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Physical Exercise and Dietary Supplementation in Middle-Aged and Older Women: A Systematic Review.
Sánchez-García, JC, López Hernández, D, Piqueras-Sola, B, Cortés-Martín, J, Reinoso-Cobo, A, Menor-Rodríguez, MJ, Rodríguez-Blanque, R
Journal of clinical medicine. 2023;12(23)
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Menopause is a process that marks the end of the reproductive phase in women. Menopause means both that the ovaries stop producing eggs and that there is a sharp decline in the production of female hormones such as progesterone and oestrogen. The aim of this study was to discuss the benefits of exercise and dietary supplements during menopause. This study was a systematic review of ten articles. Results showed that: - both strength and aerobic training, as well as supplementation with calcium and vitamin D, increase bone mineral density. - combined strength and resistance training provide cardiovascular benefits, increase strength and muscle mass, and reduce the risk of sarcopenia. - physical exercise has a synergistic effect with some supplements, enhancing their effectiveness. Authors concluded that physical exercise can help combat many of the symptoms associated with menopause, providing benefits for a more vital menopause and a more vital old age.
Abstract
UNLABELLED With the aging of the population in developed countries, the number of middle-aged and older women is progressively increasing. During this stage, women suffer from a number of signs and symptoms that could be reduced or treated with physical exercise and dietary supplements. The main objective of this study was to analyse the benefits of exercise and dietary supplements during menopause. MATERIALS AND METHODS A systematic review of the scientific literature was performed according to the PRISMA 2020 protocol, searching the PubMed, Cochrane, Scopus, and WOS databases. Studies that met the inclusion criteria were assessed for methodological quality using the PEDro or AMSTAR-2 scales. RESULTS The searches yielded a total of 104 results, of which 10 were selected, with methodological quality ranging from fair to excellent. Each article examined the combination of a dietary supplement plan versus a placebo; plus an exercise routine versus another routine or a sedentary lifestyle. The results showed the benefits of combining a nutritional supplementation plan with an exercise routine during menopause. CONCLUSIONS The practice of weekly strength and endurance exercises, together with the consumption of certain dietary supplements, may be a good resource for coping with menopause in a healthy way.
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Advancements in Nutritional Strategies for Gestational Diabetes Management: A Systematic Review of Recent Evidence.
Sánchez-García, JC, Saraceno López-Palop, I, Piqueras-Sola, B, Cortés-Martín, J, Mellado-García, E, Muñóz Sánchez, I, Rodríguez-Blanque, R
Journal of clinical medicine. 2023;13(1)
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Gestational Diabetes Mellitus (GDM) causes hyperglycaemia due to the deficit of insulin during pregnancy. Dietary and lifestyle management plays a vital role in maintaining glycaemic control in women with GDM to avoid health risks to the mother and baby. Therefore, this systematic review of fourteen randomised controlled trials evaluated the latest research advancements to identify effective nutritional strategies for managing hyperglycaemia in women with GDM. Among all the dietary strategies implemented in the included randomised controlled trials, probiotic supplementation and supplementation of probiotics and vitamin D were most effective in GDM. Further robust studies are required to evaluate the potential effectiveness of different nutritional strategies for managing GDM. Healthcare professionals can use the results of this systematic review to understand the latest evidence supporting nutritional strategy for women with GDM and the need for personalised support for managing hyperglycaemia in GDM.
Abstract
Gestational diabetes mellitus (GDM) is defined as hyperglycaemia first detected at any time during pregnancy with values lower than those determined by the WHO for diabetes diagnosis in adults. This pathology, with a worldwide prevalence of 13.4%, causes significant maternal and foetal risks. The first line of treatment consists of maintaining normo-glycaemia through an adequate diet and lifestyle changes. The aim is to synthesize the scientific evidence updating the nutritional recommendations for the effective management of GDM. A systematic review of the scientific literature was conducted following the PRISMA guidelines. Randomized clinical trials published within the last five years and providing information on nutritional recommendations to achieve an effective management of gestational diabetes were selected. The databases searched were PubMed, the WOS Core Collection, SCOPUS, and CINAHL, using the MeSH terms: "Diabetes, Gestational"; "Nutrition Assessment (nutrition*)"; "Diet"; "Eating"; and "Food"; with the Boolean operators "AND" and "OR". The PEDro scale (Physiotherapy Evidence Database) was used to assess the scientific quality of the studies, with a mean score of 8.9, indicating an average good scientific quality. Results: A total of 809 papers were collected, of which, after applying the inclusion and exclusion criteria, 14 randomized clinical trials were selected. Probiotic supplementation and co-supplementation with vitamin D have been found to be the most beneficial options for both mothers with GDM and neonates, but the most effective regimens are not known. Diets enriched with extra virgin olive oil (EVOO) and oat bran, as well as some recommendations focused on carbohydrates also seem effective, as well as diets designed for this group of women with GDM such as "CHOICE". Conclusions: Although there are numerous proposals that have been published in recent years focused on the diet of women with GDM in order to improve their results and those of their children, it is the supplementation with probiotics and the co-supplementation with vitamin D that is most agreed upon as beneficial; however, more research is needed into which protocols are most effective. Other proposals that could also be beneficial should be further studied.
