Exercise and bone mineral density in men: a meta-analysis of randomized controlled trials.

OBJECTIVE: Use the meta-analytic approach to examine the effects of ground and/or joint reaction force exercise on femoral neck (FN) and lumbar spine (LS) bone mineral density (BMD) in men. METHODS: Randomized controlled exercise trials ≥ 24 weeks were included. Standardized effect sizes (g) were calculated and pooled using random-effects models, z-score alpha values and 95% confidence intervals (CI). Heterogeneity was examined using Q and I(2). Statistical significance was set at a two-tailed alpha value (p) of ≤ 0.05 and a trend at >0.05 to ≤ 0.10. RESULTS: A moderate and statistically significant improvement was found at the FN (3 g's, 187 participants, g=0.583, 95% CI=0.031, 1.135, p=0.04, Q=5.6, p=0.06, I(2)=64%) while a small trend was observed at the LS (5 g's, 275 participants, g=0.190, 95% CI=-0.036, 0.416, p=0.10, Q=3.0, p=0.55, I(2)=0%). Results were sensitive to influence analysis as well as collapsing multiple groups from the same studies so that only one g represented each study. CONCLUSIONS: There is currently insufficient evidence to recommend ground and/or joint reaction force exercise for improving and/or maintaining FN and LS BMD in men. Additional well-designed randomized controlled trials are needed before any final recommendations can be formulated.

Exercise improves global well-being in adults with fibromyalgia: confirmation of previous meta-analytic results using a recently developed and novel varying coefficient model.

OBJECTIVES: To determine the effects of exercise (aerobic, strength training or both) on global well-being in adults with fibromyalgia (FM). METHODS: The meta-analytic approach and recently developed varying coefficient model were used to pool the results of previous randomised controlled trials of exercise (aerobic, strength training or both) on global well-being in adults with FM. The standardised effect size (ES) for global well-being from each study was pooled using a recently developed and novel varying coefficient (VC) model and partitioned according to per-protocol and intention-to-treat analyses. Results were also compared to the traditionally used random effects (RE) model. Non-overlapping 95% confidence intervals were considered statistically significant with negative ESs indicative of improvements in global well-being. RESULTS: Five ESs representing 377 participants were included in the per-protocol analysis and 5 ESs representing 252 participants were included in the intention-to-treat analysis. Using the VC model, statistically significant improvements in global-well being were found for both per-protocol (-X, -0.39, 95% CI, -0.62, -0.15) and intention-to-treat analysis (-X, -0.40, 95% CI, -0.68, -0.13). Results were similar to those from the RE model. CONCLUSIONS: Using the recently developed and more valid varying coefficient model, these findings confirm that exercise improves global-well being in adults with FM.

United States (US) multi-center study to assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III).

STUDY DESIGN: Multi-center, prospective, cohort study. OBJECTIVES: To assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III) in measuring functional ability in persons with spinal cord injury (SCI). SETTING: Inpatient rehabilitation hospitals in the United States (US). METHODS: Functional ability was measured with the SCIM III during the first week of admittance into inpatient acute rehabilitation and within one week of discharge from the same rehabilitation program. Motor and sensory neurologic impairment was measured with the American Spinal Injury Association Impairment Scale. The Functional Independence Measure (FIM), the default functional measure currently used in most US hospitals, was used as a comparison standard for the SCIM III. Statistical analyses were used to test the validity and reliability of the SCIM III. RESULTS: Total agreement between raters was above 70% on most SCIM III tasks and all κ-coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.81 and intraclass correlation coefficients were above 0.81. Cronbach's-α was above 0.7, with the exception of the respiration task. The coefficient of Pearson correlation between the FIM and SCIM III was 0.8 (P<0.001). For the respiration and sphincter management subscale, the SCIM III was more responsive to change, than the FIM (P<0.0001). CONCLUSION: Overall, the SCIM III is a reliable and valid measure of functional change in SCI. However, improved scoring instructions and a few modifications to the scoring categories may reduce variability between raters and enhance clinical utility.

