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Examine true inter-individual response differences (IIRD) as a result of resistance training on cardiorespiratory fitness in older adults. Data from a recent meta-analysis of 22 randomized controlled trials representing 552 men and women (292 resistance training, 260 control) ≥ 60 years of age were included. The primary outcome was cardiorespiratory fitness (VO2max) in ml.kg-1.min-1. Using the inverse variance heterogeneity (IVhet) model, statistically significant treatment effect (resistance training minus control) increases in VO2max in ml.kg-1.min-1 were found (mean, 1.8, 95% CI, 0.4 to 3.3 ml.kg-1.min-1, p = 0.01; Q = 82.8, p < 0.001; I2 = 74.6%, 95% CI, 61.6 to 83.3%; τ2 =1.1). The 95% prediction interval (PI) was -0.8 to 4.5 ml.kg-1.min-1. However, no statistically significant IIRD was observed (mean, 0.6, 95% CI, -1.1 to 1.4 ml.kg-1.min-1; τ2 =1.5). The 95% PI was -1.8 to 2.0 ml.kg-1.min-1. In conclusion, while progressive resistance training may increase VO2max in ml.kg-1.min-1, a lack of true resistance-training-associated IIRD exist.

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Whether true inter-individual response differences (IIRD) occur as a result of resistance training on body weight and body composition in older adults with overweight and obesity is not known. To address this gap, data from a previous meta-analysis representing 587 men and women (333 resistance training, 254 control) ≥ 60 years of age nested in 15 randomized controlled trials of resistance training ≥ 8 weeks were included. Resistance training and control group change outcome standard deviations treated as point estimates for body weight and body composition (percent body fat, fat mass, body mass index in kg.m2, and lean body mass) were used to calculate true IIRD from each study. True IIRD as well as traditional pairwise comparisons were pooled using the inverse-variance (IVhet) model. Both 95% confidence intervals (CI) and prediction intervals (PI) were calculated. While statistically significant improvements were found for body weight and all body composition outcomes (p < 0.05 for all), no statistically significant IIRD was observed for any of the outcomes (p > 0.05 for all) and all 95% PIs overlapped. Conclusions: While resistance training is associated with improvements in body weight and body composition in older adults, the lack of true IIRD suggests that factors other than training response variation (random variation, physiological responses associated with behavioral changes that are not the result of resistance training) are responsible for the observed variation in body weight and body composition.

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The purpose of this study was to conduct a systematic review with meta-analysis to determine the representation of adults with rheumatoid arthritis (RA) according to sex, race, and ethnicity in exercise randomized controlled trials (RCTs) conducted in the USA. Exercise RCTs ≥ 4 weeks conducted in the USA in adults ≥ 18 years with RA were eligible. Studies were retrieved by searching six electronic databases, cross-referencing and searching a clinical trials registry. Dual, independent, study selection and data abstraction were conducted. The primary outcomes were the proportion of participants in each study according to sex as well as race/ethnicity. Results were pooled meta-analytically using the inverse-variance heterogeneity (IVhet) model after applying the double-arcsine transformation. Of the 1030 unique articles screened, five RCTs representing 353 participants with RA were included. The pooled participant prevalence was 83% (95% CI = 73 to 92%) for women and 17% (95% CI = 8 to 27%) for men, suggesting an over-representation of women and an under-representation of men by approximately 7.4% based on current prevalence US estimates for each. Qualitative examination for race and ethnicity demonstrated an under-representation of racial/ethnic minority groups. There is a lack of representation of men with RA in US-based randomized controlled exercise intervention studies. Additional US-based randomized controlled exercise trials, including greater inclusion and reporting of the racial/ethnic composition of participants, are also needed. Key Points • This systematic review with meta-analysis of US studies found an under-representation of men in randomized controlled trials examining the effects of exercise in those with rheumatoid arthritis (RA). • Qualitative examination according to race/ethnicity found both a lack of reporting as well as under-representation of selected racial/ethnic minorities in US-based randomized controlled exercise studies among adults with RA. • This study highlights the need for additional US-based randomized controlled trials of exercise in adults with RA that better represent the RA population in the USA.

