Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews

Abstract

Background Sedentary lifestyle is a major risk factor for noncommunicable diseases such as cardiovascular diseases, cancer and diabetes. It has been estimated that approximately 3.2 million deaths each year are attributable to insufficient levels of physical activity. We evaluated the available evidence from Cochrane systematic reviews (CSRs) on the effectiveness of exercise/physical activity for various health outcomes. Methods Overview and meta-analysis. The Cochrane Library was searched from 01.01.2000 to issue 1, 2019. No language restrictions were imposed. Only CSRs of randomised controlled trials (RCTs) were included. Both healthy individuals, those at risk of a disease, and medically compromised patients of any age and gender were eligible. We evaluated any type of exercise or physical activity interventions; against any types of controls; and measuring any type of health-related outcome measures. The AMSTAR-2 tool for assessing the methodological quality of the included studies was utilised. Results Hundred and fifty CSRs met the inclusion criteria. There were 54 different conditions. Majority of CSRs were of high methodological quality. Hundred and thirty CSRs employed meta-analytic techniques and 20 did not. Limitations for studies were the most common reasons for downgrading the quality of the evidence. Based on 10 CSRs and 187 RCTs with 27,671 participants, there was a 13% reduction in mortality rates risk ratio (RR) 0.87 [95% confidence intervals (CI) 0.78 to 0.96]; I2 = 26.6%, [prediction interval (PI) 0.70, 1.07], median effect size (MES) = 0.93 [interquartile range (IQR) 0.81, 1.00]. Data from 15 CSRs and 408 RCTs with 32,984 participants showed a small improvement in quality of life (QOL) standardised mean difference (SMD) 0.18 [95% CI 0.08, 0.28]; I2 = 74.3%; PI -0.18, 0.53], MES = 0.20 [IQR 0.07, 0.39]. Subgroup analyses by the type of condition showed that the magnitude of effect size was the largest among patients with mental health conditions. Conclusion There is a plethora of CSRs evaluating the effectiveness of physical activity/exercise. The evidence suggests that physical activity/exercise reduces mortality rates and improves QOL with minimal or no safety concerns. Trial registration Registered in PROSPERO (CRD42019120295) on 10th January 2019.

Summary of the Effects of Exercise Therapy in Non-Communicable Diseases: Clinically Relevant Evidence from Meta-Analyses of Randomized Controlled Trials

“…While randomization and intention-to-treat analyses have been carried out in recent RCTs, there appears to be an ongoing problem with concealment of allocation, as in many meta-analyses the effects are not as strong in the sub-group of studies where concealment of allocation has been properly described. This also explains why effects of exercise therapy on mortality did not reach a high enough standard of evidence to be included in the present study [91, 92]. A common problem in exercise therapy studies is the insufficient documentation and analysis of possible co-interventions, such as changes in medication or diet.…”

Post-COVID-19 Syndrome and the Potential Benefits of Exercise

“…Overwhelming evidence exists that exercise produces short-, middle-and long-term health benefits that prevent, delay, mitigate and even reverse a large number of metabolic, pulmonary, cardiovascular, neurocognitive, inflammatory, rheumatic and musculoskeletal diseases [7][8][9][10][11][12][13]. Accordingly, physical inactivity has been associated with a higher risk for severe COVID-19 outcomes [14].…”

Relationships among types of activity engagement and insomnia symptoms among older adults

“…Also, physical activity can lead to an increase in core body temperature, which can facilitate initiation of sleep [15] and improve sleep through the anxiolytic effects of physical activity [16]. Furthermore, physical activity, which may lead to energy expenditure, requires body restoration and better sleep [17]. Accordingly, there is a growing body of research examining the association of sleep and different types of activity engagement.…”