic BP occurred in the D+E group ( all P < 0.05 ) but not in the D group . Diet with or without exercise results in significant decreases in IHF content accompanied by considerable improvements in insulin sensitivity in obese older adults . The addition of exercise to diet therapy improves physical function and other obesity- and aging-related metabolic abnormalities AIMS AND OBJECTIVES Promoting physical fitness of young-older adults is essential in reducing healthcare expenditures which would occur in the future for those with chronic health problems . The silver yoga exercise programme was developed to accommo date the reduced body flexibility experienced by many older adults and was critically review ed by experts and pilot-tested with community-dwelling older adults . This study aim ed to test older adults ' physical fitness after a 24-week silver yoga exercise programme and to examine whether the programme could be further shortened to fit senior activity centres ' programme design s. DESIGN A quasi-experimental , pre-post tests design was used : baseline , at 12-week and at 24-week periods . METHODS Convenience sample s of 204 subjects were recruited from eight senior activity centres and 176 subjects completed the study . Subjects were r and omly assigned into three groups based on the centres : ( 1 ) Experiment I : complete silver yoga with stretching and meditation , ( 2 ) Experiment II : shortened silver yoga without the guided-imagery meditation and ( 3 ) Wait-list control . The interventions were conducted three times per week for 24 weeks . Physical fitness indicators included body compositions , cardiovascular-respiratory functions , physical functions and the range of motion . RESULTS At the end of the 24-week period , the physical fitness of subjects in Experiments I and II had significantly improved whether or not guided-imagery meditation was used and all had better physical fitness than subjects in the control group ( all p < 0.05 ) . CONCLUSIONS The physical fitness of older adults in both the 70-minute complete silver yoga group and the 55-minute shortened silver yoga group had significantly improved after the interventions . It was recommended that the silver yoga programme be shortened by eliminating the guided-imagery meditation . RELEVANCE TO CLINICAL PRACTICE The shortened silver yoga exercise programme is recommended to be incorporated as an activity programme in community- setting s to promote the physical fitness of older adults Background Objective ly measured physical activity is low in British children , and declines as childhood progresses . Observational studies suggest that dog-walking might be a useful approach to physical activity promotion in children and adults , but there are no published public health interventions based on dog-walking with children . The Children , Parents , and Pets Exercising Together Study aims to develop and evaluate a theory driven , generalisable , family-based , dog walking intervention for 9 - 11 year olds . Methods / design The Children , Parents , and Pets Exercising Together Study is an exploratory , assessor-blinded , r and omised controlled trial as defined in the UK MRC Framework on the development and evaluation of complex interventions in public health . The trial will follow CONSORT guidance . Approximately 40 dog-owning families will be allocated r and omly in a ratio of 1.5:1 to receive a simple behavioural intervention lasting for 10 weeks or to a ' waiting list ' control group . The primary outcome is change in objective ly measured child physical activity using Actigraph accelerometry . Secondary outcomes in the child , included in part to shape a future more definitive r and omised controlled trial , are : total time spent sedentary and patterning of sedentary behaviour ( Actigraph accelerometry ) ; body composition and bone health from dual energy x-ray absorptiometry ; body weight , height and BMI ; and finally , health-related quality of life using the PedsQL . Secondary outcomes in parents and dogs are : changes in body weight ; changes in Actigraph accelerometry measured physical activity and sedentary behaviour . Process evaluation will consist of assessment of simultaneous child , parent , and dog accelerometry data and brief interviews with participating families . Discussion The Children , Parents , and Pets Exercising Together trial should be the first r and omised controlled study to establish and evaluate an intervention aim ed at dog-based physical activity promotion in families . It should advance our underst and ing of whether and how to use  pet dogs to promote physical activity and /or to reduce sedentary behaviour in children and adults . The