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Effect of resistance training volume on body adiposity, metabolic risk, and inflammation in postmenopausal and older females: Systematic review and meta-analysis of randomized controlled trials.
Nunes, PRP, Castro-E-Souza, P, de Oliveira, AA, Camilo, BF, Cristina-Souza, G, Vieira-Souza, LM, Carneiro, MADS
Journal of sport and health science. 2023
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Postmenopausal women are at a higher risk of obesity due to lower levels of oestrogen, which acts to protect the body against fat storage. Resistance training is recommended for healthy ageing in postmenopausal women. It can be of benefit for fitness and prevent chronic disease. This systematic review and meta-analysis of 20 randomised control trials aimed to determine the effects of low (44 sets per week) and high volume (77 sets per week) resistance training on body fat, inflammation, and risk for metabolic disease in postmenopausal women. The results showed that regardless of whether postmenopausal women undertook high or low volume resistance training, total body fat, fat around the middle, metabolic risk, and inflammation were improved compared to not undertaking any resistance training at all. High volume resistance training had a greater benefit than low volume resistance exercise to blood sugar levels and a certain measure of inflammation known as C-reactive protein. It was concluded that resistance training is effective for improving measures of body fat, inflammation, and metabolic risk in postmenopausal women. This study could be used by healthcare professionals to recommend resistance training to postmenopausal women as part of a fat loss programme and to reduce risk of metabolic disease.
Abstract
OBJECTIVE This meta-analytical study explored the effects of resistance training (RT) volume on body adiposity, metabolic risk, and inflammation in postmenopausal and older females. METHODS A systematic search was performed for randomized controlled trials in PubMed, Scopus, Web of Science, and SciELO. Randomized controlled trials with postmenopausal and older females that compared RT effects on body adiposity, metabolic risk, and inflammation with a control group (CG) were included. Independent reviewers selected the studies, extracted the data, and performed the risk of bias and certainty of the evidence (Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)) evaluations. Total body and abdominal adiposity, blood lipids, glucose, and C-reactive protein were included for meta-analysis. A random-effects model, standardized mean difference (Hedges' g), and 95% confidence interval (95%CI) were used for meta-analysis. RESULTS Twenty randomized controlled trials (overall risk of bias: some concerns; GRADE low to very low) with overweight/obese postmenopausal and older females were included. RT groups were divided into low-volume RT (LVRT, ∼44 sets/week) and high-volume RT (HVRT, ∼77 sets/week). Both RT groups presented improved body adiposity, metabolic risk, and inflammation when compared to CG. However, HVRT demonstrated higher effect sizes than LVRT for glucose (HVRT = -1.19; 95%CI: -1.63 to -0.74; LVRT = -0.78; 95%CI:-1.15 to -0.41) and C-reactive protein (HVRT = -1.00;95%CI: -1.32 to -0.67; LVRT = -0.34;95%CI, -0.63 to -0.04)) when compared to CG. CONCLUSION Compared to CG, HVRT protocols elicit greater improvements in metabolic risk and inflammation outcomes than LVRT in overweight/obese postmenopausal and older females.
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The Influence of Whey Protein on Muscle Strength, Glycemic Control and Functional Tasks in Older Adults with Type 2 Diabetes Mellitus in a Resistance Exercise Program: Randomized and Triple Blind Clinical Trial.