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The purpose of this study was to examine the effects of exercise on cardiovascular disease (CVD) risk factors in children and adolescents with obesity. Randomized controlled trials (RCTs) of exercise ≥4 weeks in children and adolescents with obesity were included if one or more CVD risk factors were included as an outcome. Studies were retrieved by searching 7 electronic databases, cross-referencing, and expert review. Data were pooled using the inverse-variance heterogeneity (IVhet) model and strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. Thirty-nine studies representing 1548 participants (847 exercise, 701 control) met the inclusion criteria. Aerobic exercise improved 10 of 12 (83.3%) outcomes (P < .05 for all) while combined aerobic and strength training improved 5 of 8 (62.5%) outcomes (P < .05 for all). The strength of evidence ranged from "very low" to "moderate." It was concluded that aerobic exercise, as well as combined aerobic and strength training, is associated with improvements in multiple CVD risk factors among children and adolescents with obesity. However, the generally low strength of evidence suggests a need for future well-designed and conducted RCTs on the effects of exercise, especially strength training, in children and adolescents with obesity.

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CONCLUSIONS: While walking is associated with reductions in resting SBP and DBP, a lack of true IIRD exists, suggesting that factors other than training response variation (random variation, physiological responses associated with behavioral changes that are not the result of walking) are responsible for the observed variation in resting SBP and DBP.

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The clinical relevance of Tai Chi on pain, stiffness, and physical function in adults with knee osteoarthritis (KOA) has not been established. Therefore, the purpose of the current study was to address this gap. Eight randomized controlled trials from a recent meta-analysis representing 407 participants (216 Tai Chi, 191 control) in adults ≥18 years of age with KOA and included the assessment of pain, stiffness, and physical function using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were assessed. The inverse variance heterogeneity model (IVhet) was first used to pool standardized mean difference effect sizes (ES) for each outcome. Clinical relevance, i.e., number-needed-to treat (NNT) ≤10 and relative risk reduction (RRR) ≥25% was calculated across assumed controlled risks (ACR) ranging from 0.01 to 0.99. Statistically significant improvements were found for pain (ES, -0.75, 95% CI, -0.99, -0.51; Q = 8.9, p = 0.26; I2 = 21%), stiffness (ES, -0.70, 95% CI, -0.95, -0.46; Q = 9.6, p = 0.21; I2 = 27%), and physical function (ES, -0.91, 95% CI, -1.12, -0.70; Q = 7.2, p = 0.40; I2 = 3%). The intersection of results for a NNT ≤10 and RRR ≥25% yielded high evidence and clinically relevant improvements across a wide range of ACR for pain (0.15 to 0.88), stiffness (0.15 to 0.87), and physical function (0.13 to 0.97). These findings suggest that Tai Chi results in statistically significant as well as clinically important improvements in pain, stiffness, and physical function across a wide range of ACR in adults with KOA.

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OBJECTIVE: Conduct an ancillary meta-analysis to determine whether true inter-individual response differences (IIRD) exist with respect to the effects of qigong on resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) in adults. METHODS: Data from a meta-analysis representing 370 participants (181 qigong, 189 control) from 7 randomized trials on qigong and resting SBP and DBP in men and women were included. Qigong and control group change outcome standard deviations treated as point estimates for both resting SBP and DBP were used to calculate true IIRD from each study. The inverse variance heterogeneity (IVhet) model was used to pool results. RESULTS: For participants with essential hypertension, statistically significant and clinically important reductions in resting SBP (X̅, -18.2 mmHg, 95% CI, -21.3 to -15.2 mmHg) and DBP (X̅, -11.7 mmHg, 95% CI, -17.0 to -6.3 mmHg) were found. However, true IIRD were neither significant nor clinically important for either SBP (X̅, -6.0 mmHg, 95% CI, -9.1 to 3.5 mmHg) or DBP (X̅, 2.8 mmHg, 95% CI, -3.4 to 5.2 mmHg). The 95% prediction interval for true IIRD was - 11.9 to 8.4 mmHg for SBP and - 5.8 to 7.0 mmHg for DBP. CONCLUSIONS: While qigong is associated with reductions in resting SBP and DBP in adults with essential hypertension, a lack of true IIRD exists, suggesting that other external factors are responsible for any variation.

