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Question: Systematic Reviews And Meta-Analysis Please Read The Following Abstract From A Systematic Review And Meta-analysis Conducted By Umpierre And Colleagues Which Was Published In The Journal Of The American Medical Association. 2011;305(17):1790-1799): Https://www.natap.org/2011/newsUpdates/JAMA2011Umpierre.pdf Physical Activity Advice Only Or Structured …

by | Jan 2, 2022 | Uncategorized

Systematic Reviews and Meta-Analysis

Please read the following abstract from a systematic review andmeta-analysis conducted by Umpierre and colleagues which waspublished in the Journal of the American MedicalAssociation. 2011;305(17):1790-1799):

https://www.natap.org/2011/newsUpdates/JAMA2011Umpierre.pdf

Physical activity advice only or structured exercisetraining and association with HbA1c levels in type 2diabetes. A systematic review and meta-analysis

Abstract

Note: Glycated hemoglobin (HbA1c) isa blood marker used to monitor blood glucoselevels.  Higher amounts of HbA1c indicatepoorer control of blood glucose and have been associated withcardiovascular disease in type 2 diabetes patients.  TheAmerican Diabetes Association Standards of Medical Care in Diabetes2011 guidelines state HbA1c ≥6.5% the criterion for thediagnosis of diabetes.

Context: Regular exercise improves glucosecontrol in diabetes, but the association of different exercisetraining interventions on glucose control is unclear.

Objective: To conduct a systematic review andmeta-analysis of randomized controlled clinical trials (RCTs)assessing associations of structured exercise training regimens(aerobic, resistance, or both) and physical activity advice with orwithout dietary co-intervention on change in hemoglobinA1c (HbA1c) in type 2 diabetes patients.

Data Sources: MEDLINE, Cochrane-CENTRAL,EMBASE, ClinicalTrials.gov, LILACS, and SPORTDiscus databases weresearched from January 1980 through February 2011.

Study Selection: RCTs of at least 12 weeks’duration that evaluated the ability of structured exercise trainingor physical activity advice to lower HbA1c levels ascompared with a control group in patients with type 2 diabetes.

Data Extraction: Two independent reviewersextracted data and assessed quality of the included studies.

Data Synthesis: Of 4191 articles retrieved, 47RCTs (8538 patients) were included. Pooled mean differences inHbA1c levels between intervention and control groupswere calculated using a random-effects model. Overall, structuredexercise training (23 studies) was associated with a decline inHbA1c level (−0.67%; 95% confidence interval [CI],−0.84% to −0.49%; I2, 91.3%) compared withcontrol participants. In addition, structured aerobic exercise(−0.73%; 95% CI, −1.06% to −0.40%; I2, 92.8%),structured resistance training (−0.57%; 95% CI, −1.14% to −0.01%;I2, 92.5%), and both combined (−0.51%; 95% CI,−0.79% to −0.23%; I2, 67.5%) were eachassociated with declines in HbA1C levels compared withcontrol participants. Structured exercise durations of more than150 minutes per week were associated with HbA1creductions of 0.89%, while structured exercise durations of 150minutes or less per week were associated with HbA1Creductions of 0.36%. Overall, interventions of physical activityadvice (24 studies) were associated with lower HbA1clevels (−0.43%; 95% CI, −0.59% to −0.28%; I2,62.9%) compared with control participants. Combined physicalactivity advice and dietary advice was associated with decreasedHbA1c (−0.58%; 95% CI, −0.74% to −0.43%;I2, 57.5%) as compared with controlparticipants. Physical activity advice alone was not associatedwith HbA1c changes.

Conclusions: Structured exercise training thatconsists of aerobic exercise, resistance training, or both combinedis associated with HbA1c reduction in patients with type2 diabetes. Structured exercise training of more than 150 minutesper week is associated with greater HbA1c declines thanthat of 150 minutes or less per week. Physical activity advice isassociated with lower HbA1c, but only when combined withdietary advice.

  1. Read the abstract and state two inclusioncriteria for studies to be selected for the systematic review (3marks).

Answer:    
  1. During the ‘Data Extraction’ phase of the studytwo independent reviewers extracted data and assessed qualityof the included studies. Why? (2 marks)

Answer:    
  1. Name two potential sources of bias relatedto the literature search (2 marks)

Answer:    
  1. State one strength andone limitation of a meta-analysis? (2marks)

Strength:

Limitation:
  1. Which test can be used to determine the presence ofheterogeneity in a meta-analysis? (1 mark)

Answer:    
  1. In the ‘Data Synthesis’ section of the abstract the authorsstate that “pooled mean differences in HbA1clevels between intervention and control groups were calculatedusing a random-effects model.” What is the main assumption of arandom effects model?(2 marks)

Answer:    
  1. The authors provide details of which databases were usedduring the literature search to find published articles. Nameone method of obtaining unpublished literature. (2marks)

Answer:   
  1. Which type of graph can be used to assess publication biasin a meta-analysis? (2 marks)

Answer:    
  1. Look at the Forest Plot displayed in Figure 1 (below).Three studies (Raz et al., 1994; Vancea et al., 2009c;Vancea et al., 2009d) appear to have wide confidenceintervals which cross the line of unity, what does that suggestabout the results of those individual studies? (2 marks)

Answer:    
  1. Based on the results in the ‘Data Synthesis’ section of theabstract and the Forest plot presented in Figure 1 (below), whichtype of exercise training (i.e. aerobic, resistance, or combinedaerobic and resistance training) and duration (minutes per week)would you prescribe to a diabetes patient looking to maximise thebeneficial effects of exercise training onHbA1c? (2 marks)

Type of ExerciseTraining:

Weekly Duration ofExercise Training (minutes per week):
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