Effects of aerobic exercise on lipids and lipoproteins in adults with type 2 diabetes: a meta-analysis of randomized-controlled trials.

OBJECTIVE: To conduct a meta-analysis of randomized-controlled trials in order to examine the effects of 8 weeks or more of aerobic exercise on lipids and lipoproteins in adults with Type 2 diabetes. METHODS: Studies were included if total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), ratio of TC to HDL-C (TC/HDL-C), triglycerides (TG), or all of the above, were assessed. A secondary outcome was glycosylated haemoglobin (HbA1). RESULTS: Seven studies representing 220 men and women (112 exercise, 108 control) were available for pooling. Using a random-effects model, a statistically significant reduction of about 5% was found for LDL-C, whereas no statistically significant improvements were found for TC, HDL-C, TC/HDL-C or TG. A trend for a statistically significant reduction in HbA1 was also found. CONCLUSIONS: Although our overall results suggest that aerobic exercise lowers LDL-C in adults with Type 2 diabetes, additional randomized-controlled trials are needed on this topic.

Aerobic exercise and HDL2-C: a meta-analysis of randomized controlled trials.

PURPOSE: Use the meta-analytic approach to examine the effects of aerobic exercise on high-density lipoprotein two cholesterol (HDL2-C) in adults. STUDY SOURCES: (1) Computerized literature searches; (2) cross-referencing from retrieved articles; (3) hand-searching; and (4) expert review of our reference list. STUDY SELECTION: (1) Randomized controlled trials; (2) aerobic exercise > or = 8 weeks; (3) adults > or = 18 years of age; (4) studies published in journal, dissertation, or master's thesis format; (5) studies published in the English-language between January 1, 1955 and January 1, 2003; and (6) assessment of HDL2-C in the fasting state. DATA ABSTRACTION: All coding conducted by both authors, independent of each other. Discrepancies were resolved by consensus. RESULTS: Nineteen randomized controlled trials representing 20 HDL2-C outcomes from 984 males and females (516 exercise, 468 control) were pooled for analysis. Using random-effects modeling and bootstrap confidence intervals (BCI), a statistically significant increase of approximately 11% was observed for HDL2-C (X +/- S.E.M., 2.6 +/- 0.9 mg/dl, 95% BCI, 1.0-4.4 mg/dl). With each study deleted from the model once, results remained statistically significant. Increases in HDL2-C were independent of decreases in body weight, body mass index (kg/m2), and percent body fat. CONCLUSION: Aerobic exercise increases HDL2-C in adults.

Aerobic exercise, lipids and lipoproteins in overweight and obese adults: a meta-analysis of randomized controlled trials.

OBJECTIVE: Use the meta-analytic approach to examine the effects of aerobic exercise on lipids and lipoproteins in overweight and obese adults. DATA SOURCES: (1) Computerized literature searches, (2) cross-referencing from review and original articles, (3) hand searching, and (4) expert review of reference list. STUDY SELECTION: (1) randomized controlled trials, (2) aerobic exercise > or =8 weeks, (3) adult humans > or =18 y of age, (4) all subjects overweight or obese (BMI > or =25 kg/m(2)), (5) studies published in journal, dissertation, or master's thesis format, (6) studies published in the English-language, (7) studies published between 1 January 1955 and 1 January 2003, (8) assessment of one or more of the following lipid and/or lipoprotein variables: total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), and triglycerides (TG). DATA ABSTRACTION: Dual-coding by the first two authors (inter-rater agreement=0.96). RESULTS: In total, 13 studies representing 31 groups (17 exercise, 14 control), 613 subjects (348 exercise, 265 control), and up to 17 outcomes were available for pooling. Across all categories, random-effects modeling resulted in statistically significant improvements for TC (X +/- s.e.m., - 3.4+/-1.7 mg/dl, 95% CI, - 6.7 to - 0.2 mg/dl) and TG (X +/-s.e.m., - 16.1+/-7.3 mg/dl, 95% CI, - 30.2 to - 2.1 mg/dl) but not HDL (X +/- s.e.m., 1.6+/-0.8 mg/dl, 95% CI, - 0.02 to 3.2 mg/dl) or LDL (X +/-s.e.m., - 0.5+/-1.3 mg/dl, 95% CI, - 3.0 to 2.0 mg/dl). Changes were equivalent to improvements of 2% (TC), 11% (TG), 3% (HDL), and 0.3% (LDL). After conducting sensitivity analyses (each study deleted from the model once), only decreases in TG remained statistically significant. Increases in HDL were associated with increases in maximum oxygen consumption (VO(2 max) in ml/kg/min, r=0.75, P=0.002) and decreases in body weight (r=0.77, P<0.001), while decreases in LDL were associated with decreases in body weight (r=0.75, P=0.009). CONCLUSIONS: Aerobic exercise decreases TG in overweight and obese adults. However, a need exists for additional randomized controlled trials in various overweight and/or obese populations above and beyond those included in our analysis.