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OBJECTIVE: To determine whether true interindividual response differences (IIRD) exist with respect to changes in anxiety because of aerobic exercise training in adults with fibromyalgia (FM). DATA SOURCES: Data from a previous meta-analytical database of randomized controlled trials of exercise in adults with arthritis and other rheumatic diseases. STUDY SELECTION: Randomized controlled trials limited to aerobic exercise training on anxiety in adults 18 years or older with FM were included. DATA EXTRACTION: Change outcome SDs treated as point estimates for anxiety were used to calculate true IIRD from each study. In addition, treatment effect data were extracted. DATA SYNTHESIS: The inverse variance heterogeneity model was used to pool all results. For the 5 studies and 321 participants in which results were pooled, statistically significant treatment effect reductions in anxiety were observed (mean, -0.77 points, 95% CI, -1.25 to -0.77). However, no significant IIRD were found (mean, 0.6 points, 95% CI, -1.2 to 1.5). The 95% prediction interval for true IIRD in a future study was -1.7 to 0.8. The percent chance, ie, probability, of a clinically meaningful difference in variability, was 61.5% (only possibly clinically important). CONCLUSIONS: The results of the current study suggest that aerobic exercise is associated with reductions in anxiety among adults with fibromyalgia. However, there is currently a lack of convincing evidence to support the notion that true IIRD exist. Therefore, a search for potential mediators and moderators associated with aerobic exercise and changes in anxiety among adults with FM may not be warranted. However, additional research is needed before any true level of certainty can be established. This includes (1) the assessment of IIRD in future randomized controlled trials, (2) randomized controlled trials of longer duration, and (3) an increase in the proportion of men included in randomized controlled trials.

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The aim of this systematic review and meta-analysis was to provide an updated analysis, including the use of more robust methods, on the effects of exercise on bone mineral density in men. Randomised Control Trials of > 24 weeks and published in English up to 01/05/20 were retrieved from 3 electronic databases, cross-referencing, and expert review. The primary outcome measures were changes in FN, LS, and lower limb BMD Standardised effect sizes were calculated from each study and pooled using the inverse heterogeneity model. A statistically significant benefit of exercise was observed on FN BMD [g = 0.21 (0.03, 0.40), Z = 2.23 p = 0.03], with no observed statistically significant benefit of exercise on LS BMD [g = 0.10 (- 0.07, 0.26), Z = 1.15 p = 0.25]. This analysis provided additional evidence to recommend ground- and/or joint-reaction force exercises for improving or maintaining FN, but not LS BMD. Additional well-designed RCTs are unlikely to alter this evidence, although interventions that include activities that directly load the lumbar spine are needed to ensure this is not a potential method of improving LS BMD.

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PURPOSE: Isometric exercise (IE) has been shown to reduce resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) in adults. However, no one to date has determined whether true inter-individual response differences (IIRD) versus random variability exist with respect to IE and resting SBP and DBP in adults ≥18 years of age. The purpose of the current study was to address this gap. METHODS AND MATERIALS: Using the meta-analytic approach, randomised controlled trials from a recent meta-analysis that examined the effects of IE on resting SBP and DBP were included. Change outcome standard deviations for SBP and DBP from IE and control groups were used to calculate true IIRD from each study. The inverse variance heterogeneity (IVhet) model was used to pool results. RESULTS: Pooled changes for true IIRD in SBP (16 studies, 411 participants) were 3.3 mmHg (95% confidence interval, -3.1 to 5.6 mmHg) while tau (τ) was 4.2. For DBP, true IIRD (16 studies, 411 participants) were 2.3 mmHg (95% confidence interval, -0.7 to 3.3 mmHg) while tau (τ) was 2.2. The 95% prediction interval for true IIRD in a future study was -5.8 to 7.4 mmHg for SBP and -2.7 to 4.2 mmHg for DBP. The percent chance, i.e. probability, of a clinically meaningful difference of 2 mmHg was 68% for SBP and 75% for DBP, both of which were only considered as 'possibly clinically important'. CONCLUSION: While IE reduces resting SBP and DBP in adults, the results of the current study suggest that random variability versus true IIRD account for any potential differences as a result of IE on changes in resting SBP and DBP in adults. Thus, a search for potential moderators and mediators, including potential genetic interactions associated with IE, may not be warranted.

