Effectiveness of Tai Chi on fibromyalgia patients: A meta-analysis of randomized controlled trials

ObjectiveTo identify empirical evidence on the effectiveness of Tai Chi in treating fibromyalgia (FM).MethodWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the effectiveness of Tai Chi and standard care or conventional therapeutic exercise in patients with FM. PubMed, Medline, and Physiotherapy Evidence Database were searched for relevant studies published before May 2019. Treatment effectiveness was evaluated using the fibromyalgia impact questionnaire (FIQ), and the total score, pain score, sleep quality index, fatigue, depression, and quality of life were assessing among the patients.ResultsSix RCTs with 657 patients were included. Results of our meta-analysis indicated that Tai Chi exerts significant positive effects on reducing the total FIQ score at 12–16 weeks (standard mean difference [SMD]: −0.61; 95% confidence interval [CI]: −0.90 to −0.31) and pain score (SMD: −0.88; 95% CI: −1.58 to −0.18), improving sleep quality (SMD: −0.57; 95% CI: −0.86 to −0.28), relieving fatigue (SMD: −0.92; 95% CI: −1.81 to −0.04), alleviating depression (SMD: −0.49; 95% CI: −0.97 to −0.01), and enhancing quality of life physically (SMD: 6.21; 95% CI: 3.18–9.24) and psychologically (SMD: 5.15; 95% CI: 1.50–8.81).ConclusionTai Chi exerts significantly greater effects on patients with FM than standard care; therefore, we suggest that Tai Chi can be used as an alternative treatment. However, more large-scale, high-quality, and multicenter trials are required to provide stronger evidence on the effectiveness of Tai Chi, as an alternative to aerobic exercise, compared with conventional therapeutic exercise.     

Effect of yoga on anthropometry,quality of life,and lipid profile in patients with obesity and central obesity: A systematic review and meta-analysis

ObjectiveThis systematic review and meta-analysis aimed to determine the effectiveness of yoga on anthropometry, quality of life, and lipid profiles in patients with obesity and central obesity.MethodologyThe Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed (1985-January 2022) and trial registries for relevant randomised clinical trials were used. Relevant and published randomised clinical trials were reviewed and evaluated. The primary outcomes were anthropometry measurements, which were weight, waist circumference, body mass index (BMI), and body fat percentages. The secondary outcomes were changes in quality of life, psychological impact, lipid profile measurement, presence of adverse events, and changes in blood pressure and blood glucose. We assessed the data for risk of bias, heterogeneity, sensitivity, reporting bias, and quality of evidence.Results15 studies are included, involving 1161 participants. The analysis performed is based on three comparisons. For the first comparison between yoga and control, yoga reduces the waist circumference (MD −0.84, 95% CI [−5.12 to 3.44]), while there is no difference in body weight, BMI, or body fat percentages. In the second comparison between yoga and calorie restriction, yoga reduces body weight (MD −3.47, 95% CI [−6.20 to −0.74]), while there is no difference in waist circumference, BMI, or body fat percentage. In the third comparison between yoga and exercise, yoga reduces the body weight (MD −7.58, 95% CI [−11.51 to −3.65]), while there is no difference in waist circumference or BMI. For the secondary outcomes, yoga intervention reduces total cholesterol (MD −17.12, 95% CI [−32.24 to −2.00]) and triglycerides (MD −21.75, 95% CI [−38.77 to −4.73]) compared to the control group, but there is no difference compared to the calorie restriction and exercise group. There is no difference in the rest of the outcomes, which are LDL, HDL, quality of life, psychological impact, adverse events, blood pressure, and blood glucose. However, findings are not robust due to a high risk of bias and low-quality evidence.ConclusionFrom our review, there were methodological drawbacks and very low to moderate quality of evidence across all comparisons, and hence, it is inconclusive to say that yoga can significantly improve anthropometric parameters. More well-designed trials are needed to confirm and support the beneficial effects of yoga.     

The effects of myofascial release technique for patients with low back pain: A systematic review and meta-analysis

