Jill Livingston

Dynamic Resistance Training as Stand‐Alone Antihypertensive Lifestyle Therapy: A Meta‐Analysis

Background Aerobic exercise (AE) is recommended as first‐line antihypertensive lifestyle therapy based on strong evidence showing that it lowers blood pressure (BP) 5 to 7 mm Hg among adults with hypertension. Because of weaker evidence showing that dynamic resistance training (RT) reduces BP 2 to 3 mm Hg among adults with hypertension, it is recommended as adjuvant lifestyle therapy to AE training. Yet, existing evidence suggests that dynamic RT can lower BP as much or more than AE. Methods and Results We meta‐analyzed 64 controlled studies (71 interventions) to determine the efficacy of dynamic RT as stand‐alone antihypertensive therapy. Participants (N=2344) were white (57%), middle‐aged (47.2±19.0 years), and overweight (26.8±3.4 kg/m2) adults with prehypertension (126.7±10.3/76.8±8.7 mm Hg); 15% were on antihypertensive medication. Overall, moderate‐intensity dynamic RT was performed 2.8±0.6 days/week for 14.4±7.9 weeks and elicited small‐to‐moderate reductions in systolic BP (SBP; d+=−0.31; 95% CIs, −0.43, −0.19; −3.0 mm Hg) and diastolic BP (DBP; d+=−0.30; 95% CIs, −0.38, −0.18; −2.1 mm Hg) compared to controls (Ps<0.001). Greater BP reductions occurred among samples with higher resting SBP/DBP: ≈6/5 mm Hg for hypertension, ≈3/3 mm Hg for prehypertension, and ≈0/1 mm Hg for normal BP (Ps<0.023). Furthermore, nonwhite samples with hypertension experienced BP reductions that were approximately twice the magnitude of those previously reported following AE training (−14.3 mm Hg [95% CIs, −19.0, −9.4]/−10.3 mm Hg [95% CIs, −14.5, −6.2]). Conclusions Our results indicate that for nonwhite adult samples with hypertension, dynamic RT may elicit BP reductions that are comparable to or greater than those reportedly achieved with AE training. Dynamic RT should be further investigated as a viable stand‐alone therapeutic exercise option for adult populations with high BP.

The Benefits of Library Liaison Programs for Small Libraries: An Overview

Abstract Library liaison programs are commonly used and provide a successful framework for communication in academic libraries. Liaison programs, whereby librarians are formally designated as the primary contact between the library and one or more departmental or administrative units, are proven to improve the transfer of information between the library and users, to improve the quality of collections and services, and to enhance the librarys image. Previously published literature on liaison programs is primarily devoted to large-scale liaison programs in academic settings, the market where this model is commonly employed. Small hospital and other smaller libraries are nearly absent in the literature, reflecting the low level of liaison use in the smaller library setting. This article invites hospital and other smaller libraries to explore the liaison model by presenting common liaison goals and activities that are not only pertinent to, but also scalable, adaptable, and adoptable by smaller and larger libraries alike.

Is Concurrent Training Efficacious Antihypertensive Therapy? A Meta-analysis.

: Aerobic exercise training and, to a lesser degree, dynamic resistance training, are recommended to lower blood pressure (BP) among adults with hypertension. Yet the combined influence of these exercise modalities, termed concurrent exercise training (CET), on resting BP is unclear. PURPOSE This study aimed to meta-analyze the literature to determine the efficacy of CET as antihypertensive therapy. METHODS Electronic databases were searched for trials that included the following: adults (>19 yr), controlled CET interventions, and BP measured pre- and postintervention. Study quality was assessed with a modified Downs and Black Checklist. Analyses incorporated random-effects assumptions. RESULTS Sixty-eight trials yielded 76 interventions. Subjects (N = 4110) were middle- to older-age (55.8 ± 14.4 yr), were overweight (28.0 ± 3.6 kg·m), and had prehypertension (systolic BP [SBP]/diastolic BP [DBP] = 134.6 ± 10.9/80.7 ± 7.5 mm Hg). CET was performed at moderate intensity (aerobic = 55% maximal oxygen consumption, resistance = 60% one-repetition maximum), 2.9 ± 0.7 d·wk for 58.3 ± 20.1 min per session for 19.7 ± 17.8 wk. Studies were of moderate quality, satisfying 60.7% ± 9.4% of quality items. Overall, CET moderately reduced SBP (db = -0.32, 95% confidence interval [CI] = -0.44 to -0.20, -3.2 mm Hg) and DBP (db = -0.35, 95% CI = -0.47 to -0.22, -2.5 mm Hg) versus control (P < 0.01). However, greater SBP/DBP reductions were observed among samples with hypertension in trials of higher study quality that also examined BP as the primary outcome (-9.2 mm Hg [95% CI = -12.0 to -8.0]/-7.7 mm Hg [95% CI = -14.0 to -8.0]). CONCLUSIONS Among samples with hypertension in trials of higher study quality, CET rivals aerobic exercise training as antihypertensive therapy. Because of the moderate quality of this literature, additional randomized controlled CET trials that examine BP as a primary outcome among samples with hypertension are warranted to confirm our promising findings.

Can Exercise Improve Cognitive Symptoms of Alzheimer's Disease?

To examine the effects of exercise training on cognitive function in individuals at risk of or diagnosed with Alzheimers disease (AD).