Soares, ALS, Machado-Lima, A, Brech, GC, Greve, JMD, Dos Santos, JR, Inojossa, TR, Rogero, MM, Salles, JEN, Santarem-Sobrinho, JM, Davis, CL, et al
International journal of environmental research and public health. 2023;20(10)
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Type 2 Diabetes Mellitus (T2DM) is a common metabolic disease and the prevalence of T2DM is increasing among older adults. Resistance training is known to be an effective therapeutic strategy as it can positively influence the mechanisms of T2DM pathophysiology. Previous research suggests that whey protein supplementation can positively influence the different mechanisms of T2DM pathophysiology and improve muscle mass and glycaemic control. This triple-blinded, randomised controlled parallel-arm trial included twenty-eight male older adults to assess the effect of whey protein supplementation combined with resistance training for twelve weeks on glycaemic control, functional tasks, muscle strength, and body composition. The control group was supplemented with maltodextrin. All participants followed resistance training and were given nutritional guidance. Twelve weeks of resistance training improved muscle strength significantly. However, 20g whey protein supplementation did not improve performance in functional tasks, glycaemic control, or body composition in the test group of older adults with T2DM. Whey protein supplementation showed no significant synergetic effects when combined with resistance training in the test group. Due to the heterogeneity of the present study, further robust studies are warranted to investigate the effects of whey protein supplementation and resistance training. However, healthcare professionals can use the results of this study to understand the effect of resistance training alone and the safety profile of whey protein supplementation in older adults with T2DM.
Abstract
OBJECTIVES To evaluate the effect of whey protein (WP) supplementation associated with resistance training (RT) on glycemic control, functional tasks, muscle strength, and body composition in older adults living with type 2 diabetes mellitus (T2DM). Secondly, to evaluate the safety of the protocol for renal function. METHODS The population comprised twenty-six older men living with T2DM (68.5 ± 11.5 years old). The participants were randomly assigned to the Protein Group (PG) and the Control Group (CG). The handgrip test and evolution of exercise loads, according to the Omni Resistance Exercise Scale, evaluated muscle strength. Functional tasks were assessed by force platform in three different protocols: Sit-to-Stand, Step/Quick Turn, and Step Up/Over. Body composition was evaluated by bioimpedance and glycemic control and renal function were assessed by biochemical analyses. Both groups performed RT for 12 weeks, twice a week, prioritizing large muscle groups. Protein supplementation was 20 g of whey protein isolate and the CG was supplemented with an isocaloric drink, containing 20 g of maltodextrin. RESULTS There was a significant difference in muscle strength, according to the evolution of the exercise loads, but it was not confirmed in the handgrip test. However, there was no significant difference between the groups, regarding performance in functional tasks, glycemic control, or body composition. Renal function showed no alteration. CONCLUSION The intake of 20 g of WP in older male adults living with T2DM did not increase the effect of RT on muscle strength, functional tasks, and glycemic control. The intervention was proven safe regarding renal function.
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Effectiveness of a minimally processed food-based nutritional counselling intervention on weight gain in overweight pregnant women: a randomized controlled trial.
Sartorelli, DS, Crivellenti, LC, Baroni, NF, de Andrade Miranda, DEG, da Silva Santos, I, Carvalho, MR, de Lima, MC, Carreira, NP, Chaves, AVL, Manochio-Pina, MG, et al
European journal of nutrition. 2023;62(1):443-454
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Excessive gestational weight gain exposes the woman and the child to a higher risk of harmful health outcomes in the short and long term. Dietary patterns based on the substitution of meals made with unprocessed or minimally processed foods for the consumption of ultra-processed items can be partly blamed for the exponential global growth in the incidence of obesity. The main aim of this study was to evaluate the effectiveness of a nutritional intervention based on encouraging the consumption of unprocessed and minimally processed foods rather than ultra-processed products. This study is a two-armed parallel randomised controlled trial conducted among overweight, pregnant women receiving prenatal care in seven primary health units. Participants (n=350) were randomly allocated into the intervention group (IG) or control group (CG). The women allocated into the IG, in addition to the usual prenatal care, were invited to participate in three individualised nutritional counselling sessions conducted by trained nutritionists. Results show that even though there were more women in the IG who had increased their daily intake of minimally processed foods and vegetables at lunch time when compared to the CG, this was not statistically significant. Additionally, there weren’t any differences between the groups in relation to physical activity. Authors conclude that their study was unprecedented in demonstrating that a nutritional counselling intervention based on the NOVA food classification system, together with the practice of physical activity, is effective in preventing excessive gestational weight gain in overweight pregnant women.