ObjectiveThe purpose of this meta-analytic review was to quantitatively examine the effects of myofascial release technique (MFR) on pain intensity, back disability, lumbar range of motion, and quality of life in patients with low back pain (LBP).MethodsPotential articles were retrieved using five electronic databases (Web of Science, PubMed, Scopus, China National Knowledge Infrastructure, and Wanfang). The search period was from inception to January 27, 2021. Two researchers independently completed record retrieval and selection, data extraction, and methodological quality assessment. Randomized controlled trials (RCTs) assessing the effect of MFR on pain intensity, back disability, lumbar range of motion, and quality of life in LBP patients were included. Pooled effect sizes were calculated using random effects models and 95 % confidence interval (95 % CI).ResultsData from eight RCTs (386 patients with back pain) meeting the inclusion criteria were extracted for meta-analysis with methodological quality assessment scores ranging from 6 to 10. Compared to the control intervention, MFR induced significant decrease in back disability (SMD = −0.35, 95 % confidence interval [CI] = −0.68, –0.02, P = 0.04, I² = 46 %, n = 284). MFR induced non-significant decrease in the pain intensity (SMD = −0.12, 95 % confidence interval[CI] = −0.35, 0.11, P = 0.32, I² = 0%, n = 294), non-significant improvement in quality of life (SMD = −0.09, 95 % confidence interval [CI] = −0.46, 0.28, P = 0.62, I² = 0%, n = 114), and non-significant improvement in lumbar range of motion (Flexion SMD = 0.57,95 % confidence interval [CI] = −0.09, 1.24, P = 0.09, I² = 54 %, n = 80) (Extension SMD = 0.68, 95 % confidence interval[CI] = −0.72, 2.08, P = 0.34, I² = 89 %, n = 80) (Right flexion SMD = 0.05, 95 % confidence interval[CI] = −0.90, 0.99, P = 0.92, I² = 78 %, n = 80) (Left flexion SMD = 0.14, 95 % confidence interval[CI] = −0.59, 0.88, P = 0.70, I² = 64 %, n = 80).ConclusionThe findings suggest that MFR can improve the effect of physical therapy alone and exercise therapy alone, and that MFR can be an effective adjuvant therapy. Meta-analysis showed that MFR has a significant effect on reducing back disability in patients with low back pain, but no significant effect on reducing pain intensity, improving quality of life, and improving lumbar range of motion.     

Effects of transcutaneous electrical acupoint stimulation on gastrointestinal dysfunction after gastrointestinal surgery: A meta-analysis

BackgroundPostoperative gastrointestinal dysfunction (PGD) is a common complication in patients undergoing gastrointestinal surgery. Several studies have evaluated the effect of transcutaneous electrical acupoint stimulation (TEAS) on PGD, so we conducted a systematic review and meta-analysis to better understand these studies methodologic limitations and summarize clinical effects.MethodsArticles (published from January 2010 to April 2022) were searched from the following databases: Wanfang Database, China National Knowledge Infrastructure (CNKI), Cochrane Library, PubMed, Web of Science and Embase. Two authors conducted literature selection, data extraction and statistical analysis independently. This meta-analysis used RevMan 5.4 software to implement statistical analysis and applied Cochrane bias risk tool to assess methodologic weaknesses of included articles. We assessed the effect of TEAS on time to first flatus, first defecation and bowel sound recovery through meta-analyses using a random-effects model.ResultsThe meta-analysis included 10 articles including 1497 patients. This study showed that TEAS could effectively promote postoperative gastrointestinal function recovery by analyzing the time to first flatus (MD−14.81 h, 95% CI −15.88 to −13.75 h), time to first defecation (MD−14.68 h, 95% CI −20.59 to −8.76 h), time to bowel sound recovery (MD−5.79 h, 95% CI −10.87 to −0.71 h), length of hospital stay (MD−1.48d, 95% CI −1.86 to −1.11d), and the incidence of postoperative nausea and vomiting (PONV) (OR 0.41, 95% CI 0.29–0.58). In addition, we assessed the quality of the articles and found small sample sizes and lower methodological quality in some articles.ConclusionOur meta-analysis revealed that TEAS could be a nonpharmacological treatment for PGD in patients after gastrointestinal surgery. However, positive findings should be treated carefully and future studies with high quality and large samples are needed to support this results.     

The effect of exercise,yoga and physiotherapy on the quality of life of people with multiple sclerosis: Systematic review and meta-analysis

IntroductionMultiple sclerosis (MS) is a chronic autoimmune disease affecting the myelinated axons of the central nervous system causing neurological deterioration. People living with MS have a poor quality of life (QOL) because of the symptoms caused by the disease and there are various types of treatments to manage the symptoms aside from medication.ObjectiveThis meta-analysis examines the effect of exercise, yoga and physiotherapy on the physical, mental and social QOL among individuals living with MS.SettingA systematic review with meta-analysis was conducted using PubMed, Medline, and Scopus from 1990 to 2017. The standard mean difference scores were computed in each study for the domains of physical, mental and social functioning.ResultsEighteen studies met the inclusion criteria for this meta-analysis. Aerobic exercise was effective in improving satisfaction with physical functioning,d = 0.35 (95% CI = 0.08 to 0.62), mental functioning d = 0.42 (95% CI = 0.11 to 0.72), and social functioning d = 0.42 (95% CI = 0.15 to 0.69). Physiotherapy was also found to be effective for physical functioning d = 0.50 (95% CI 0.19 to 0.80), mental functioning d = 0.44 (95% CI 0.14 to 0.75) and social functioning d = 0.60 (95% CI 0.21 to 0.90). However yoga and combination of exercises did not have a significant effect on any of the QOL domains.ConclusionThese findings suggest that aerobic exercise and physiotherapy improves the satisfaction of MS patients with their physical, mental and social functioning and may be included as normal practice in the treatment of MS.     