Walking and resting blood pressure in adults: a meta-analysis.

BACKGROUND: The purpose of this study was to examine the effects of walking on resting systolic and diastolic blood pressure in adults. METHODS: A total of 24 primary outcomes from 16 studies and 650 subjects (410 exercise, 240 control) met the criteria for inclusion: (1) randomized and nonrandomized controlled trials, (2) walking as the only intervention, (3) subjects apparently sedentary, (4) adult humans > or =18 years of age, (5) English-language studies published between January 1966 and December 1998, (6) resting blood pressure assessed, (7) training studies > or =4 weeks. RESULTS: Using a random effects model, statistically significant decreases of approximately 2% were found for both resting systolic and diastolic blood pressure (systolic, mean +/- SEM = -3 +/- 1 mm Hg, 95% confidence interval: -5 to -2 mm Hg; diastolic, mean +/- SEM = -2 +/- 1 mm Hg, 95% confidence interval: -3 to -1 mm Hg). CONCLUSION: Walking exercise programs reduce resting blood pressure in adults.

Resistance training and bone mineral density in women: a meta-analysis of controlled trials.

The purpose of this study was to use meta-analysis to examine the effects of resistance training on bone mineral density at the femur, lumbar spine, and radius in pre- and postmenopausal women. Resistance training had a positive effect on bone mineral density at the lumbar spine of all women and at the femur and radius sites for postmenopausal women. It was concluded that resistance training has a positive effect on bone mineral density in women.

Exercise and bone mineral density in men: a meta-analysis.

The purpose of this study was to use the meta-analytic approach to examine the effects of exercise on bone mineral density (BMD) in men. A total of 26 effect sizes (ES) representing 225 subjects from 8 studies met the criteria for inclusion. When BMD sites assessed were specific to the sites loaded during exercise, increases of approximately 2.6% (2.1% in the exercisers and -0.5% in the controls) were found. These results were statistically significant (ES = 0.213, 95% bootstrap confidence interval = 0.007-0.452). Statistically significant ES changes were found for older (>31 yr) but not younger (<31 yr) adults, with differences between groups statistically significant (P = 0.04). Statistically significant changes were also observed at the femur, lumbar, and os calcis sites. The results of this study suggest that site-specific exercise may help improve and maintain BMD at the femur, lumbar, and os calcis sites in older men. However, the biological importance of the small changes observed for most outcomes, quality of studies, and limited data pool prevent us from forming any firm conclusion regarding the use of exercise for maintaining and/or improving BMD in men. Clearly, a need exists for additional studies.

Progressive resistance exercise and resting blood pressure : A meta-analysis of randomized controlled trials.