Abstract
PURPOSE This study aimed at evaluating the effectiveness of a nutritional counselling intervention based on encouraging the consumption of unprocessed and minimally processed foods, rather than ultra-processed products, and the practice of physical activities to prevent excessive gestational weight gain in overweight pregnant women. METHODS This was a two-armed, parallel, randomized controlled trial conducted in primary health units of a Brazilian municipality from 2018 to 2021. Overweight, adult pregnant women (n = 350) were randomly assigned to control (CG) or intervention groups (IG). The intervention consisted of three individualized nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods rather than ultra-processed products, following the NOVA food classification system, and the practice of physical activities. The primary outcome was the proportion of women whose weekly gestational weight gain (GWG) exceeded the Institute of Medicine guidelines. Adjusted logistic regression models were employed. RESULTS Complete data on weight gain were available for 121 women of the IG and 139 of the CG. In modified intention-to-treat analysis, there was a lower chance of the IG women having excessive GWG [OR 0.56 (95% CI 0.32, 0.98), p = .04], when compared to the CG. No between-group differences were observed for the other maternal outcomes investigated. CONCLUSION The present study was unprecedented in demonstrating that nutritional counselling based on the NOVA food classification system, together with encouraging the practice of physical activity, is effective in preventing excessive weight gain in overweight pregnant women. TRIAL REGISTRATION Registered on July 30th 2018 at Brazilian Registry of Clinical Trials (RBR-2w9bhc).
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Effect of aerobic exercise, slow deep breathing and mindfulness meditation on cortisol and glucose levels in women with type 2 diabetes mellitus: a randomized controlled trial.
Obaya, HE, Abdeen, HA, Salem, AA, Shehata, MA, Aldhahi, MI, Muka, T, Marques-Sule, E, Taha, MM, Gaber, M, Atef, H
Frontiers in physiology. 2023;14:1186546
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Stress is considered to be an important factor in type 2 diabetes mellitus (T2DM) and aerobic exercise can help modulate the stress response as well as being important in the management of diabetes. Mindfulness meditation and deep breathing have also been shown to have positive effects on both stress and T2DM. This 6-week single-blind, randomised, controlled trial evaluated the effect of 10 min slow deep breathing and 10 min mindfulness meditation following a 40 min aerobic exercise programme, compared to the 40 min aerobic exercise alone, on fasting blood glucose (FBG) and cortisol levels in 58 stressed women with T2DM. FBG and cortisol levels improved in both groups but more so in the group who received the deep breathing and mindfulness meditation in addition to the exercise intervention: 20% vs 30% reduction in cortisol and 10% vs 15% reduction in FBG. The authors conclude that adding slow deep breathing and mindfulness meditation to an exercise programme may be useful in the management of stressed women with T2DM and reduce their cardiometabolic risk.
Expert Review
Conflicts of interest:
None
Take Home Message:
Practitioners could consider slow deep breathing and mindfulness meditation, added to aerobic exercise, as potentially useful components of the T2DM management program for stressed women.
Evidence Category:
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X
A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Introduction
Stress, a key factor for Type 2 diabetes mellitus (T2DM), stimulates the hypothalamus-pituitary-adrenal gland (HPA) and triggers parasympathetic nerve withdrawal, leading to increased circulating cortisol levels and higher levels of blood glucose. Exercise is a key intervention that can modulate the HPA axis and help manage stress.
Methods
Fifty-eight women (aged between 40-50), diagnosed with T2DM for at least 5 years but medically stable with moderate to high stress scores were randomised to either aerobic training (AT) or aerobic exercise combined with slow deep breathing and mindfulness meditation (DMM) training three times weekly over 6-weeks.
AT group performed aerobic exercise on a treadmill at an intensity of 60%– 75% of the maximum heart rate for a total of 40 min, including a 5 minute warm up and 5 min cool down.
AT + DMM group performed a combination of aerobic exercise as per the AT group followed by a total of 10 minutes of diaphragmatic slow, deep breathing; and mindfulness meditation.
Results
Both groups showed a change from baseline in serum cortisol to p<0.0001
At 6 weeks in the AT + DMM group, the primary outcome of serum cortisol (nmol/L) levels was 12.59 nmol/L [95% CI 4.45-6.52] a decrease of 30.29% and the fasting blood glucose levels (secondary outcome) was 136.37mg/dl (95% CI: 9.19–2.6) a decrease of 14.54%
In the AT group performing only aerobic exercise decreased serum cortisol levels by 20.16% and FBG levels decreased by 9.97%.