trial is intended to lead to a subsequent more definitive r and omised controlled trial , and the work should inform future dog-based public health interventions such as secondary prevention interventions in children or adults . Trial registration numberIS RCT BACKGROUND Multiple sclerosis ( MS ) is a major cause of chronic , neurological disability , with a significant long-term disability burden , often requiring comprehensive rehabilitation . OBJECTIVES To systematic ally evaluate evidence from published Cochrane Review s of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS ( pwMS ) , to improve patient outcomes , and to highlight current gaps in knowledge . METHODS We search ed the Cochrane Data base of Systematic Review s up to December 2017 , to identify Cochrane Review s that assessed the effectiveness of organised rehabilitation interventions for pwMS . Two review ers independently assessed the quality of included review s , using the Revised Assessment of Multiple Systematic Review s ( R-AMSTAR ) tool , and the quality of the evidence for reported outcomes , using the GRADE framework . MAIN RESULTS Overall , we included 15 review s published in the Cochrane Library , comprising 164 r and omised controlled trials ( RCTs ) and four controlled clinical trials , with a total of 10,396 participants . The included review s evaluated a wide range of rehabilitation interventions , including : physical activity and exercise therapy , hyperbaric oxygen therapy ( HBOT ) , whole-body vibration , occupational therapy , cognitive and psychological interventions , nutritional and dietary supplements , vocational rehabilitation , information provision , telerehabilitation , and interventions for the management of spasticity . We assessed all review s to be of high to moderate method ological quality , based on R-AMSTAR criteria .Moderate- quality evidence suggested that physical therapeutic modalities ( exercise and physical activities ) improved functional outcomes ( mobility , muscular strength ) , reduced impairment ( fatigue ) , and improved participation ( quality of life ) . Moderate- quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation , and interventions that provided information improved patient knowledge . Low-qualitty evidence suggested that neuropsychological interventions , symptom-management programmes ( spasticity ) , whole body vibration , and telerehabilitation improved some patient outcomes . Evidence for other rehabilitation modalities was inconclusive , due to lack of robust studies . AUTHORS ' CONCLUSIONS The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit , although the certainty of evidence varies across the different types of interventions evaluated by the review s. Structured , multidisciplinary rehabilitation programmes and physical therapy ( exercise or physical activities ) can improve functional outcomes ( mobility , muscle strength , aerobic capacity ) , and quality of life . Overall , the evidence for many rehabilitation interventions should be interpreted cautiously , as the majority of included review s did not include data from current studies . More studies , with appropriate design , which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge Exercise and diet are the cornerstones of management of non-insulin-dependent diabetes mellitus ( NIDDM ) . Many older people have difficulty in exercising , missing benefits on glycaemic control , weight , cardiac disease and mood . We report the outcomes of a 6 month structured exercise and support programme based on a health promotion model , on physical activity , glycaemic control and parameters of cardiovascular risk in non-exercisers , compared with st and ard outpatient clinic education . A total of 26 non-exercising patients were r and omised to an intervention or control group ( ten men , 16 women ; mean age ( + /- S.D. ) 60 + /- 8 years ) . Programme participation was not associated with any significant increase in activity . Glycated hemoglobin ( HbAtc ) levels tended to stabilise in the intervention group during the 6 month programme and to deteriorate in the control group ( P = 0.03 ) ; by 12 months HbA1C levels deteriorated to a similar level in both . Programme participation did not cause significant change in anthropometric or metabolic parameters . Examining the cohort as a whole , increased activity over 6 months was associated with improvements in weight , body mass index ( BMI ) , body fat and fasting insulin . Activity increases over 12 months were associated with improvements in weight and BMI . These changes could not be attributed to changes in energy intake or dietary composition . We conclude that while exercise can benefit older