• Age-related degeneration of the lumbar paravertebral muscles: Systematic review and three-level meta-regression

      Dallaway, Alexander; Kite, Chris; Griffin, Corbyn; Duncan, Michael; Tallis, J; Renshaw, D; Hattersley, John; Coventry University, University Hospitals Coventry and Warwickshire, Aston University, University of Chester
      Background Morphological changes of the lumbar spine muscles are not well characterised with ageing. To further the understanding of age-related degeneration of the lumbar spine musculature, normative morphological changes that occur within the paravertebral muscles must first be established. Methods A systematic review and meta-regressions were conducted adhering to PRISMA guidelines. Searches for published and unpublished data were completed in June 2019. Results Searches returned 4781 articles. 34 articles were included in the quantitative analysis. Three-level meta-analyses showed age-related atrophy (r = −0.26; 95% CI: −0.33, −0.17) and fat infiltration (r = 0.39; 95% CI: 0.28, 0.50) in the lumbar paravertebral muscles. Degenerative changes were muscle-specific and men (r = −0.32; 95% CI: −0.61, 0.01) exhibited significantly greater muscle atrophy than women (r = −0.24; 95% CI: −0.47, 0.03). Imaging modality, specifically ultrasound, also influenced age-related muscle atrophy. Measurements taken across all lumbar levels revealed the greatest fat infiltration with ageing (r = 0.58, 95% CI: 0.35, 0.74). Moderators explained a large proportion of between-study variance in true effects for muscle atrophy (72.6%) and fat infiltration (79.8%) models. Conclusions Lumbar paravertebral muscles undergo age-related degeneration in healthy adults with muscle, lumbar level and sex-specific responses. Future studies should use high-resolution imaging modalities to quantify muscle atrophy and fat infiltration.
    • A comparison of self-reported and device measured sedentary behaviour in adults: a systematic review and meta-analysis.

      Prince, Stephanie; Cardilli, Luca; Reed, Jennifer; Saunders, Travis; Kite, Chris; Douillette, Kevin; Fournier, Karine; Buckley, John; University of Ottawa Heart Institute, Public Health Agency of Canada, Birmingham Community Healthcare NHS Foundation Trust, University of Chester, University of Ottawa, University of Prince Edward Island, Aston University
      Background Sedentary behaviour (SB) is a risk factor for chronic disease and premature mortality. While many individual studies have examined the reliability and validity of various self-report measures for assessing SB, it is not clear, in general, how self-reported SB (e.g., questionnaires, logs, ecological momentary assessments (EMAs)) compares to device measures (e.g., accelerometers, inclinometers). Objective The primary objective of this systematic review was to compare self-report versus device measures of SB in adults. Methods Six bibliographic databases were searched to identify all studies which included a comparable self-report and device measure of SB in adults. Risk of bias within and across studies was assessed. Results were synthesized using meta-analyses. Results The review included 185 unique studies. A total of 123 studies comprising 173 comparisons and data from 55,199 participants were used to examine general criterion validity. The average mean difference was -105.19 minutes/day (95% CI: -127.21, -83.17); self-report underestimated sedentary time by ~1.74 hours/day compared to device measures. Self-reported time spent sedentary at work was ~40 minutes higher than when assessed by devices. Single item measures performed more poorly than multi-item questionnaires, EMAs and logs/diaries. On average, when compared to inclinometers, multi-item questionnaires, EMAs and logs/diaries were not significantly different, but had substantial amount of variability (up to 6 hours/day within individual studies) with approximately half over-reporting and half under-reporting. A total of 54 studies provided an assessment of reliability of a self-report measure, on average the reliability was good (ICC = 0.66). Conclusions Evidence from this review suggests that single-item self-report measures generally underestimate sedentary time when compared to device measures. For accuracy, multi-item questionnaires, EMAs and logs/diaries with a shorter recall period should be encouraged above single item questions and longer recall periods if sedentary time is a primary outcome of study. Users should also be aware of the high degree of variability between and within tools. Studies should exert caution when comparing associations between different self-report and device measures with health outcomes.
    • Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis

      Kite, Chris; Lahart, Ian; Afzal, Islam; Broom, David; Randeva, Harpal; Kyrou, Ioannis; Brown, James (2019-02-12)
      Background: Typically, management of PCOS focuses on lifestyle changes (exercise and diet), aiming to alleviate symptoms, and lower the associated risk of type 2 diabetes and cardiovascular disease. Our objective was to analyse evidence on the effectiveness of exercise in the management of PCOS, when compared to (i) usual care, (ii) diet alone, and (iii) exercise combined with diet, and also exercise combined with diet, compared to (i) control or usual care and (ii) diet alone. Methods: Relevant databases were searched (June 2017) with no time limit for trial inclusion. Eligible trials employed a randomised or quasi-randomised design to measure the chronic effects of exercise, or exercise and diet in women with PCOS. Results: Searches returned 2390 articles; of those, 27 papers from 18 trials were included. Results are presented as mean difference (MD) and 95% confidence intervals (95% CI). Compared with control, exercise had a statistical effect on change from baseline fasting insulin (MD − 2.44 μIU/mL, 95% CIs − 4.24 to − 0.64; very low-quality evidence), HOMA-IR (− 0.57, − 0.99 to − 0.14; very low-quality evidence), total cholesterol (− 5.88 mg/dL, − 9.92 to − 1.83; low-quality evidence), LDL cholesterol (− 7.39 mg/dL, − 9.83 to − 4.95; low-quality evidence), and triglycerides (− 4.78 mg/dL, − 7.52 to − 2.05; low-quality evidence). Exercise also improved VO2 max (3.84 ml/kg/min, 2.87 to 4.81), waist circumference (− 2.62 cm, − 4.13 to − 1.11), and body fat percentage (− 1.39%, − 2.61 to − 0.18) when compared with usual care. No effect was found for change value systolic/ diastolic blood pressure, fasting glucose, HDL cholesterol (all low-quality evidence), or waist-to-hip ratio. Many favourable change score findings were supported by post-intervention value analyses: fasting insulin (− 2.11 μIU/mL, − 3.49 to − 0.73), total cholesterol (− 6.66 mg/dL, − 11.14 to − 2.17), LDL cholesterol (− 6.91 mg/dL, − 12.02 to − 1.80), and VO2 max (5.01 ml/kg/min, 3.48 to 6.54). Statistically lower BMI (− 1.02 kg/m2, − 1.81 to − 0.23) and resting heart rate (− 3.26 beats/min − 4.93 to − 1.59) were also revealed in post-intervention analysis. Subgroup analyses revealed the greatest improvements in overweight/obese participants, and more outcomes improved when interventions were supervised, aerobic in nature, or of a shorter duration. Based on limited data, we found no differences for any outcome between the effects of exercise and diet combined, and diet alone. It was not possible to compare exercise vs diet or exercise and diet combined vs diet. Conclusion: Statistically beneficial effects of exercise were found for a range of metabolic, anthropometric, and cardiorespiratory fitness-related outcomes. However, caution should be adopted when interpreting these findings since many outcomes present modest effects and wide CIs, and statistical effects in many analyses are sensitive to the addition/removal of individual trials. Future work should focus on rigorously designed, well-reported trials that make comparisons involving both exercise and diet. Systematic review registration: This systematic review was prospectively registered on the Prospero International Prospective Register of Systematic Reviews (CRD42017062576)