Conclusion
This study showed that combining slow deep breathing and mindfulness meditation with aerobic exercise reduced the serum cortisol (p = 0.01) and FBG levels (p = 0.001) in women with T2DM compared to when only aerobic training was performed.
Clinical practice applications:
Consider a combined therapy approach with diaphragmatic breathing exercises and aerobic exercises that targets both the endocrine and autonomic nervous systems, as this may have a synergistic effect to assist with maintaining normal blood sugar levels and cortisol levels in individuals with T2DM.
Considerations for future research:
Future research is needed to determine the most effective combination of therapies for managing both FBG and serum cortisol levels in individuals with T2DM.
Abstract
Background: Aerobic exercise combined with breathing exercise can be an integral part of diabetes mellitus treatment. This single-center, randomized, parallel-group study investigated the effect of the combination of aerobic exercise with slow deep breathing and mindfulness meditation on the glucose and cortisol levels of women with type 2 diabetes mellitus (T2DM). Materials and Methods: Fifty-eight middle-aged women with T2DM (mean age: 45.67 ± 2.92 years) were randomly assigned to either the aerobic training group (AT: n = 29; mean age [46.1 ± 2.7 years]) or the aerobic exercise combined with slow deep breathing and mindfulness meditation (AT + DMM: n = 29; mean age [45.24 ± 3.14 years]). Aerobic exercise was performed at 60%-75% of the maximum heart rate. The women in each group were asked to perform the training three times weekly over a 6-week period. The duration of each session was 40 min for the AT group and 60 min for the AT + DMM group. The two groups were asked to perform aerobic exercise at 60%-75% of the maximum heart rate. Their fasting blood glucose (FBG) and serum cortisol levels were measured at the baseline and after the 6 weeks. Results: Compared with the AT group, the group undertaking 6 weeks of aerobic training combined with slow, deep breathing exercises and mindfulness meditation showed significantly lower levels of FBG (p = 0.001) and cortisol levels (p = 0.01) than the AT group. Conclusion: The addition of slow deep breathing and mindfulness meditation to aerobic exercise can better control the glucose and cortisol levels of women with T2DM and thereby improve their outcomes and decrease their cardiometabolic risk.
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Effect of Health Promotion Interventions in Active Aging in the Elderly: A Randomized Controlled Trial.
Davodi, SR, Zendehtalab, H, Zare, M, Behnam Vashani, H
International journal of community based nursing and midwifery. 2023;11(1):34-43
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The change in global demographics, with an increase in the proportion of the elderly who take up a large proportion of healthcare resources, will become a major challenge for health systems. Active ageing is defined by the WHO as “the process of promoting health, social security, and social contribution of the elderly to promote their quality of life”. The aim of this Iranian 6-week randomised controlled trial, including 60 participants aged 60 years or over, was to evaluate the effectiveness of an active ageing programme. The weekly group sessions included the topics nutrition, physical activity, responsibility, stress management, communications and spiritual aspects. Outcome measures were various questionnaires. Compared to controls, patients undergoing the programme experienced significant improvements in active mind maintenance, physical-functional activity, social contacts, productive engagement, social-institutional participation, but not agent attitude. The authors conclude that training programmes at the level of health centres are effective in promoting active ageing in an elderly population.
Abstract
BACKGROUND Active aging has been the paradigm of the old-age lifestyle. Integrated aging care interventions in health centers primarily focus on diseases such as diabetes, hypertension, depression, and cardiovascular diseases, and there is no program or training regarding active aging. This study was carried out from September to December 2021 to determine the effectiveness of an intervention program to promote active aging in the elderly referred to Mashhad health centers. METHODS This randomized controlled clinical trial was conducted on 60 elderly individuals without disabling diseases and cognitive impairment who presented to the Daneshamooz health center in Mashhad in 2021. Through a simple block allocation scheme, those who met the inclusion criteria were randomly divided into the intervention and control groups. The intervention group received the health promotion program during 6 sessions (one session per week) about nutrition, physical activity, responsibility, stress management, communications, and spiritual aspects. The data were gathered using the active aging questionnaire and analyzed using the SPSS software version 25; independent and paired t-test, Wilcoxon, and Mann-Whitney U tests were utilized. P value< 0.05 was considered statistically significant. RESULTS The results of this study demonstrated that after the intervention, the total active aging score in the intervention group increased significantly (68.5±3 to 85±8.25) (P<0.001) and there was a significant difference between the control and intervention groups (68±3.25 to 85±8.25) (P<0.001). CONCLUSION According to the results, training based on a health-enhancement approach can effectively promote active aging in the elderly. Therefore, more attention should be paid to strategic planning for active aging in health centers.Trial Registration Number: IRCT20210308050639N.