people with NIDDM , a programme based on a model of health promotion was not effective in increasing physical activity Purpose There is research evidence which supports the effectiveness of exercise in reducing pain and increasing function in patients with patellofemoral pain syndrome . However , what is unclear are the parameters underpinning this intervention . This has led to uncertainty when operationalizing exercises for patients with patellofemoral pain syndrome in clinical practice . The aim of this review was to evaluate the parameters of exercise programs reported in primary research , to provide clinicians with evidence -based recommendations for exercise prescription for patellofemoral pain . Methods A systematic review of r and omized controlled trials was undertaken . Only trials that identified exercise to be effective in treating patellofemoral pain were included . Appropriate data bases and reference lists were search ed using established keywords . Data relating to common exercise parameters such as the type of exercise , length , and frequency of intervention , intensity , repetitions , sets , and specific technique were extracted , along with details of co- interventions that may have been used . Results A total of ten r and omized controlled trials were included in this review and from these trials 14 interventions arms were evaluated . All 14 interventions focused on active exercises , all but two of which also included a passive stretching component . The current body of evidence demonstrates positive results with exercise interventions such as  knee extension , squats , stationary cycling , static quadriceps , active straight leg raise , leg press , and step-up and down exercises  for patients with patellofemoral pain syndrome . A progressive regime of daily exercises of two to four sets of ten or more repetitions over an intervention period of 6 weeks or more , combined with exercises to address flexibility of the lower limb musculature was commonly used . Conclusion Currently , the primary research on this topic supports the use of closed kinetic chain , strengthening exercises for musculature of the lower limb , combined with flexibility options . The current evidence base supports a prescription of daily exercises of two – four sets of ten or more repetitions over a period of 6 weeks or more Recreational soccer ( RS ) is becoming a popular alternative to the classical continuous exercise mode used for the improvement of cardiovascular and metabolic fitness in untrained people . The objective of this paper was to conduct a detailed systematic review of the literature , identifying the physiological responses to RS and the training effects of RS on aerobic fitness and health in untrained healthy individuals and clinical patients . PubMed , Google Scholar and ScienceDirect data bases were search ed using terms related to recreational soccer . Inclusion criteria were r and omized controlled trials ( RCT ) that assessed acute physiological responses to RS or the training effects of RS on physical fitness and health in sedentary , untrained subjects of any age or health status . All studies were assessed for method ological quality using the PEDro scale . Thirty-five articles met the inclusion criteria ; seven examined the acute response to RS , and 28 assessed training effects . Clear evidence was found that RS had positive effects on many health-related indices and variables , including VO2max ( gains of 7 - 16 % ) , blood pressure ( reductions of 6 - 13 mmHg ) , body composition ( decreased fat mass and improved indices of bone health ) , and metabolic and cardiac function . These positive effects were observed in both healthy individuals and clinical patients , irrespective of age or sex . Although this review provides clear evidence of the positive effects of RS on health , most studies had limitations of methodology ( an average PEDro score < 6 ) . Furthermore , many of the training studies were from a small number of research groups . Future studies should be extended to other countries and institutions to ensure generality of the results . Regular RS training leads to significant cardiovascular and muscular adaptations and gains of health both in sedentary individuals and clinical patients at all ages , suggesting that RS is a potentially highly motivational method to enhance population health Objectives To up date our previous evaluation of the exercise interventions used in r and omised controlled trials of breast cancer survivors in relation to ( 1 ) the application of the principles of exercise training in the exercise prescription ; ( 2 ) the reporting of the components of the exercise prescription ; and ( 3 ) the reporting of adherence of participants to the prescribed interventions . Design Systematic review . Data sources The OVID Medline , Embase , CINAHL and SPORTD iscus electronic data bases were search ed from January 2010 to January 2017 . Eligibility criteria R and omised controlled trials of at least 4 weeks of aerobic and /or resistance exercise in women diagnosed with breast cancer , reporting on physical fitness or body composition outcomes .  