Improving vasomotor symptoms; psychological symptoms; and health-related quality of life in peri- or post-menopausal women through yoga: An umbrella systematic review and meta-analysis

ObjectivesVasomotor symptoms (VMS), commonly reported during menopausal transition, negatively affect psychological health and health-related quality of life (HRQoL). While hormone therapy is an effective treatment, its use is limited by concerns about possible harms. Thus, many women with VMS seek nonhormonal, nonpharmacologic treatment options. However, evidence to guide clinical recommendations is inconclusive. This study reviewed the effectiveness of yoga, tai chi and qigong on vasomotor, psychological symptoms, and HRQoL in peri- or post-menopausal women.DesignMEDLINE, Cochrane Database of Systematic Reviews, EMBASE, CINAHL and the Allied and Complementary Medicine Database were searched. Researchers identified systematic reviews (SR) or RCTs that evaluated yoga, tai chi, or qigong for vasomotor, psychological symptoms, and health-related quality of life (HRQoL) in peri- or post-menopausal women. Data were abstracted on study design, participants, interventions and outcomes. Risk of bias (ROB) was assessed and updated meta-analyses were performed.ResultsWe identified one high-quality SR (5 RCTs, 582 participants) and 3 new RCTs (345 participants) published after the SR evaluating yoga for vasomotor, psychological symptoms, and HRQoL; no studies evaluated tai chi or qigong. Updated meta-analyses indicate that, compared to controls, yoga reduced VMS (5 trials, standardized mean difference (SMD) −0.27, 95% CI −0.49 to −0.05) and psychological symptoms (6 trials, SDM −0.32; 95% CI −0.47 to −0.17). Effects on quality of life were reported infrequently. Key limitations are that adverse effects were rarely reported and outcome measures lacked standardization.ConclusionsResults from this meta-analysis suggest that yoga may be a useful therapy to manage bothersome vasomotor and psychological symptoms.     

Yoga for secondary prevention of coronary heart disease: A systematic review and meta-analysis

ObjectivesYoga has been widely practiced and has recently shown benefits in patients with coronary heart disease (CHD), however, evidence is inconsistent.MethodsWe conducted a systematic review and meta-analysis by searching PubMed/Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Web of Science from inception to May 31, 2020 for randomised controlled trials (RCTs) comparing yoga with usual care or non-pharmacological interventions in patients with CHD. The primary outcomes were all-cause mortality and health related quality of life (HR-QoL). Secondary outcomes were a composite cardiovascular outcome, exercise capacity and cardiovascular risk factors (blood pressure, lipid profiles and body mass index).ResultsSeven RCTs with a total of 4671 participants were included. Six RCTs compared yoga with usual care and one compared yoga with designed exercise. The mean age of the participants ranged from 51.0–60.7 years and the majority of them were men (85.4 %). Pooled results showed that compared with usual care, yoga had no effect on all-cause mortality (RR, 1.02; 95 % CI, 0.75–1.39), but it significantly improved HR-QoL (SMD, 0.07; 95 % CI, 0.01 - 0.14). A non-significant reduction of the composite cardiovascular outcome was observed (133 vs. 154; RR, 0.63; 95 % CI, 0.15–2.59). Serum level of triglyceride and high density lipoprotein cholesterol, blood pressure and body mass index were also significantly improved. The study comparing yoga with control exercise also reported significantly better effects of yoga on HR-QoL (85.75 vs. 75.24, P < 0.001). No severe adverse events related to yoga were reported.ConclusionsYoga might be a promising alternative for patients with CHD as it is associated with improved quality of life, less number of composite cardiovascular events, and improved cardiovascular risk factors.     

Qigong for women with breast cancer: An updated systematic review and meta-analysis

ObjectiveThe purpose of this review was to evaluate the effectiveness of Qigong in improving the quality of life and relieving fatigue, sleep disturbance, and cancer-related emotional disturbances (distress, depression, and anxiety) in women with breast cancer.MethodsThe PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Sinomed, Wanfang, VIP, and China National Knowledge Infrastructure databases were searched from their inceptions to March 2020 for controlled clinical trials. Two reviewers selected relevant trials that assessed the benefit of Qigong for breast cancer patients independently. A methodological quality assessment was conducted according to the criteria of the 12 Cochrane Back Review Group for risk of bias independently. A meta-analysis was performed by Review Manager 5.3.ResultsThis review consisted of 17 trials, in which 1236 cases were enrolled. The quality of the included trials was generally low, as only five of them were rated high quality. The results showed significant effectiveness of Qigong on quality of life (n = 950, standardized mean difference (SMD), 0.65, 95 % confidence interval (CI) 0.23–1.08, P = 0.002). Depression (n = 540, SMD = −0.32, 95 % CI −0.59 to −0.04, P = 0.02) and anxiety (n = 439, SMD = −0.71, 95 % CI −1.32 to −0.10, P = 0.02) were also significantly relieved in the Qigong group. There was no significant benefit on fatigue (n = 401, SMD = −0.32, 95 % CI 0.71 to 0.07, P = 0.11) or sleep disturbance relief compared to that observed in the control group (n = 298, SMD = −0.11, 95 % CI 0.74 to 0.52, P = 0.73).ConclusionThis review shows that Qigong is beneficial for improving quality of lifeand relieving depression and anxiety; thus, Qigong should be encouraged in women with breast cancer.     