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INTRODUCTION: The American Association of Colleges of Pharmacy Pharmacy Practice Section appointed a task force charged with developing a formal, national mentorship program for association section members. This manuscript provides insight into the creation of a mentorship program in a professional organization. METHODS: Eighteen task force volunteers were divided into four sub-teams, along with a chair and vice chair. Sub-team responsibilities were segmented into the following: (1) mission and vision development, (2) structure and content, (3) assessment and impact, and (4) dissemination and scholarship. Task force members were surveyed to generate recommendations for creating a formal mentorship program within a professional organization and reflect on the process. RESULTS: Seven of 14 eligible task force members completed the questionnaire (50% response rate). Most participants were mid-career, involved in a range of development aspects, and represented both committee members and leadership within the task force. The average time commitment was 15-19 hours over the year. The most common resource utilized was published literature and guidance documents. Identified needs included validated assessment tools, a wider range of exemplary programs to review, and guidance on broader organizational support. Strengths included organization and sub-team structure. Areas for improvement included coordination between sub-teams and resources available. Participants noted the challenges of creating a program to meet the diverse needs of a large membership. CONCLUSIONS: This manuscript demonstrates the feasibility and evidence-based approach in creation of a mentorship program within a national organization.

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Background: Provide national estimates of the number of US children and adolescents with overweight and obesity who could improve their percent body fat by exercising. Methods: Data were derived from (1) a previous meta-analysis, (2) 2015-2016 prevalence data from the National Health and Nutrition Examination Survey (NHANES), and (3) 2017 US Census population data. Multiplicative calculations were based on (1) number-needed-to treat data from a previous meta-analysis of the number of children with overweight and obesity who could reduce their percent body fat by participating in either aerobic, strength, or combined aerobic and strength training, (2) 2015-2016 NHANES data on the prevalence of children and adolescents with overweight or obesity, and (3) 2017 US Census population data on children and adolescents 2-19 years of age. Results: For both children and adolescents with overweight or obesity, the number who could improve their percent body fat was estimated at 4,388,273 [95% confidence interval (CI) 3,831,523-4,845,023] for either aerobic or strength exercise and 6,507,410 (95% CI 5,744,285-7,267,534) for combined aerobic and strength exercise. Conclusions: A large number of US children and adolescents with overweight and obesity could improve their percent body fat by exercising.

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BACKGROUND: Exercise has been recommended as an important intervention for reducing adiposity in children and adolescents with overweight and obesity. OBJECTIVE: Determine whether inter-individual differences exist in relation to exercise-induced changes in adiposity among children and adolescents with overweight and obesity. METHODS: Meta-analysis of randomized controlled aerobic exercise trials and body mass index (BMI) in kg · m-2 . Change outcome standard deviations were pooled using the inverse-variance heterogeneity model. RESULTS: Twenty-eight studies (1185 participants) were included. Inter-individual differences in BMI were -0.1 (95% compatibility interval, -0.7 to 0.7). The 95% prediction interval for inter-individual responses in a future study was -2.9 to 2.9. The probability of a clinically meaningful difference in variability was 29% (possibly clinically important) in favour of controls vs exercisers. CONCLUSIONS: Inter-individual differences for BMI in kg · m-2 were not observed as a result of aerobic exercise in children and adolescents with overweight and obesity.

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We estimated the number of physically inactive US adults with arthritis by state and nationally who could improve their physical function and pain control by participating in an exercise program. Our calculations were based on number-needed-to-treat, arthritis prevalence, physical inactivity, and 2010 US Census data. Estimates were lowest in the District of Columbia (physical function, n = 4,412; pain, n = 2,451) and highest in Texas (physical function, n = 325,504; pain, n = 180,835). Overall estimates were 4,119,792 for physical function and 2,288,771 for pain control. State-level estimates are important for allocating resources, public health program planning, and future research.

