Hamish Reid

Will Exercise Advice Be Sufficient for Treatment of Young Adults With Prehypertension and Hypertension? A Systematic Review and Meta-Analysis.

Previous studies report benefits of exercise for blood pressure control in middle age and older adults, but longer-term effectiveness in younger adults is not well established. We performed a systematic review and meta-analysis of published randomized control trials with meta-regression of potential effect modifiers. An information specialist completed a comprehensive search of available data sources, including studies published up to June 2015. Authors applied strict inclusion and exclusion criteria to screen 9524 titles. Eligible studies recruited younger adults with a cardiovascular risk factor (with at least 25% of cohort aged 18–40 years); the intervention had a defined physical activity strategy and reported blood pressure as primary or secondary outcome. Meta-analysis included 14 studies randomizing 3614 participants, mean age 42.2±6.3 (SD) years. At 3 to 6 months, exercise was associated with a reduction in systolic blood pressure of −4.40 mm Hg (95% confidence interval, −5.78 to −3.01) and in diastolic blood pressure of −4.17 mm Hg (95% confidence interval, −5.42 to −2.93). Intervention effect was not significantly influenced by baseline blood pressure, body weight, or subsequent weight loss. Observed intervention effect was lost after 12 months of follow-up with no reported benefit over control, mean difference in systolic blood pressure −1.02 mm Hg (95% confidence interval, −2.34 to 0.29), and in diastolic blood pressure −0.91 mm Hg (95% confidence interval, −1.85 to 0.02). Current exercise guidance provided to reduce blood pressure in younger adults is unlikely to benefit long-term cardiovascular risk. There is need for continued research to improve age-specific strategies and recommendations for hypertension prevention and management in young adults.

Making physical activity evidence accessible: are these infographics the answer?

Non-communicable diseases (NCDs) account for 68% of all deaths worldwide. In the UK, NCDs are responsible for 80% of all deaths.1 Physical inactivity is one of the four key behavioural risk factors for NCDs. Across the four countries of the UK, at least one-third of adults are insufficiently active, which is higher than the global average, the majority of our European neighbours and the USA.2 The 2011 physical activity recommendations, published by the four UK Chief Medical Officers (CMOs), emphasised the goal of achieving an active lifestyle across the life course. The challenge of increasing and sustaining the physical activity levels of the UKs child and adult populations has been central to national policies and plans since the mid-1990s. A consistent feature of these plans has been the role of the healthcare setting in the promotion of physical activity for the prevention and treatment of disease. Reports by the Royal Colleges,3 ,4 House of Commons Health Committee,5 Public Health England (PHE)6 and the National …

What works to promote walking at the population level? A systematic review

Objective Interventions to promote walking have focused on individual or group-based approaches, often via the randomised controlled trial design. Walking can also be promoted using population health approaches. We systematically reviewed the effectiveness of population approaches to promote walking among individuals and populations. Design A systematic review. Data sources 10 electronic databases searched from January 1990 to March 2017. Eligibility criteria Eligibility criteria include pre-experimental and postexperimental studies of the effects of population interventions to change walking, and the effects must have been compared with a ‘no intervention’, or comparison group/area/population, or variation in exposure; duration of ≥12 months of follow up; participants in free-living populations; and English-language articles. Results 12 studies were identified from mostly urban high-income countries (one focusing on using tax, incentivising the loss of parking spaces; and one using policy only, permitting off-leash dogs in city parks). Five studies used mass media with either environment (n=2) or community (n=3) approaches. Four studies used environmental changes that were combined with policies. One study had scaled up school-based approaches to promote safe routes to schools. We found mass media, community initiatives and environmental change approaches increased walking (range from 9 to 75 min/week).

Tourniquet Test for Dengue Diagnosis: Systematic Review and Meta-analysis of Diagnostic Test Accuracy.