Effects of Yoga in Daily Life program in rheumatoid arthritis: A randomized controlled trial

ObjectivesTo explore the feasibility and effectiveness of a yoga program in improving health-related quality of life (HQOL), physical and psychological functioning in rheumatoid arthritis (RA) patients.DesignSingle-centre parallel-arms randomized controlled trial comparing yoga (n = 30) and education control group (n = 27).SettingTertiary care University hospital.InterventionA 12-week yoga program, based on the Yoga in Daily Life system, included 2x weekly/90-minute sessions. The control group had 1xweekly/60-minute educational lectures on arthritis-related topics.Main outcome measuresAssessments were performed at baseline, 12 (post-intervention) and 24 weeks (follow-up). The primary outcome was change in The Short Form-36 (SF-36) HQOL at 12 weeks. Linear regression analysis was adjusted for baseline scores.ResultsNo significant between-group differences were found for SF-36 (all p > 0.05). At 12 weeks the adjusted mean difference between groups favoured yoga for Functional Assessment of Chronic Illness Therapy-fatigue (5.08 CI 1.29 to 8.86; p = 0.009) and Hospital Anxiety and Depression Scale (HADS)-depression (−1.37 CI −2.38 to −0.36); p = 0.008) and at 24 weeks for HADS-anxiety (−1.79 CI −3.34 to − 0.23; p = 0.025), while the impact on fatigue was sustained (5.43 CI 1.33 to 9.54, p = 0.01). The program had no impact on RA disease activity. Feasibility outcomes included recruitment rate 16 %, retention 80.7 %, and adherence to yoga 87.5 vs 82.7 % for control. No serious adverse events were recorded.ConclusionsYoga in Daily Life program was not associated with change in health-related quality of life of RA patients. Significant improvements in fatigue and mood were observed at postintervention and follow-up. This yoga program was found feasible and safe for patients and may complement standard RA treat-to-target strategy.     

Administration of dietary antioxidants for patients with inflammatory bowel disease: A systematic review and meta-analysis of randomized controlled clinical trials

ObjectiveAccumulating evidence has been reported regarding the effect of dietary antioxidants on clinical variables in IBD patients, however, findings are controversial. This systematic review and meta-analysis aimed to investigate effect of dietary antioxidants on clinical variables in patients with IBD or its subtypes.MethodsWe searched PubMed, Scopus, and ISI Web of Science from inception to January 2021 using relevant keywords. Data were pooled by using the random-effect model. All statistical analyses were done using STATA version 14.ResultsOur meta-analysis was exclusively done on studies about the effect of curcumin on IBD patients, because limited studies were done on other antioxidants. Curcumin administration resulted in significant increment of clinical remission in patients with IBD (SMD: 0.86%, 95% CI: 0.16, 1.56, p = 0.016), significant remission in clinical symptoms (SMD: −0.96 score, 95% CI: −1.34, −0.57, p < 0.001), and significant increment in endoscopic remission in IBD patients (SMD: 0.51%, 95% CI: 0.16, 0.85, p = 0.004), comparing to control group. Curcumin supplementation also made better clinical response than control group (SMD: 0.74%, 95% CI: 0.22, 1.26, p = 0.005) and also resulted in significant improvement in quality of life of patients with IBD, as compared to control group (SMD: 1.23 score, 95% CI: 0.72, 1.74, p < 0.001).ConclusionsOur meta-analysis showed that curcumin significantly improved clinical and endoscopic remissions in IBD patients. This supplementation also caused significant reduction in clinical symptoms of IBD patients along with better clinical response and the increased quality of life. Further researches with larger sample size and longer period of intervention are required to evaluate efficacy of dietary antioxidants on clinical variables in patients with IBD.     

Effects of curcumin supplementation on inflammatory biomarkers in patients with Rheumatoid Arthritis and Ulcerative colitis: A systematic review and meta-analysis