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Background: Determine whether inter-individual response differences exist with respect to changes in fat mass and percent body fat as a result of aerobic exercise training in overweight and obese children and adolescents. Methods: Using the meta-analytic approach, randomized controlled trials that examined the effects of aerobic exercise training on fat mass and percent body fat in overweight and obese children and adolescents were included. Change outcome standard deviations for fat mass and percent body fat were used to calculate true inter-individual differences from each study. The inverse variance heterogeneity model was used to pool results. Results: Pooled changes for inter-individual response differences in fat mass (16 studies, 575 participants) were 0.9 kg (95% confidence interval [CI], -1.4 to 1.8 kg) while tau ([Formula: see text]) was 2.9. For percent body fat, inter-individual differences (27 studies, 1035 participants) were 0.6% (95% CI, -0.6% to 1.0%, [Formula: see text] = 0.7). The 95% prediction interval for true inter-individual responses in a future study was -4.9 to 5.5 kg for fat mass and -0.7% to 1.7% for percent body fat. The percent chance, that is, probability, of a clinically meaningful difference in variability was 47% for fat mass and 26% for percent body fat, both of which were considered as only possibly clinically important. Conclusions: There is a lack of convincing evidence to suggest that true inter-individual response differences exist with respect to aerobic exercise training and changes in fat mass and percent body fat in overweight and obese children and adolescents.

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OBJECTIVE: Provide state-level estimates of the number of physically inactive adults in the United States with arthritis and other rheumatic and musculoskeletal diseases (RMDs) who could improve their anxiety and depression by exercising. METHODS: Utilizing 1) number-needed-to treat (NNT) data from two prior meta-analyses of randomized controlled trials addressing the effects of exercise on anxiety and depression in adults with arthritis and other RMDs, 2) recent state-level prevalence estimates on arthritis and physical inactivity in adults with arthritis and other RMDs, and 3) state-level 2010 US Census population data, the number of physically inactive adults with arthritis and other RMDs who could improve their anxiety and depression by exercising was estimated. RESULTS: Across all states and the District of Columbia, the number of adults with arthritis and other RMDs who could improve their anxiety and depression by starting an exercise program was estimated at 3 433 167 (95% confidence interval [CI] = 3 171 000-3 703 522) for anxiety and 2 942 706 (95% CI = 2 718 000-3 174 438) for depression. For anxiety, numbers ranged from 3677 (95% CI = 3235-4154) in the District of Columbia to 271 253 (95% CI = 243 998-298 508) in Texas. For depression, numbers ranged from 3151 (95% CI = 2773-3561) in the District of Columbia to 232 502 (95% CI = 209 140-255 863) in Texas. CONCLUSION: These state-specific data suggest that a large number of physically inactive US adults with arthritis and other RMDs could improve their anxiety and depression by starting and maintaining a regular exercise program.

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BACKGROUND: Provide robust and practically relevant information regarding the association between yoga, health-related quality-of-life (HRQOL), and mental well-being (MWB) in older adults. METHODS: Data were derived from a recent meta-analysis of 12 randomized controlled yoga trials representing 752 adults ≥60 years of age. Standardized mean difference effect sizes (ESs) were pooled using the recently developed quality effects model and 95% compatibility intervals (CI). Small-study effects were examined using the Doi plot and Luis Furuya-Kanamori (LFK) index. Sensitivity and cumulative meta-analyses were conducted as well as percentile improvement, number needed to treat (NNT), and number to benefit. The grading of recommendations assessment, development, and evaluation (GRADE) instrument was used to assess the strength of the evidence. RESULTS: Yoga was associated with improvements in both HRQOL (ES = 0.51, 95% CI, 0.25-0.77, I2 = 63.1%) and MWB (ES = 0.39, 95% CI, 0.15-0.63, I2 =56.2%). Percentile improvements were 19.5 for HRQOL and 15.3 for MWB whereas the NNT was 4 for HRQOL and 5 for MWB. An estimated 378,222 and 302,578 U.S. yoga-practicing adults ≥65 years of age could potentially improve their HRQOL and MWB, respectively. Major asymmetry suggestive of small-study effects was observed for MWB but not HRQOL. Further examination for asymmetry revealed that greater improvements in MWB were associated with more (151 vs. 68) minutes of yoga per week (p = .007). Overall strength of evidence was considered "high" for HRQOL and "moderate" for MWB. CONCLUSIONS: Yoga is associated with improvements in HRQOL and MWB among older adults, with approximately 150 minutes or more per week possibly optimal.