Background Dengue fever is a ubiquitous arboviral infection in tropical and sub-tropical regions, whose incidence has increased over recent decades. In the absence of a rapid point of care test, the clinical diagnosis of dengue is complex. The World Health Organisation has outlined diagnostic criteria for making the diagnosis of dengue infection, which includes the use of the tourniquet test (TT). Purpose To assess the quality of the evidence supporting the use of the TT and perform a diagnostic accuracy meta-analysis comparing the TT to antibody response measured by ELISA. Data Sources A comprehensive literature search was conducted in the following databases to April, 2016: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, BIOSIS, Web of Science, SCOPUS. Study Selection Studies comparing the diagnostic accuracy of the tourniquet test with ELISA for the diagnosis of dengue were included. Data Extraction Two independent authors extracted data using a standardized form. Data Synthesis A total of 16 studies with 28,739 participants were included in the meta-analysis. Pooled sensitivity for dengue diagnosis by TT was 58% (95% Confidence Interval (CI), 43%-71%) and the specificity was 71% (95% CI, 60%-80%). In the subgroup analysis sensitivity for non-severe dengue diagnosis was 55% (95% CI, 52%-59%) and the specificity was 63% (95% CI, 60%-66%), whilst sensitivity for dengue hemorrhagic fever diagnosis was 62% (95% CI, 53%-71%) and the specificity was 60% (95% CI, 48%-70%). Receiver-operator characteristics demonstrated a test accuracy (AUC) of 0.70 (95% CI, 0.66–0.74). Conclusion The tourniquet test is widely used in resource poor settings despite currently available evidence demonstrating only a marginal benefit in making a diagnosis of dengue infection alone. Registration The protocol for this systematic review was registered at PROSPERO: CRD42015020323.

Physical activity and pregnancy: time for guidance in the UK

Regular physical activity during pregnancy has a positive impact on pregnancy outcomes and fetomaternal health.1–3 Pregnancy also offers the chance to increase physical activity and sustain this healthy behaviour beyond childbirth. Health behaviours established during childhood can last across the life course, so physical activity interventions during pregnancy may provide a powerful opportunity for population change.4 Despite these benefits, national recommendations do not exist in the UK for physical activity during pregnancy. In their 2011 physical activity recommendations, the UK Chief Medical Officers (CMOs) emphasised the importance of achieving an active lifestyle across the life course, producing guidelines for four categories: the under 5s, children and young people, adults, and older adults. Pregnancy, however, was omitted from their reviews of evidence and no specific physical activity recommendations exist for this group of women. This omission is to the detriment of antenatal care as recommendations provide an important benchmark …

Will Exercise Advice Be Sufficient for Treatment of Young Adults With Prehypertension and Hypertension

Previous studies report benefits of exercise for blood pressure control in middle age and older adults, but longer-term effectiveness in younger adults is not well established. We performed a systematic review and meta-analysis of published randomized control trials with meta-regression of potential effect modifiers. An information specialist completed a comprehensive search of available data sources, including studies published up to June 2015. Authors applied strict inclusion and exclusion criteria to screen 9524 titles. Eligible studies recruited younger adults with a cardiovascular risk factor (with at least 25% of cohort aged 18–40 years); the intervention had a defined physical activity strategy and reported blood pressure as primary or secondary outcome. Meta-analysis included 14 studies randomizing 3614 participants, mean age 42.2±6.3 (SD) years. At 3 to 6 months, exercise was associated with a reduction in systolic blood pressure of −4.40 mm Hg (95% confidence interval, −5.78 to −3.01) and in diastolic blood pressure of −4.17 mm Hg (95% confidence interval, −5.42 to −2.93). Intervention effect was not significantly influenced by baseline blood pressure, body weight, or subsequent weight loss. Observed intervention effect was lost after 12 months of follow-up with no reported benefit over control, mean difference in systolic blood pressure −1.02 mm Hg (95% confidence interval, −2.34 to 0.29), and in diastolic blood pressure −0.91 mm Hg (95% confidence interval, −1.85 to 0.02). Current exercise guidance provided to reduce blood pressure in younger adults is unlikely to benefit long-term cardiovascular risk. There is need for continued research to improve age-specific strategies and recommendations for hypertension prevention and management in young adults.

