As the main cause of death in the world, the morbidity and mortality of cardiovascular diseases are increasing year by year. Chronic inflammation of circulatory system is common in middle-aged and older people, which is closely related to the pathogenesis of various cardiovascular diseases. Dyslipidemia is also one of the age-specific cardiovascular risk factors. Exercise has attracted much attention as an important intervention method, among which resistance training can reduce the risk of cardiovascular diseases in middle-aged and older people, but the regulation effect of inflammation and dyslipidemia is still controversial.
To explore the effect of resistance training on cardiovascular risk factors in middle-aged and older people, and to provide a basis for formulating exercise prescriptions for middle-aged and elderly people.
PubMed, Cochrane, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Chinese Science and Technology Journal Full-text Database were retrieve by computer for randomized controlled trials on the effects of resistance training on cardiovascular risk factors in middle-aged and older people published from the date of establishment to 2021-08-31. The retrieved literatures were screened and data extracted, including the first author, the year of publication, general characteristics of the study population, resistance training protocols and outcome indicators. The bias risk assessment tool of Cochrane system evaluation manual was used to evaluate the bias risk of literature. Meta-analysis was performed using RevMan 5.3 software, including the statistics of combined effect size, heterogeneity test, sensitivity analysis, and subgroup analysis. Publication bias of included studies was analyzed using Stata 16.0 software, using Egger's test.
Fifteen papers with 476 observations were included. Meta-analysis showed that, resistance training were superior to control group in decreasing C-reactive protein〔SMD (95%CI) =-0.67 (-0.89, -0.46) , P<0.01〕, total cholesterol〔SMD (95%CI) =-0.37 (-0.66, -0.08) , P=0.01〕, triglyceride〔SMD (95%CI) =-0.29 (-0.53, -0.05) , P=0.02〕, low-density lipoprotein cholesterol〔SMD (95%CI) =-0.37 (-0.67, -0.06) , P=0.02〕 and improving high-density lipoprotein cholesterol levels〔SMD (95%CI) =0.33 (0.09, 0.57) , P<0.01〕. Subgroup analysis showed that C-reactive protein and total cholesterol levels were lower in the resistance training group than in the control group at training duration ≤12 weeks, with statistically significant differences (P<0.05) . In both the training intensity of high intensity and the chronic disease population, C-reactive protein levels were lower in the resistance training group than in the control group and high-density lipoprotein cholesterol levels were higher, with statistically significant differences (P<0.05) .
Resistance training has been shown to be effective in reducing cardiovascular risk factors, reducing chronic inflammation and improving dyslipidaemia in the middle-aged and older population.
Telerehabilitation (TR) is an emerging model of rehabilitation service delivery based on communication technology, remote sensing and control technology, virtual reality technology and computer technology to to achieve cross-regional rehabilitation medical services. However, the effectiveness of TR in functional rehabilitation after stroke is still unclear, the methodological quality of related studies is uneven, and few researchers have systematically evaluated it.
To re-evaluate the systematic reviews/meta-analyses on the effectiveness of TR for functional rehabilitation after stroke.
In August 2021, PubMed, Web of science, the Cochrane Library, VIP, WanFang Data, CNKI and CBM were retrieved by computer for systematic reviews/meta-analyses on the effectiveness of TR applied to functional rehabilitation after stroke from the establishment of the database to August 2021. After the literature screen and data extract by two researchers independently, the methodological quality of the included literature was evaluated by AMSTAR 2 scale, and the evidence quality of the outcome index was graded by GRADE system. Descriptive analysis was used to analyze the effectiveness of TR in functional rehabilitation after stroke.
A total of 10 systematic reviews/meta-analyses were included, and the results of the AMSTAR 2 review showed that 2 systematic reviews were of high quality, 3 were of low quality, and 5 were of very low quality. The main reasons for the low methodological quality were the failure to report the preliminary study protocol, the list and reasons for excluded studies, the publication bias of the original study and the funding sources. The GRADE evidence quality assessment resulted in 10 systematic reviews addressing seven outcome measures, 41 bodies of evidence, with eight grade graded as intermediate, 23 grade graded as low, and 10 grade graded as very low. TR promoted the improvement of activities of daily living, motor function, quality of life, depressive symptoms and speech function of stroke patients to a certain extent, and had the same curative effect as face-to-face rehabilitation therapy or routine treatment, and even some TR rehabilitation effects were better than traditional rehabilitation therapy.
TR can promote the functional rehabilitation of stroke patients, but considering that the methodological quality and reliability of outcome measures of current systematic reviews/meta-analyses on the effectiveness of TR applied to functional recovery after stroke are mostly low, strict, standardized and comprehensive high-quality randomized controlled trials are still needed to provide evidence support; The results of this study can provide reference for the topic selection, research design and results report of future TR research.
Cognitive impairment (CI) is a common complication of chronic heart failure (CHF) , which may significantly increase the risk of poor prognosis, so early identification of associated factors of CI in CHF is of great significance. Although there have been many relevant studies recently, their conclusions are inconsistent.
To perform a systematic review of the influencing factors of CI in CHF.
In August 2021, studies relevant to influencing factors of CI among patients with CHF were searched in databases including PubMed, Embase, The Cochrane Library, Web of Science, CINAHL, PsychINFO, CNKI, Wanfang Data, CQVIP, and SinoMed from inception to August 2021. Two researchers independently screened studies based on the inclusion and exclusion criteria, extracted data, and performed risk of bias assessment using the Newcastle-Ottawa Scale and The Agency for Healthcare Research and Quality methodology checklist, then conducted a descriptive analysis of the factors associated with CI in CHF. RevMan 5.3 was adopted for meta-analysis.
Fourteen studies were included, involving 6 324 cases of CHF, and 1 753 of them also with CI. Descriptive analysis indicated that five factors decreased the risk of CI in CHF, and 22 factors increased the risk, but the influence of sex and systolic blood pressure on CI is still far from inclusive. Meta-analysis demonstrated that education level〔OR=0.45, 95%CI (0.30, 0.70) 〕, age〔OR=1.17, 95%CI (1.10, 1.24) 〕, diabetes〔OR=2.17, 95%CI (1.17, 4.01) 〕, anemia〔OR=3.03, 95%CI (1.80, 5.10) 〕and left ventricular ejection fraction〔OR=0.91, 95%CI (0.88, 0.94) 〕were associated with CI in CHF.
High education level lowered the risk of CI in CHF, while older age, diabetes, anemia and decreased left ventricular ejection fraction increased the risk. Due to limited number and quality of included studies, the above-mentioned conclusion still needs to be verified by more high-quality studies.