BackgroundAlthough previous studies have examined the impact of curcumin supplementation on cytokine levels in patients with autoimmune disorders, we were unable to find a systematic review of the effect of curcumin supplementation on inflammatory biomarkers such as CRP and ESR in patients with rheumatoid arthritis or ulcerative colitis; therefore we conducted this systematic review and meta-analysis.MethodsRelevant studies published from inception to December 2020 were systematically searched through the PubMed, SCOPUS, and google scholar databases. We conducted our systematic review and meta-analysis according to the 2020 PRISMA guidelines. The quality of the papers were assessed by using the Cochrane Collaboration's risk of bias tool. Included studies were randomized clinical trials on the effects of supplementation with curcumin or its derivative on inflammatory factors in patients with rheumatoid arthritis and ulcerative colitis. Pooled effect sizes were calculated using a random-effects model and reported as the weighted mean difference (WMD) and 95 % CI.ResultsIn all, six studies met the inclusion criteria for this study. Curcumin supplementation in doses of 250−1500 mg/day over 8–12 weeks was observed to be associated with decreases in CRP and ESR in adult patients with rheumatoid arthritis and ulcerative colitis in comparison with the control group (WMD: −0.42; 95 % CI: −0.59, −0.26, I² = 94.3 %; WMD: −55.96; 95 % CI: −93.74, −18.17, I² = 99.7 %, respectively). Significant findings were also observed based on subgroup analyses by the study sample size, duration, participants’ age, curcumin dosage, and type of disease.ConclusionsCurcumin supplementation was associated with significant reductions in levels of CRP and ESR in patients with rheumatoid arthritis and ulcerative colitis. Earlier studies reported curcumin as a safe complementary therapy for several diseases. However, a handful of studies were found on the effect of curcumin on autoimmune diseases despite our comprehensive search. Further studies are therefore warranted in this area.     

Flavonoid-containing supplements for preventing acute respiratory tract infections: A systematic review and meta-analysis of 20 randomized controlled trials

BackgroundThis systematic review and meta-analysis was conducted to investigate the efficacy and safety of flavonoid-containing supplements in preventing acute respiratory tract infection (ARTI).MethodsRandomized controlled trials (RCTs) investigating the effects of flavonoid-containing supplements on ARTI prevention in the aspects of ARTI incidence, mean ARTI sick days, symptoms, bio-immune markers, and adverse effects were searched in 5 databases. Data were searched from inception to November 26, 2021. Stata 16.0 was used to perform the meta-analysis.ResultsTwenty RCTs (n = 4521) were included in this systematic review and meta-analysis. Pooled results showed that in the flavonoid-containing supplement group, the ARTI incidence and mean ARTI sick days were significantly decreased compared to those in the control group (RR = 0.81, 95% CI: 0.74–0.89, p < 0.001; WMD = −0.56, 95% CI: −1.04 to −0.08, p = 0.021; respectively). In 8 RCTs, flavonoids were singly used for interventions, ARTI incidence in the experimental group significantly decreased compared to that in the control group (RR = 0.85, 95% CI: 0.72–1.00, p = 0.047). In ten RCTs, flavonoid-containing mixtures were applied for interventions, and ARTI incidence in the experimental group significantly decreased compared to that in the control group (RR = 0.79, 95% CI: 0.71–0.89, p < 0.001). Furthermore, the ARTI incidence and mean ARTI sick days were significantly decreased in the experimental group compared to those in the control group in the flavan-3-ols subgroup (RR = 0.79, 95% CI: 0.67–0.92, p = 0.002; WMD = −2.75, 95% CI: −4.30 to −1.21, p < 0.001; respectively) and the multiple subclasses subgroup (RR = 0.75, 95% CI: 0.63–0.88, p = 0.001; WMD = −0.56, 95% CI: −1.11 to −0.01, p = 0.046; respectively). However, the bio-immune markers including interleukin-6, hypersensitive-c-reactive-protein, tumor necrosis factor-α, and interferon-γ did not differ between the flavonoid group and the control group. Moreover, in the flavonoid-containing supplement group, the incidence of adverse reactions did not increase compared to that in the control group (RR = 1.16, 95% CI: 0.78–1.73, p = 0.469).ConclusionsThis systematic review and meta-analysis showed that flavonoid-containing supplements were efficacious and safe in preventing ARTIs. The most important limitations result from the small number of trials, poor quality of some included RCTs, differences in the composition and types of interventions, principal subclasses of flavonoids, methods of administration, and methodology. Moreover, only a few RCTs conducted independent verification of the flavonoid supplements used in the trial in terms of purity and potency, which may lead to a potential source of bias. Thus, larger and better-designed studies are needed to further verify this conclusion.     

Essential of Immediate Exercises on Cancer-Related Fatigue in Patients with Prostate Cancer Receiving Androgen Deprivation Therapy: A Meta-Analysis of Randomized Controlled Trials

ObjectiveAndrogen deprivation therapy (ADT) can cause several adverse effects, including cancer-related fatigue (CRF). CRF has multiple manifestations, with no definitive treatment to date. Among management, exercise has been a field with high complexity and uncertainty. In other words, it has much potential to be explored. To evaluate whether exercise reduces cancer-related fatigue (CRF) in patients receiving androgen deprivation therapy (ADT).Data SourcesRandomized controlled trials were included and searches were performed from PubMed, Embase, and Cochrane Library databases. We extracted and pooled the CRF, quality of life (QoL), muscle strength, and adverse event severity. The study is registered with PROSPERO (number: CRD 42020203165). Eightteen RCTs were included. The CRF in the exercise group (SMD: −0.18, 95% CI: −0.31 to −0.05) was significantly lower than in the usual care group. The CRF subgroup analysis showed a significant reduction in the immediate exercise group (SMD: −0.37, 95% CI: −0.61 to −0.13), and the combined exercise group (aerobic plus resistance)(SMD: −0.18, 95% CI: −0.36 to −0.01). QoL improvement was also known in the exercise group (SMD: 0.16, 95% CI: 0.01 to 0.32). Leg press and chess press increase ability in the exercise group (SMD: 0.5, 95% CI: 0.42 to 1.05; SMD: 0.42, 95% CI: 0.17 to 0.67, respectively). The enhanced ability of leg press and chess press can also help patients deal with the feeling of CRF.ConclusionExercises improve CRF, QoL, and muscle strength in patients receiving ADT.Implications for Nursing Practice We suggest immediate combined exercise intervention as supportive therapy to relieve cancer-related fatigue and enhance QoL.     

