Physical Activity For The Prevention And Treatment Of Major Chronic Disease: An Overview Of Systematic Reviews

TY - JOUR

T1 - Physical Activity For The Prevention And Treatment Of Major Chronic Disease: An Overview Of Systematic Reviews

AU - Nunan, David

AU - Bobrovitz, N

AU - Ajanaku, A

AU - Hacke, Claudia

AU - Onakpoya, I

AU - Roberts, Nia

AU - Thomas, Sarah

AU - Tompson, Alice

AU - Heneghan, Carl

AU - Mahtani, Kamal

PY - 2017/6

Y1 - 2017/6

N2 - PURPOSE:Evidence of physical activity (PA) as beneficial for health stems mainly from observational studies. Findings from randomised controlled trials (RCTs) often differ and systematic reviews of RCTs demonstrate mixed results making translation into clinical practice difficult. An overview of existing review evidence is needed to identify PA interventions that are effective in preventing or treating major chronic disease.METHODS:We searched the Cochrane Database of Systematic Reviews for reviews of RCTs restricted to 20 major chronic diseases. A minimum of two authors independently screened search outputs, selected studies, extracted data and assessed quality of included reviews using AMSTAR. Certainty of effect estimates was assessed using the GRADE method. Primary RCTs within included reviews found to demonstrate confounding were excluded, and affected pooled estimates were re-calculated. RESULTS:56 Cochrane systematic reviews (49[88%] deemed high quality according to AMSTAR) across 20 chronic health conditions consisting a total of 829 RCTs and 65,032 participants were included. Data were extracted on 435 outcomes of which GRADE assessments were already available for 56 (13%) and newly derived for a further189 (43%). We re-analysed 159 pooledestimates across 27 reviews due to exclusion of 321 confounded trials.We found high quality evidence of a clinical and statistical benefit of PA for self reported pain and self reported pain and physical function in patients with osteoarthritis of the knee and hip; and dyspnoea and fatigue quality of life measures in patients with COPD. Conversely, high quality evidence for no effect of PA was found for bone mineral density of the neck, hip and trochanter in postmenopausal women; and disease activity and radiological damage in patients with rheumatoid arthritis. The remaining outcomes showed moderate (42[17%]), low (112[46%]) and very low (79[32%]) quality evidence, predominantly in favour of PA.CONCLUSIONS:A number of chronic health conditions for which clinical guidelines recommend physical activity may not be supported by high quality, clinically relevant evidence. Where there is a strong evidence base, a formula of efficacious physical activity interventions is warranted but maybe hampered by heterogeneity within the available literature.

AB - PURPOSE:Evidence of physical activity (PA) as beneficial for health stems mainly from observational studies. Findings from randomised controlled trials (RCTs) often differ and systematic reviews of RCTs demonstrate mixed results making translation into clinical practice difficult. An overview of existing review evidence is needed to identify PA interventions that are effective in preventing or treating major chronic disease.METHODS:We searched the Cochrane Database of Systematic Reviews for reviews of RCTs restricted to 20 major chronic diseases. A minimum of two authors independently screened search outputs, selected studies, extracted data and assessed quality of included reviews using AMSTAR. Certainty of effect estimates was assessed using the GRADE method. Primary RCTs within included reviews found to demonstrate confounding were excluded, and affected pooled estimates were re-calculated. RESULTS:56 Cochrane systematic reviews (49[88%] deemed high quality according to AMSTAR) across 20 chronic health conditions consisting a total of 829 RCTs and 65,032 participants were included. Data were extracted on 435 outcomes of which GRADE assessments were already available for 56 (13%) and newly derived for a further189 (43%). We re-analysed 159 pooledestimates across 27 reviews due to exclusion of 321 confounded trials.We found high quality evidence of a clinical and statistical benefit of PA for self reported pain and self reported pain and physical function in patients with osteoarthritis of the knee and hip; and dyspnoea and fatigue quality of life measures in patients with COPD. Conversely, high quality evidence for no effect of PA was found for bone mineral density of the neck, hip and trochanter in postmenopausal women; and disease activity and radiological damage in patients with rheumatoid arthritis. The remaining outcomes showed moderate (42[17%]), low (112[46%]) and very low (79[32%]) quality evidence, predominantly in favour of PA.CONCLUSIONS:A number of chronic health conditions for which clinical guidelines recommend physical activity may not be supported by high quality, clinically relevant evidence. Where there is a strong evidence base, a formula of efficacious physical activity interventions is warranted but maybe hampered by heterogeneity within the available literature.

U2 - 10.1249/01.mss.0000518545.93316.c0

DO - 10.1249/01.mss.0000518545.93316.c0

M3 - Conference abstract in journal

VL - 49

SP - 591

JO - MED SCI SPORT EXER

JF - MED SCI SPORT EXER

SN - 0195-9131

IS - 5S

ER -