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Cognitive behavioral therapy for lifestyle changes in patients with obesity and type 2 diabetes: a systematic review and meta-analysis.
Kurnik Mesarič, K, Pajek, J, Logar Zakrajšek, B, Bogataj, Š, Kodrič, J
Scientific reports. 2023;13(1):12793
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Obesity and type 2 diabetes mellitus (T2DM) are two of the most common chronic diseases and lifestyle modification, including diet, exercise and weight management, are recognised as important for prevention. Cognitive behavioural therapy (CBT) has been shown to contribute to lifestyle modification. The aim of this meta-analysis was to evaluate the effect of CBT, compared to no intervention/standard care only, in patients with obesity and/or T2DM, with a focus on health outcomes and implementation of changes long-term. Nine randomised controlled trials (RCT) with 902 participants were included in this meta-analysis. The health outcomes included weight loss and maintenance and glycosylated haemoglobin (HbA1c, a measure of blood glucose control) whilst the lifestyle changes included diet, physical activity, smoking, and compliance with treatments. There was a statistically significant benefit of CBT for weight loss and weight maintenance (based on 3 RCTs each) with a medium effect size, but no significant effect on HbA1c (based on 3 RCTs). In all 3 RCTs that evaluated depression, a significant benefit was observed. As the behavioural outcomes were too heterogenous to be pooled for a meta-analysis, they were reviewed in a descriptive manner only. Benefits were reported in terms of better dietary choices/reduced energy intake, increased physical activity, better adherence to medication and glucose monitoring as well as a reduction in smoking. The authors suggest that CBT appears to be moderately effective in promoting lifestyle modifications and weight loss.
Abstract
The aim of this systematic review and meta-analysis was to examine the contribution of cognitive behavioral therapy (CBT) to the implementation of lifestyle changes, considering health-related and behavioral outcomes. A systematic literature review was performed using multiple databases (PsycInfo, PubMed and MEDLINE). The inclusion criteria comprised randomised controlled trials of CBT for lifestyle changes in patients with obesity and/or type 2 diabetes. The quality of study reporting was assessed with the revised Cochrane Collaboration's risk of bias tool. A meta-analysis was conducted on studies with appropriate outcomes. Nine randomised controlled trials, with a total sample size of 902 participants, met the inclusion criteria. The meta-analysis has shown a medium, significant effect size of CBT interventions for weight loss and weight maintenance, and a low, non-significant effect size of CBT interventions for reducing glycated hemoglobin (HbA1c) levels. A separate, combined, meta-analysis for all nine calculated effect sizes has yielded a medium and significant overall effect size for the model. Our review of the studies about the effectiveness of CBT in implementing lifestyle changes has, in comparison to usual control groups, proven the efficacy of CBT interventions in implementing lifestyle changes, especially for weight loss and weight maintenance.
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The comparative effect of exercise interventions on balance in perimenopausal and early postmenopausal women: A systematic review and network meta-analysis of randomised, controlled trials.
Walsh, GS, Delextrat, A, Bibbey, A
Maturitas. 2023;175:107790
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The decline in oestrogen with perimenopause is associated with decline in muscle mass and function which in turn increases the risk of falls, a major concern for postmenopausal women. Balance is important in the prevention of falls. The aim of this systematic review and network meta-analysis, including 26 randomised controlled studies with 1560 participants, was to evaluate the effects of different types of exercise on balance in peri- and postmenopausal women. Outcome measures and interventions varied across the included studies. Whole body vibration training (a form of passive exercise through standing on a vibrating platform) showed the most consistent benefits of balance although this was based on a small number of small trials. Other types of exercise (resistance and balance training and a combination of resistance, aerobic and balance training) also showed some benefits but not across all outcome measures. The authors conclude that exercise should be considered for peri-and postmenopausal women to improve balance.