Results Specificity was appropriately applied by 84 % , progression by 29 % , overload by 38 % and initial values by 67 % of newly identified studies . Reversibility was reported by 3 % and diminishing returns by 22 % of newly identified studies . No studies reported all components of the exercise prescription in the methods , or adherence to the prescribed intervention in the results . Reporting of reversibility has increased from 2010 , but no other improvements in reporting were noted from the previous review . Summary / Conclusion No studies of exercise in women with breast cancer attended to all principles of exercise training , or reported all components of the exercise prescription  in the methods , or adherence to the prescription in the results . Full reporting of the exercise prescribed and completed is essential for study replication in research and translating research findings into the community , and should be prioritised in future trials OBJECTIVES To revise 2010 guidance on grading the strength of evidence ( SOE ) of the effectiveness of drugs , devices , and other preventive and therapeutic interventions in systematic review s produced by the Evidence -based Practice Center ( EPC ) program , established by the US Agency for Healthcare Research and Quality ( AHRQ ) . STUDY DESIGN AND SETTING A cross-EPC working group review ed authoritative systems for grading SOE [ primarily the approach from the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) working group ] and conducted extensive discussion s with GRADE and other experts . RESULTS Up date d guidance continues to be conceptually similar to GRADE . Review ers are to evaluate SOE separately for each major treatment comparison for each major outcome . We added reporting bias as a required domain and retained study limitations ( risk of bias ) , consistency , directness , and precision ( and three optional domains ) . Additional guidance covers scoring consistency , precision , and reporting bias , grading bodies of evidence with r and omized controlled trials and observational studies , evaluating single study bodies of evidence , using studies with high risk of bias , and presenting findings with greater clarity and transparency . SOE is grade d high , moderate , low , or insufficient , reflecting review ers ' confidence in the findings for a specific treatment comparison and outcome . CONCLUSION No single approach for grading SOE suits all review s , but a more consistent and transparent approach to reporting summary information will make review s more useful to the broad range of audiences that AHRQ 's work aims to reach . EPC working groups will consider ongoing challenges and modify guidance as needed , on issues such as combining trials and observational studies in bodies of evidence , weighting domains , and combining qualitative and quantitative syntheses OBJECTIVE The long-term impact of intentional weight loss on cardiovascular events remains unknown . We describe 12-month changes in body weight and cardiovascular risk factors in PREvención con DIeta MEDiterránea (PREDIMED)-Plus , a trial design ed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention . RESEARCH DESIGN AND METHODS Overweight/obese adults with metabolic syndrome aged 55–75 years ( n = 626 ) were r and omized to an intensive weight loss lifestyle intervention based on an energy-restricted Mediterranean diet , physical activity promotion , and behavioral support ( IG ) or a control group ( CG ) . The primary and secondary outcomes were changes in weight and cardiovascular risk markers , respectively . RESULTS Diet and physical activity changes were in the expected direction , with significant improvements in IG versus CG . After 12 months , IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG ( P < 0.001 ) , a mean difference of −2.5 kg ( 95 % CI −3.1 to −1.9 ) . Weight loss ≥5 % occurred in 33.7 % of IG participants compared with 11.9 % in the CG ( P < 0.001 ) . Compared with the CG , cardiovascular risk factors , including waist circumference , fasting glucose , triglycerides , and HDL cholesterol , significantly improved in IG participants ( P < 0.002 ) . Reductions in insulin resistance , HbA1c , and circulating levels of leptin , interleukin-18 , and MCP-1 were greater in IG than CG participants ( P < 0.05 ) . IG participants with prediabetes/diabetes significantly improved glycemic control and insulin sensitivity , along with triglycerides and HDL cholesterol levels compared with their CG counterparts . CONCLUSIONS PREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight/obese older adults with metabolic syndrome , as well as in individuals with or at risk for diabetes Background Although cardiorespiratory fitness ( CRF ) in childhood and adolescence may be linked to future cardiovascular health , there is currently limited evidence for a longitudinal association . Objectives To provide a systematic review on the prospect i ve association between CRF in childhood and adolescence and cardiovascular disease ( CVD ) risk factors at least 2 years later . Methods Using a systematic search of Medline , Embase , and SPORTD iscus , relevant articles were identified by the following criteria : generally healthy children and adolescents between 3 and 18 years of age with CRF assessed at baseline , and a follow-up period of ≥ 2 years . The outcome measures were CVD risk factors . We appraised quality of the included articles with STROBE and QUIPS checklists . Results After screening 7524 titles and abstract s , we included 38 articles , assessing 44,169 children and adolescents followed up for a median of 6 years . Eleven articles were of high quality . There was considerable heterogeneity in methodology , measurement of CRF , and outcomes , which hampered meta- analysis . In approximately half of the included articles higher CRF in childhood and adolescence was associated with lower body mass index ( BMI ) , waist circumference , body fatness and lower prevalence of metabolic syndrome in later life . No associations between CRF in childhood and adolescence and future waist-to-hip ratio , blood pressure , lipid profile , and glucose homeostasis were observed . Conclusion Although about half of the included articles reported inverse associations between CRF in childhood and adolescence and future BMI , body fatness , and metabolic syndrome , evidence for other CVD risk factors was unconvincing . Many articles did not account for important confounding factors such as adiposity . Recommendations for future research include st and ardizing the measurement of CRF , i.e. by reporting VO2max , using st and ardized outcome assessment s , and performing individual patient data meta-analyses BACKGROUND Although it is known that plasma leptin concentrations correlate with the amount of adipose tissue in the body , little information is available on the long-term effects on leptin concentrations of changes in diet and exercise . OBJECTIVE We wanted to examine whether changes in dietary energy sources and exercise-mediated energy expenditure , alone or in combination , affect plasma leptin concentrations . DESIGN In a r and omized , 2 x 2 factorial trial , 186 men with metabolic syndrome were divided into 4 groups : diet , exercise , a combination of diet and exercise , and control . Data on dietary intake , physical fitness , and demographics were collected and plasma leptin concentrations were measured before and after a 1-y intervention period . RESULTS Plasma leptin concentrations , body mass index , and fat mass decreased in association with long-term reductions in food intake as well as increased physical activity . By adjusting for either body mass index or fat mass , we observed a highly significant reduction in plasma leptin concentration after both the diet and the exercise interventions . There was no interaction between the interventions , suggesting a direct and additive effect of changes in diet and physical activity on plasma leptin concentrations . CONCLUSION Long-term changes in lifestyle consisting of decreased intake of dietary fat and increased physical activity reduced plasma leptin concentrations in humans beyond the reduction expected as a result of changes in fat mass CONTEXT There is debate over the independent and combined effects of dieting and increased physical activity on improving metabolic risk factors ( body composition and fat distribution ) . OBJECTIVE The objective of the study was to conduct a r and omized , controlled trial ( CALERIE ) to test the effect of a 25 % energy deficit by diet alone or diet plus exercise for 6 months on body composition and fat distribution . DESIGN This was a r and omized , controlled trial . SETTING The study was conducted at an institutional research center . PARTICIPANTS Thirty-five of 36 overweight but otherwise healthy participants ( 16 males , 19 females ) completed the study . INTERVENTION Participants were r and omized to either