Will Exercise Advice Be Sufficient for Treatment of Young Adults With Prehypertension and Hypertension? A Systematic Review and Meta-AnalysisNovelty and Significance

Previous studies report benefits of exercise for blood pressure control in middle age and older adults, but longer-term effectiveness in younger adults is not well established. We performed a systematic review and meta-analysis of published randomized control trials with meta-regression of potential effect modifiers. An information specialist completed a comprehensive search of available data sources, including studies published up to June 2015. Authors applied strict inclusion and exclusion criteria to screen 9524 titles. Eligible studies recruited younger adults with a cardiovascular risk factor (with at least 25% of cohort aged 18–40 years); the intervention had a defined physical activity strategy and reported blood pressure as primary or secondary outcome. Meta-analysis included 14 studies randomizing 3614 participants, mean age 42.2±6.3 (SD) years. At 3 to 6 months, exercise was associated with a reduction in systolic blood pressure of −4.40 mm Hg (95% confidence interval, −5.78 to −3.01) and in diastolic blood pressure of −4.17 mm Hg (95% confidence interval, −5.42 to −2.93). Intervention effect was not significantly influenced by baseline blood pressure, body weight, or subsequent weight loss. Observed intervention effect was lost after 12 months of follow-up with no reported benefit over control, mean difference in systolic blood pressure −1.02 mm Hg (95% confidence interval, −2.34 to 0.29), and in diastolic blood pressure −0.91 mm Hg (95% confidence interval, −1.85 to 0.02). Current exercise guidance provided to reduce blood pressure in younger adults is unlikely to benefit long-term cardiovascular risk. There is need for continued research to improve age-specific strategies and recommendations for hypertension prevention and management in young adults.

THE EFFECTIVENESS OF PHYSICAL ACTIVITY INTERVENTIONS TO REDUCE BLOOD PRESSURE IN YOUNG ADULTS WITH INCREASED CARDIOVASCULAR RISK: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction Young adults with cardiovascular risk factors, such as hypertension, may gain long-term risk benefits from effective targeted lifestyle interventions. We compared the effectiveness of lifestyle interventions with defined physical activity components targeting change in blood pressure, in young adults (aged 20 to 40) with established cardiovascular risk factors. Methods We searched databases including CENTRAL, MEDLINE, EMBASE, CINAHL (from earliest dates available to May 2014) and assessed reference lists of relevant articles for potential titles. Study selection criteria including: randomised control trials with at least 12 weeks follow-up; reporting blood pressure as the primary outcome; targeting participants aged between 20 to 40 years or within one standard deviation of this age range. Four authors (WW, PK, AL, HR), independently screened the eligibility of trials. Titles selected for full review were discussed and disagreement settled with an independent pair of authors (CF and PL). Meta-analysis was completed using Review Manager (RevMan) Version 5.2 using a random effects model imputing post intervention blood pressures. Study protocol available on PROSPERO 2014:CRD42014009604. Results 13 studies satisfied all inclusion criteria, baseline mean age of participants was 42.7 years (SD 6.4) (n = 3338). 11 trials targeted increased moderate to vigorous physical activity (MVPA) either via supervised exercise (n = 8) or via behavioural counselling (n = 3). One trial investigated effects of resistance exercise and 1 study implemented a yoga trial. Meta-analysis was restricted to the trials targeting increased MVPA with analysis performed according to duration of follow-up. In total 10 studies (n = 2716) reported 3 to 6 months outcomes, mean reduction in systolic BP was –4.4 mmHg (95% CI -5.8 to -3) and mean reduction in diastolic BP was –4.3 mmHg (95% CI -5.6 to -3.0). The effects of intervention on blood pressure at 3 to 5 year follow-up (3 studies, n = 2553) was positive but with significant heterogeneity. Mean reduction in systolic BP was -1.3 mmHg (95% CI -2.9 to 0.3, I2 80%) and mean reduction in diastolic BP was –1.2 mmHg (95% CI -2.3 to -0.2, I2 74%). Conclusions Our review found that interventions targeting an increased dose of MVPA through supervised and self-directed programmes achieved significant short-term improvements in blood pressure. However, studies targeting blood pressure reduction in participants below the age of 40 years with cardiovascular risk factors are limited in number. The clinical and statistical heterogeneity of the studies limits conclusions on the effectiveness of individual components of the interventions. It remains unclear how to translate short-term intervention effects into sustained reduction in blood pressure and cardiovascular risk. As understanding increases of young adult populations predisposed to early cardiovascular disease more research is needed on primary and secondary prevention in these groups.