Abstract
In addition to a range of physiological and psychological symptoms, menopause causes a decrement to balance performance and risk of falls. This review aimed to determine the effects of exercise interventions on balance in perimenopausal and early postmenopausal women. Web of Science, PubMed, CINAHL, SPORTDiscus and Cochrane Central Register of Controlled Trials databases were searched. Randomised, controlled trials of exercise interventions in perimenopausal or early postmenopausal populations with an average age of 65 years or younger reporting balance measures were included. Risk of bias was assessed using Cochrane RoB 2. A random effects model network meta-analysis was performed to assess the effect of exercise on balance. Standardised mean differences with 95 % confidence intervals were used as the measure of effect. Twenty-six studies were included after screening. Network meta-analyses were conducted for 5 balance variables. Whole-body vibration (standardised mean difference: 2.25, confidence interval: 0.08; 4.43), balance (standardised mean difference: 1.84, confidence interval: 0.15; 3.53), balance + nutrition (standardised mean difference: 3.81, confidence interval: 1.57; 6.05) and resistance (standardised mean difference: 1.43, confidence interval: 0.41; 2.46) exercise improved Berg balance scale performance. Resistance + aerobic + balance exercise improved one-leg stance (standardised mean difference: 0.80, confidence interval: 0.39; 1.22) and whole-body vibration improved anterior-posterior (standardised mean difference: -0.89, confidence interval: -1.48; -0.31), medio-lateral (standardised mean difference: -0.58, confidence interval: -1.15; -0.01) postural sway and falls indices (standardised mean difference: -0.75, confidence interval: -1.45; -0.04). Exercise improved all balance measures and should be considered as an adjunct therapy in perimenopausal and postmenopausal women. Whole-body vibration was most frequently the highest ranked intervention; resistance and balance training also improved balance.
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Effect of lifestyle intervention on HbA1c levels in overweight and obese adults with type 2 diabetes across ethnicities: A systematic review and meta-analysis of randomized controlled trials.
Yang, J, Xia, Y, Sun, Y, Guo, Y, Shi, Z, Cristina do Vale Moreira, N, Zuo, H, Hussain, A
Diabetes research and clinical practice. 2023;199:110662
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Weight loss can benefit overweight and obese patients with type 2 diabetes mellitus (T2DM) with regards to cardiovascular risk factors, including glycaemic control. This systematic review and meta-analysis of 30 randomised controlled trials, including 7850 patients, aimed to evaluate racial/ethnic differences in response to lifestyle interventions for weight loss on glycosylated haemoglobin (HbA1c, a measure of glycaemic control) in overweight or obese patients with T2DM. Lifestyle interventions were associated with statistically significant reductions in HbA1c in White and Asian, but not in Black/African or Hispanic populations, although the latter were based on only 2 and 3 small trials, respectively, and may have therefore lacked statistical power. Reductions in HbA1c were seen in studies which led to a weight loss of more than 5% as well as those less than 5%, with greater reductions being seen in the former group. The authors conclude that ethnic differences should be taken into account when considering lifestyle interventions for diabetes management.
Abstract
AIMS: Weight reduction is fundamental for the management and remission of diabetes. We aimed to assess ethnic differences in the effects of lifestyle weight-loss interventions on HbA1c levels in overweight or obese adults with type 2 diabetes mellitus (T2DM). METHODS We systematically searched PubMed/MEDLINE and Web of Science online databases up to 31 Dec 2022. Randomized controlled trials using lifestyle weight-loss interventions in overweight or obese adults with T2DM were selected. We performed subgroup analyses to explore the heterogeneity across different ethnicities (Asians, White/Caucasians, Black/Africans and Hispanics). A random effects model was applied to calculate weighted mean difference (WMD) with 95% confidence interval (CI). RESULTS Thirty studies including 7580 subjects from different ethnicities were identified according to the predefined inclusion and exclusion criteria. HbA1c levels were significantly reduced by lifestyle weight-loss intervention. Notably, a significantly beneficial effect on HbA1c was observed in White/Caucasians (WMD = -0.59, 95% CI: -0.90, -0.28, P < 0.001) and Asians (WMD = -0.48, 95% CI: -0.63, -0.33, P < 0.001), but not in the Black/African or Hispanic group (both P > 0.05). The findings remained essentially unchanged in the sensitivity analysis. CONCLUSIONS Lifestyle weight-loss interventions had distinct beneficial effects on HbA1c levels in different ethnic groups with T2DM, especially in Caucasians and Asians.