The effects of carnitine supplementation on clinical characteristics of patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials

ObjectiveThe beneficial effects of carnitine supplementation on nonalcoholic fatty liver disease are unclear. We conducted a systematic review and meta-analysis to evaluate the effects of carnitine supplementation on liver function, lipid profile, body mass index, body weight, and homeostasis model assessment of insulin resistance in patients with nonalcoholic fatty liver disease.MethodsA comprehensive search of PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases were performed. Only randomized placebo-controlled human studies that examined the effects of carnitine supplementation on liver function, lipid profile, body mass index, body weight, and homeostasis model assessment of insulin resistance up to September 2019 were included. Fixed effects or random-effects models were applied to compute the pooled effect size. Heterogeneity assessments were performed using Cochran’s Q test and I-squared statistics. The quality of the studies was assessed using the Jaded scale.ResultsA total of 5 articles were selected, including 334 individuals (167 in control and 167 in intervention groups). The results demonstrated that carnitine supplementation significantly reduced homeostasis model assessment of insulin resistance (HOMA-IR) (WMD: −0.91; 95 % CI: −1.11, −0.72; p < 0.001, I² = 0.0 %) and the levels of aspartate aminotransferase (AST) (WMD: −16.62; 95 % CI: −28.11, −5.14; IU/l; p = 0.005, I² = 93.5 %), alanine aminotransferase (ALT) (WMD: -33.39; 95 % CI: −45.13, −21.66; IU/l; p < 0.001, I² = 93.4 %), and triglycerides (TG) (WMD: −22.13; 95 % CI: −38.91, −5.34; mg/dl; p = 0.01; I² = 0.0 %). However, the results of the pooled effect size did not show any significant effect of carnitine supplementation on body mass index (BMI) (WMD: 0.07; 95 % CI: −0.15, 0.29; p = 0.55; I² = 0.0 %), body weight (WMD: −0.28; 95 % CI: −2.23, 1.68; p = 0.78; I² = 45.7 %), the levels of gamma-glutamyl transferase (γGT) (WMD: −11.31; 95 % CI: −24.35, 1.73; IU/l; p = 0.09, I² = 61.1 %), cholesterol (WMD: −13.58; 95 % CI: −46.77, 19.60; mg/dl; p = 0.42; I² = 94.9 %), high-density lipoprotein-cholesterol (HDL-C) (WMD: 1.36; 95 % CI: −0.96, 3.68; mg/dl; p = 0.25; I² = 64.7 %), and low density lipoprotein-cholesterol (LDL-C) (WMD: −14.85; 95 % CI: −45.43, 15.73; mg/dl; p = 0.34; I² = 96.4 %).ConclusionsThis analysis shows that carnitine supplementation for patients with nonalcoholic fatty liver disease demonstrates a reduction in AST, ALT, TG levels and HOMA-IR. However, no significant effect of carnitine supplementation was observed on BMI, body weight, the levels of γGT, TC, HDL-cholesterol and LDL-cholesterol.     

The effect of ginger supplementation on metabolic profiles in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials

BackgroundThere is some evidence regarding the positive effects of ginger supplementation on metabolic profile in patients with type 2 diabetes (T2DM). However, they are conflicting. The present systematic review and meta-analysis aimed to summarize earlier findings for the effect of ginger supplementation on metabolic profile in patients with T2DM.MethodsScopus, PubMed and Google Scholar databases were systematically searched up until September 2021 to collect all randomized clinical trials that evaluated the effect of ginger supplementation on FBS, HbA₁c, TC, TG, LDL, HDL, SBP and DBP in patients with T2DM. We conducted our study according to the 2020 PRISMA guidelines. We included only English language publications. Pooled effect sizes were measured using a random-effects model and were reported as the weighted mean difference (WMD) and 95% CI. In addition, the Cochrane Collaboration's risk of bias tool was used to evaluate quality of the trials.ResultsIn overall, 10 articles were included in this systematic review and meta-analysis. Our pooled meta-analysis indicated a significant reduction in FBS following ginger supplementation by polling 8 effect sizes [weighted mean difference (WMD): − 18.81; 95% CI: − 28.70, − 8.92), I² = 77.4%] and in HbA₁C through 7 effect sizes (WMD: −0.57; 95% CI: −0.93, −0.20, I² =88.6%). Pooling 5 effect sizes, we found a significant reduction in SBP (WMD: −4.20; 95% CI: −7.64, −0.77, I2 =97%) and DBP [WMD: − 1.61; 95% CI: − 3.04, − 0.18), I2 = 93.2%] after supplementation with ginger. However, our pooled meta-analysis indicated that ginger supplementation had no significant influence on lipid profile involving TG, TC, LDL and HDL.ConclusionsWe found significant reductions in FBS, HbA₁C, SBP and DBP after supplementation with ginger in patients with T2DM compared to control group, with no significant changes in serum lipids. Further large RCTs are required to shed light on this issue.     