control ( healthy weight maintenance diet , n = 11 ) , caloric restriction ( CR ; 25 % reduction in energy intake , n = 12 ) , or caloric restriction plus exercise ( CR+EX ; 12.5 % reduction in energy intake + 12.5 % increase in exercise energy expenditure , n = 12 ) for 6 months . MAIN OUTCOME MEASURES Changes in body composition by dual-energy x-ray absorptiometry and changes in abdominal fat distribution by multislice computed tomography were measured . RESULTS The calculated energy deficit across the intervention was not different between CR and CR+EX . Participants lost approximately 10 % of body weight ( CR : - 8.3 + /- 0.8 , CR+EX : - 8.1 + /- 0.8 kg , P = 1.00 ) , approximately 24 % of fat mass ( CR : - 5.8 + /- 0.6 , CR+EX : - 6.4 + /- 0.6 kg , P = 0.99 ) , and 27 % of abdominal visceral fat ( CR : 0.9 + /- 0.2 , CR+EX : 0.8 + /- 0.2 kg , P = 1.00 ) . Both whole-body and abdominal fat distribution were not altered by the intervention . CONCLUSION Exercise plays an equivalent role to CR in terms of energy balance ; however , it can also improve aerobic fitness , which has other important cardiovascular and metabolic implication OBJECTIVE To compare the effects of weight loss vs aerobic exercise training on coronary artery disease risk factors in healthy sedentary , obese , middle-aged and older men . DESIGN R and omized controlled trial . SUBJECTS A total of 170 obese ( body mass index , 30 + /- 1 kg/m2 [ mean + /- SEM ] ) , middle-aged and older ( 61 + /- 1 years ) men . INTERVENTIONS A 9-month diet-induced weight loss interventions , 9-month aerobic exercise training program , and a weight-maintenance control group . MAIN OUTCOME MEASURES Change in body composition , maximal aerobic capacity ( V02 max ) , blood pressure , lipoprotein concentrations , and glucose tolerance . RESULTS Forty-four of 73 men r and omized to weight loss completed the intervention and had a 10 % mean reduction in weight ( - 9.5 + /- 0.7 kg ; P < .001 ) , with no 22 change in VO2 max . Forty-nine of 71 men r and omized to aerobic exercise completed the intervention , increased their VO2 max by a mean of 17 % ( P < .001 ) , and did not change their weight , whereas the 18 men who completed in the control group had no significant changes in body composition or VO2 max . Weight loss decreased fasting glucose concentrations by 2 % , insulin by 18 % , and glucose and insulin areas during the oral glucose tolerance test ( OGTT ) by 8 % and 26 % , respectively ( P < .01 ) . By contrast , aerobic exercise did not improve fasting glucose or insulin concentrations or glucose responses during the OGTT but decreased insulin areas by 17 % ( P < .001 ) . In analysis of variance , the decrement in fasting glucose and insulin levels and glucose areas with intervention differed between weight loss and aerobic exercise when compared with the control group ( P < .05 ) . Similarly , weight loss but not aerobic exercise increased high-density lipoprotein cholesterol levels ( + 13 % ) and decreased blood pressure compared with the control group . In multiple regression analyses , the improvement in lipoprotein and glucose metabolism was related primarily to the reduction in obesity . CONCLUSIONS These results suggest that weight loss is the preferred treatment to improve coronary artery disease risk factors in overweight , middle-aged and older men BACKGROUND Preserving fat-free mass ( FFM ) during weight loss is important in older adults . The purpose was to examine a low-fat diet ( LFD ) versus a carbohydrate-restricted diet ( CRD ) with and without progressive resistance exercise ( PRE ) on preservation of FFM in older men with metabolic syndrome . METHODS A total of 42 men ( 59±7 years ) were matched [ body mass index ( BMI ) ] and r and omized to LFD , LFD&PRE , CRD , and CRD&PRE . PRE groups performed supervised strength training three times per week . Body weight , composition , metabolic syndrome criteria , and strength were measured at baseline and week 12 . A 3-day diet record was kept at baseline and at weeks 1 , 6 , and 12 . RESULTS Attrition ( 24 % ) was similar between groups . Depicted as % carbohydrate : fat : protein , the intervention diet was : LFD=55:24:18 , LFD&PRE=57:20:20 , CRD=16:54:28 , and CRD&PRE=12:56:31  . Weight ( lb ) decreased similarly in all groups ( LFD , -18.0±7.4 ; LFD&PRE , -19.8±12.8 ; CRD , -20.2±8.0 ; CRD&PRE , -22.7±6.0 ; P<0.001 ) , and number of participants with metabolic syndrome decreased in all groups ( -3 , -6 , -3 , -4 , respectively ) . Percent of weight loss from appendicular FFM was 27.5 % , 15.9 % , 15.7 % , and 17.3 % respectively . A trend was found when comparing LFD and LFD&PRE ( P=0.068 ) , and when comparing LFD&CRD ( P=0.072 ) . Triglycerides improved more for the LFD&PRE , CRD , and CRD&PRE groups compared to the LFD group ( P<0.05 ) . Improvements in high-density lipoprotein-cholesterol were better in the CRD&PRE group ( 4.1±5.1 mg/dL ) versus the LFD group ( -5.0±5.9 mg/dL ; P<0.01 ) . CONCLUSIONS LFD&PRE , CRD , and CRD&PRE preserve FFM similarly . PRE is an important component of a LFD during weight loss in this population The aim of the present study was to compare the effects of different physical activity programs , in combination with a hypocaloric diet , on anthropometric variables and body composition in obese subjects . Ninety-six obese ( men : n = 48 ; women : n = 48 ; age range : 18 - 50 yr ) participated in a supervised 22-wk program . They were r and omized into four groups : strength training ( S ; n = 24 ) , endurance training ( E ; n = 26 ) , combined strength + endurance training ( SE ; n = 24 ) , and physical activity recommendations ( C ; n = 22 ) . In addition , all groups followed the same hypocaloric diet . At baseline and at the end of the intervention , dietetic and physical activity variables were assessed using vali date d question naires . Anthropometric variables were recorded along with body composition variables measured using dual-energy X-ray absorptiometry techniques . At the end of the intervention , significant improvements were seen within groups in terms of body weight ( S : -9.21 ± 0.83 kg ; E : -10.55 ± 0.80 kg ; SE : -9.88 ± 0.85 kg ; C : -8.69 ± 0.89 kg ) , and total fat mass ( S : -5.24 ± 0.55 % ; E : -5.35 ± 0.55 % ; SE : -4.85 ± 0.56 % ; C : -4.89 ± 0.59 % ) . No differences were seen between groups at this time in terms of any other anthropometric or body composition variables examined . All groups increased their total physical activity in metabolic equivalents ( MET ) per week during the intervention , but with no difference between groups ( S : 976 ± 367 MET-min/wk ; E : 954 ± 355 MET-min/wk ; SE : 1 329 ± 345 MET-min/wk ; C : 763 ± 410 MET-min/wk ) . This study shows that , when combined with a hypocaloric diet , exercise training and adherence to physical activity recommendations are equally effective at reducing body weight and modifying body composition in the treatment of obesity ( Clinical Trials Gov. number : NCT01116856 ) BACKGROUND The efficacy of ad libitum low-fat diets in reducing body weight and fat in overweight and obese adults remains controversial . METHODS We examined the effect of a 12-week low-fat , high-complex carbohydrate diet alone ( HI-CHO ) and in combination with aerobic exercise training ( HI-CHO + EX ) on body weight and composition in 34 individuals with impaired glucose tolerance ( 20 women and 14 men ; mean + /- SEM age , 66 + /- 1 years ) . Participants were r and omly assigned to a control diet ( 41 % fat , 14 % protein , 45 % carbohydrates , and 7 g of fiber per 1000 kcal ) , a HI-CHO diet ( 18 % fat , 19 % protein , 63 % carbohydrates , and 26 g of fiber per 1000 kcal ) , or a HI-CHO diet plus endurance exercise 4 d/wk , 45 min/d , at 80 % peak oxygen consumption ( HI-CHO + EX ) . Participants were provided 150 % of estimated energy needs and were instructed to consume food ad libitum . Total food intake , body composition , resting metabolic rate , and substrate oxidation were measured . RESULTS There was no significant difference in total food intake among the 3 groups and no change in energy intake over time . The HI-CHO + EX and HI-CHO groups lost more body weight ( -4.8 + /- 0.9 kg [ P=.003 ] and -3.2 + /- 1.2 kg [ P=.02 ] ) and a higher percentage of body fat ( -3.5 % + /- 0.7 % [ P=.01 ] and -2.2 % + /- 1.2 % [ P=.049 ] ) than controls ( -0.1 + /- 0.6 kg and 0.2 % + /- 0.6 % ) . In addition , thigh fat area decreased in the HI-CHO ( P=.003 ) and HI-CHO + EX ( P<.001 ) groups compared with controls . High carbohydrate intake and weight loss did not result in a decreased resting metabolic rate or reduced fat oxidation . CONCLUSION A high-carbohydrate diet consumed ad libitum , with no attempt at energy restriction or change in energy intake , results in losses of body weight and body fat in older men and women
4 ) Conclusions : The analysis of the information here reported sheds light for the design of future clinical trials in adults with MS .
The best anthropometric parameters and units of measurement to monitor the interventions are related to dietary and physical exercise interventions .
( 1 ) Objective : to establish practical guidance for the design of future clinical trials in MS ( metabolic syndrome ) patients aged 18 and older , based on a systematic review of r and omized clinical trials connecting diet , physical exercise and changes in body composition . (