Hypertension is a major public health problem affecting an estimated 43 million civilian, noninstitutionalized adults in the United States (24% of this population). The purpose of this study was to use the meta-analytic approach to examine the effects of progressive resistance exercise on resting systolic and diastolic blood pressure in adult humans. Studies were retrieved via (1) computerized literature searches, (2) cross-referencing from original and review articles, and (3) review of the reference list by 2 experts on exercise and blood pressure. Inclusion criteria were as follows: (1) trials that included a randomized nonexercise control group; (2) progressive resistance exercise as the only intervention; (3) adult humans; (4) journal articles, dissertations, and masters theses published in the English-language literature; (5) studies published and indexed between January 1966 and December 1998; (6) resting systolic and/or diastolic blood pressure assessed; and (7) training studies lasting a minimum of 4 weeks. Across all designs and categories, fixed-effects modeling yielded decreases of approximately 2% and 4% for resting systolic and diastolic blood pressure, respectively (mean+/-SD systolic, -3+/-3 mm Hg; 95% bootstrap CI, -4 to -1 mm Hg; mean+/-SD diastolic, -3+/-2 mm Hg; 95% bootstrap CI, -4 to -1 mm Hg). It was concluded that progressive resistance exercise is efficacious for reducing resting systolic and diastolic blood pressure in adults. However, a need exists for additional studies that limit enrollment to hypertensive subjects as well as analysis of data with an intention-to-treat approach before the effectiveness of progressive resistance exercise as a nonpharmacological intervention can be determined.

Aerobic exercise and resting blood pressure in women: a meta-analytic review of controlled clinical trials.

The purpose of this study was to use the meta-analytic approach to examine the effects of aerobic exercise on resting systolic and diastolic blood pressure in women. Twenty-one studies representing 1029 subjects (663 exercise, 366 controls) and 54 primary outcomes (28 systolic, 26 diastolic) met the criteria for inclusion. Across all designs and categories, statistically significant decreases in resting systolic (mean +/- SD, -2.03 +/- 2.87, 95% confidence interval [CI] -3.14 to -0.92 mm Hg) but not diastolic (mean +/- SD, -0.64 +/- 2.02, 95% CI -1.45 to 0.18 mm Hg) blood pressure were found. Changes in resting systolic blood pressure were correlated with initial systolic blood pressure, initial body mass index, initial resting heart rate, and rest period before assessment of blood pressure. Meta-analysis of included studies suggests that aerobic exercise causes small reductions in resting systolic blood pressure in women. However, a need exists for additional, well-designed studies on this topic, especially among hypertensive adult women.

Physical activity habits of African-American college students.

The purpose of this study was to examine the physical activity habits of African-American college students enrolled at a historically African-American institution. A total of 253 freshmen (90 males, 163 females) completed self-report measures of physical activity levels and were also assessed on height and weight. Chi-square analyses demonstrated that males (65%) were more active than females (42%). No significant differences existed between the prevalence of overfatness or obesity and activity levels for either males or females. Descriptive statistics showed a trend for groups categorized as more active to participate more frequently in selected physical activities. The authors concluded that freshmen African-American college students, especially females, display low levels of physical activity.

Nicotine-stimulated proteins in mouse cells are distinct from heat-shock proteins.

Treatment of mouse tissue-culture cells with nicotine concentrations of 1 mM or less had no significant effects on cell viability, morphology or protein synthesis, but higher concentrations resulted in both altered cell morphology (rounding and vacuolization) and alterations in [3H]leucine-labelled protein profiles on sodium dodecyl sulphate/polyacrylamide gels. The synthesis of a Mr-70 000 protein was increased more than 2-fold relative to that of other major cellular proteins in 3T3 and L929 cells treated with 5 mM-nicotine and in B16 cells treated with 10 mM-nicotine, and this protein appeared to be a soluble cytoplasmic polypeptide. The radiolabelling of several additional polypeptides (Mr 62 000 in 3T3 cells, and Mr 45 000 and 38 000 in B16 cells) was also stimulated by nicotine. The nicotine-enhanced Mr-70 000 protein was distinct, however, from a major cell stress/heat-shock protein whose synthesis was stimulated after incubation of cells at 43.5 degrees C for 20 min.