The effects of saffron (Crocus sativus L.) on mental health parameters and C-reactive protein: A meta-analysis of randomized clinical trials

BackgroundThe findings of trials investigating the effects of saffron (Crocus sativus L.) supplementation on depression, anxiety, and C-reactive protein (CRP) are inconsistent. The current meta-analysis of randomized controlled trials (RCTs) was carried out to assess the effects of saffron (Crocus sativus L.) administration on mental health parameters and CRP levels.MethodsTwo independent authors systematically searched online databases including EMBASE, Scopus, PubMed, Cochrane Library, and Web of Science from inception until 30^th July 2019. Cochrane Collaboration risk of bias tool was applied to assess the methodological quality of included trials. The heterogeneity among the included studies was assessed using Cochrane’s Q test and I-square (I²) statistic. Data were pooled using a random-effects model and weighted mean difference (WMD) was considered as the overall effect size.ResultsTwenty one trials were included in this meta-analysis. Consumption of saffron resulted in a significant reduction in Beck Depression Inventory (BDI) (11 studies with 12 effect size) (WMD: −4.86; 95 % CI: −6.58, −3.14), Beck Anxiety Inventory (BAI) (5 studies) (WMD: −5.29; 95 % CI: −8.27, −2.31) and Pittsburgh Sleep Quality Index (PSQI) scores (3 studies with 4 effect size) (WMD: −2.22; 95 % CI: −2.73, −1.72). Saffron intake did not affect Hamilton Depression Rating Scale (HDRS-D), Hamilton Anxiety Rating Scale (HARS-A) scores and C-reactive protein (CRP) levels.ConclusionsThis meta-analysis demonstrated that saffron intake significantly reduced BDI, BAI and PSQI scores, but did not affect HDRS-D, HARS-A scores and CRP levels.     

Chinese herbal medicine Dengzhan Xixin injection for acute ischemic stroke: A systematic review and meta-analysis of randomised controlled trials

ObjectiveTo evaluate the effectiveness and safety of Chinese herbal medicine Dengzhan Xixin (Erigeron breviscapus) injection for acute ischemic stroke.DesignSystematic review and meta-analysis (CRD42016038413, http://www.crd.york.ac.uk/PROSPERO).MethodsSix electronic databases were searched from inception to March 2016 for randomised controlled trials (RCTs) of Dengzhan Xixin (DZXX) injection for acute ischemic stroke. The methodological quality of RCTs was assessed by the Cochrane risk of bias tool.Data synthesiswas performed using RevMan 5.3 and was presented with mean difference (MD) or relative risk (RR) and their 95% confidence interval (CI). A summary of finding table was generated by GRADEpro (version 3.6).ResultsTwenty-five RCTs with 2498 participants were included and all trials adopted conventional therapy (CT) in both arms. Most of the studies had high risk of bias. The addition of DZXX to CT showed no significant benefit on death (RR 0.27, 95% CI 0.05–1.63) within the treatment period (14–35 d), but showed higher Barthel index score (MD 10.20, 95% CI 8.16–12.25), lower neurological function deficit score (MD −3.99, 95% CI −5.68 to −2.30, by NFDS; MD −1.67, 95% CI −2.59 to −0.76, by NIHSS), and lower treatment failure (RR 0.40, 95% CI 0.31–0.52). Thirteen trials (52%) reported the outcome of adverse events, but no serious adverse events were reported.ConclusionLow quality evidence implied that DZXX injection appeared to improve neurological function in patients with acute ischemic stroke. However, this potential benefit should be further studied in large, rigorous trials.     

Effects of chromium supplementation on blood pressure,body mass index,liver function enzymes and malondialdehyde in patients with type 2 diabetes: A systematic review and dose-response meta-analysis of randomized controlled trials