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This study used the inverse variance heterogeneity (IVhet) model to conduct a reanalysis of a recent meta-analysis that reported a positive association, based on the random-effects (RE) model, between obesity and the incidence of type 2 diabetes and coronary heart disease, but not all-cause stroke, in adults. Data emanated from a recent meta-analysis of five Mendelian randomization studies representing 881,692 adults. Results were pooled using the IVhet model and reported as OR's and 95% CI. Small-study effects were examined using the Doi plot and Luis Furuya-Kanamori (LFK) index. Influence analysis was also conducted. The association between obesity and type 2 diabetes, coronary heart disease, and all-cause stroke was, respectively, 1.38 (95% CI 1.00 to 1.90, p=0.05, I2 =93%), 1.10 (95% CI 0.90 to 1.35, p=0.35, I2 =87%), and 1.02 (95% CI 0.95 to 1.09, p=0.64, I2 =0%). Compared with the original RE model, results were similar for all-cause stroke, but point estimates for type 2 diabetes and coronary heart disease were smaller (29.3% and 9.8%) with wider (7.0% and 14.7%), overlapping CI. Major asymmetry suggestive of small-study effects was observed (LFK=3.59). With the exception of one study for type 2 diabetes, results remained uncertain (overlapping 95% CI) when each study was deleted from the model once. A lack of certainty exists regarding the association between obesity and the incidence of type 2 diabetes, coronary heart disease, and all-cause stroke in adults.

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OBJECTIVES: Determine both the effects and hierarchy of effectiveness for exercise interventions (aerobic, strength training or both) on selected measures of adiposity (body mass index (BMI) in kg/m2, fat mass and per cent body fat) in overweight and obese children and adolescents. DESIGN: Network meta-analysis of randomised exercise intervention trials. SETTING: Any setting where a randomised trial could be conducted. PARTICIPANTS: Overweight and obese male and/or female children and adolescents 2-18 years of age. INTERVENTIONS: Randomised exercise intervention trials>4 weeks, published between 1 January 1973 and 22 August 2018, and which included direct and/or indirect evidence for aerobic, strength training or combined aerobic and strength training. PRIMARY OUTCOMES: Changes in BMI in kg/m2, fat mass and per cent body fat. RESULTS: Fifty-seven studies representing 127 groups (73 exercise, 54 control) and 2792 participants (1667 exercise, 1125 control) met the criteria for inclusion. Length of training ([Formula: see text] ± SD) averaged 14.1±6.2 weeks, frequency, 3.3±1.1 days per week and duration 42.0±21.0 min per session. Significant and clinically important reductions in BMI, fat mass and per cent body fat were observed in aerobic versus control comparisons (BMI, mean, 95% CI -1.0, 1.4 to -0.6; fat mass -2.1, -3.3 to -1.0 kg; per cent fat -1.5, -2.2 to -0.9%) and combined aerobic and strength versus control comparisons (BMI -0.7, -1.4 to -0.1; fat mass -2.5, -4.1 to -1.0 kg; per cent fat, -2.2, -3.2 to -1.2%). A significant reduction in per cent fat was also found for strength vs control comparisons (-1.3,-2.5 to -0.1%). Combined aerobic and strength training was ranked first for improving both fat mass (kg) and per cent body fat while aerobic exercise was ranked first for improving BMI. CONCLUSIONS: Aerobic and combined aerobic and strength training are associated with improvements in adiposity outcomes in overweight and obese children and adolescents. PROSPERO REGISTRATION NUMBER: CRD42017073103.

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There exists an ever-increasing number of systematic reviews, with or without meta-analysis, in the field of nutrition. Concomitant with this increase is the increased use of such to guide future research as well as both practice and policy-based decisions. Given this increased production and consumption, a need exists to educate both producers and consumers of systematic reviews, with or without meta-analysis, on how to conduct and evaluate high-quality reviews of this nature in nutrition. The purpose of this paper is to try and address this gap. In the present manuscript, the different types of systematic reviews, with or without meta-analyses, are described as well as the description of the major elements, including methodology and interpretation, with a focus on nutrition. It is hoped that this non-technical information will be helpful to producers, reviewers and consumers of systematic reviews, with or without meta-analysis, in the field of nutrition.

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