Measurement of anteriorly flexed trunk posture in Parkinson's disease (PD): a systematic review

Abstract Background: Anteriorly flexed posture is a common impairment with negative consequences for individuals with Parkinsons disease (PD). Identification of objective non-radiologic procedures for measuring flexed trunk posture is therefore important. Objective: Summarise available information on objective non-radiologic procedures for measuring anterior trunk flexion in PD. Methods: A systematic review using six relevant databases was conducted. Two reviewers independently examined the search output using strict inclusion and exclusion criteria. Articles determined to be relevant were abstracted for participant characteristics, measurement technique, test position and findings and were graded using a critical appraisal checklist. Results: Seventeen studies revealed information on objective, non-radiologic procedures for measuring sagittal plane-flexed posture in PD. Participants were primarily older adults with Hoehn and Yahr scale scores of 1–5. Five different measures were reported: linear distance between the seventh cervical vertebra and wall and body angles derived from photographs, Spinal Mouse, Debrunners Kyphometer and electronic goniometer. Three articles reported measurement reliability (intraclass correlation coefficients = 0.90–0.95). Among articles addressing validity; one supported criterion validity relative to the gold standard radiological measure, three addressed concurrent validity by correlating postural measures with other measures of potential interest and seven suggested responsiveness of the measures to changes accompanying a therapeutic intervention. Quality checklist scores ranged from 1 to 7 out of nine items. Conclusion: This systematic review showed no consensus regarding how flexed posture should be measured in PD. Further investigation of multiple measures is required before recommendations can be made for measuring flexed posture in PD.

Weight bias among exercise and nutrition professionals: a systematic review: Weight bias in exercise and nutrition

Obesity affects approximately one‐third of American adults. Recent evidence suggests that weight bias may be pervasive among both exercise and nutrition professionals working with adults who have obesity. However, the published literature on this topic is limited. This review aimed to (i) systematically review existing literature examining weight bias among exercise and nutrition professionals; (ii) discuss the implications of this evidence for exercise and nutrition professionals and their clients; (iii) address gaps and limitations of this literature; and (iv) identify future research directions. Of the 31 studies that met the criteria for this review, 20 examined weight bias among exercise professionals, of which 17 (85%) found evidence of weight bias among professionals practicing physical therapy (n = 4), physical education (n = 8) and personal/group fitness training (n = 5). Of 11 studies examining weight bias among nutrition professionals, eight (73%) found evidence of weight bias. These findings demonstrate fairly consistent evidence of weight bias among exercise and nutrition professionals. However, the majority of studies were cross‐sectional (90%). Given that weight bias may compromise quality of care and potentially reinforce weight gain and associated negative health consequences in patients with obesity, it is imperative for future work to examine the causes and consequences of weight bias within exercise and nutrition professions using more rigorous study designs.

Systematic Review on Concussion Recovery Time Lacks Comprehensiveness

I read with interest the article by Williams et al. [1] titled ‘‘Concussion recovery time among high school and collegiate athletes: a systematic review and meta-analysis’’. Though the authors followed the reporting standards set forth in the PRISMA guidelines [2], they (like many other authors of systematic reviews) fell short in conducting a comprehensive review of the literature and reporting a reproducible search strategy. Expertly devised search methods for identifying relevant published and unpublished studies are the bedrock upon which the validity of the entire review is dependent; as in order for a systematic review to perform its function as a reliable resource for clinical decision making, it must include all relevant clinical studies. The shortcomings within this systematic review are commonplace. Though an electronic search strategy for one database was presented, the search as reported is not reproducible. The authors state that their search was run in PubMed from database inception to December 2013, yet a large discrepancy exists between the 141 citations the authors state were found and the 1913 citations that result when the following strategy is run through December 31, 2013: (athletes or sports) and (concussion or mild traumatic brain injury) and (recovery or symptoms or cognition). Further, the search fails to qualify as a comprehensive literature search; these searches are innately sensitive and complex. The strategy used in this study does not use controlled vocabulary or proper syntax, nor does it provide an inclusive concatenation of those terms published on sports, athletes, concussions, recovery, symptoms, or cognition. Exhaustive searches that form the foundation of systematic reviews reflect an intimate understanding of the variability of keywords and database-specific indexing. They also take advantage of database-specific limiters/filters. For example, many studies written about concussions are sport specific. A search that only includes general terms for athletes or sports will miss some studies conducted on single sport athletes, such as football or soccer players. A comprehensive PubMed search for the concept of athletes or sports follows: (‘‘Sports’’[Mesh] OR ‘‘Athletes’’[Mesh] OR sport OR sports OR athlete* OR rugby OR football OR soccer OR lacrosse OR wrestling OR swimming OR hockey OR skiing OR skiers). Additional sports could be added, as appropriate. By improving syntax use and expanding upon the comprehensiveness of terms, the authors would have found several hundred additional articles in PubMed alone. Including other databases such as PsycINFO, Web of Science, Scopus, the Cochrane Library, and clinical trial registers would yield dozens more. Databases are designed so that all searches harvest results; however, only trained and experienced searchers have the capability to conduct the exhaustive searches required for systematic reviews. This is recognized in the Institute of Medicine’s ‘‘Recommended Standards for Finding and Assessing Individual Studies’’, which stipulate that authors of systematic reviews ‘‘Work with a librarian or other information specialist trained in performing systematic reviews (SRs) to plan the search strategy’’ and ‘‘Use an independent librarian or other information specialist to peer review the search strategy’’ [3]. The expertise of a medical librarian will ensure the comprehensive collection and examination of relevant studies. Additionally, owing to their intimate knowledge of literature in the & Jill Livingston jill.livingston@uconn.edu