BackgroundSeveral studies reported beneficial effects of chromium supplementation for management of type 2 diabetes mellitus (T2DM). The present study aimed to provide a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the effects of chromium supplementation on blood pressure, body mass index (BMI), liver function enzymes and malondialdehyde (MDA) in patients with T2DM.MethodsPubMed, Scopus, and Embase were searched up to 15 November 2020 with no language and time restriction. RCTs that reported the effects of chromium supplementation on blood pressure, BMI, liver function enzymes and MDA in patients with T2DM were included. A random-effects model was used to compute weighted mean differences (WMDs) with 95 % confidence intervals (CIs). Between-study heterogeneity was assessed by Cochran's Q test and quantified by I² statistic.ResultsOf 3586 publications, 15 RCTs were included for the meta-analysis. Pooled effect sizes indicated that chromium significantly reduced diastolic blood pressure (DBP) (WMD): -2.36 mmHg, 95 % CI: −4.14, −0.60; P = 0.008), and MDA (WMD: −0.55 umol/l, 95 % CI: −0.96, −0.14; P = 0.008). However, chromium supplementation did not significantly affect BMI, systolic blood pressure (SBP), alanine aminotransferase (ALT), aspartate aminotransferase (AST). Meta-regression analysis did not show significant linear relationship between dose of chromium and change in BMI (p = 0.412), SBP (p = 0. 319), DBP (p = 0.102), ALT (p = 0.923), AST (p = 0.986) and MDA (p = 0.055).ConclusionThe present systematic review and meta-analysis shows that supplementation with chromium at dose of 200–1000 μg/day may reduce DBP and MDA in T2DM patients.     

Exercise Training for Improving Patient-Reported Outcomes in Patients With Advanced-Stage Cancer: A Systematic Review and Meta-Analysis

ContextPatients with advanced-stage cancer often suffer many physical and psychological symptoms. Exercise has been shown to improve quality of life (QoL), decrease cancer-related symptoms, and maintain or improve functional status in cancer survivors or patients with early stage cancer. However, the effect of exercise on these outcomes in patients with advanced-stage cancer is unclear.ObjectivesThis meta-analysis aimed to assess the effectiveness of exercise interventions for patients with advanced-stage cancer in improving cancer-related symptoms and functional status outcomes.MethodsWe conducted a comprehensive literature search in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science from their inception to February 3, 2019, to include randomized controlled trials (RCTs) comparing exercise and usual care for improving outcomes in patients with advanced-stage cancer. Two reviewers independently screened the studies, extracted data of interest, and assessed the risk of bias of individual RCTs using the Cochrane Handbook, Version 5.1.0.ResultsAbout 15 RCTs enrolling 1208 patients were included. Compared with usual care, exercise showed a significant improvement in QoL (standardized mean difference [SMD] 0.22; 95% CI 0.06–0.38; P = 0.009), fatigue (SMD −0.25; 95% CI −0.45 to −0.04; P = 0.02), insomnia (SMD −0.36; 95% CI −0.56 to −0.17; P = 0.0002), physical function (SMD 0.22; 95% CI 0.05–0.38; P = 0.009), social function (SMD 0.18; 95% CI 0.02–0.34; P = 0.03), and dyspnea reduction (SMD −0.18; 95% CI −0.34 to −0.01; P = 0.03).ConclusionExercise serves as an effective intervention to improve QoL and alleviate fatigue, insomnia, dyspnea, and physical and social functions for patients with advanced-stage cancer.     

The effects of pomegranate supplementation on biomarkers of inflammation and endothelial dysfunction: A meta-analysis and systematic review

ObjectsCardiovascular disease (CVD) is one of the leading causes of death worldwide. CVD is associated with increased levels of reactive oxygen species which are pro-inflammatory and can damage the endothelium. The pomegranate fruit is a rich source of phytochemicals with a high antioxidant and anti-inflammatory activity, possessing thus health benefits. This systematic review and meta-analysis aims to evaluate the effect of pomegranate juice on the biomarkers of inflammation and vascular dysfunction.MethodsStudies were identified using the PubMed/Medline and SCOPUS databases. Screening of relevant articles and references was carried out from inception until May 2019. This systematic review and meta-analysis was performed using the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsOverall, 16 randomized controlled trials (RCTs) involving 572 subjects were included in this study. Combining effect sizes from 16 studies, we recorded that pomegranate supplementation significantly reduced hs-CRP, IL-6 and TNF-α (Weighted Mean Diff ;erences (WMD): −6.57 mg/L, 95 % CI: −10.04 to −3.10, P = 0.000; WMD: −1.68 pg/mL, 95 % CI: −3.52, 0.157, P = 0.000; WMD: −2.37 pg/mL, 95 % CI: −3.67, −1.07, P = 0.00, respectively) levels, when compared to placebo. No significant reduction was found in CRP (WMD: 2.19 mg/dL, 95 % CI: −3.28, 7.67, P = 0.61), E-selectin (WMD: 8.42 ng/mL, 95 % CI: −22.9, 39.8, P = 0.599), ICAM (WMD= −17.38 ng/mL, 95 % CI: −53.43, 18.66, P = 0.107), VCAM (WMD: −69.32 ng/mL, 95 % CI: −229.26, 90.61, P = 0.396) or MDA (WMD: 0.031 μmol/L, 95 % CI: −1.56, 0.218, P = 0.746) comparing pomegranate supplementation to placebo.ConclusionWe found a significant effect of pomegranate supplementation on hs-CRP, IL-6 and TNF-α in adults. However, the effects of pomegranate supplementation on CRP, E-selectin, ICAM, VCAM or MDA were not significant in this meta-analysis.