Influence of metformin on exercise metabolism and capacity: a systematic review and meta-analysis.

Despite numerous meta-analyses examining the effects of beetroot juice (BJ) supplementation on exercise capacity in patients with chronic obstructive pulmonary disease (COPD), significant methodological shortcomings persist, including failure to stratify findings by study design. In this meta-analysis we aimed to assess the effects of BJ supplementation on exercise capacity and cardiovascular parameters in COPD patients, identifying methodological gaps by stratifying the results of parallel and crossover randomized clinical trials (RCTs). We conducted a systematic search in Scopus, Lilacs, PubMed, Embase, Web of Science, CENTRAL, and Science Direct from database inception until December 30, 2024. We identified studies of the effects on of nitrate-rich BJ supplementation on exercise capacity and cardiovascular parameters in COPD patients. Data extraction was performed independently by 2 reviewers, who collected information on participant characteristics, supplementation protocol, exercise capacity outcomes, and cardiovascular parameters. Data synthesis included subgroup and sensitivity analyses, meta-regression, and stratified random effects meta-analyses. Bias risk was assessed using the revised tool to assess risk of bias in randomized trials (RoB2), and evidence certainty was evaluated via Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The data extraction yielded 12 studies (357 participants) that were included in this study. Supplementation with BJ significantly improved the exercise capacity (standardized mean difference [SMD], 0.31; 95% CI, 0.10-0.53; I2 = 0%). Stratified analyses revealed greater benefits in parallel RCTs (standardized mean difference [SMD], 0.52; 95% CI, 0.23-0.81; I2 = 0%) compared with crossover trials (SMD, 0.06; 95% CI, -0.25 to 0.38; I2 = 0%). Beetroot juice (BJ) reduced systolic (mean difference [MD], -5.33 mmHg; 95% CI, -6.45 to -4.21) and diastolic blood pressure (MD, -3.01 mmHg; 95% CI, -4.39 to -1.63; I2 = 0%). This meta-analysis provides robust evidence that BJ improves exercise capacity and key cardiovascular parameters in COPD patients. By addressing critical methodological limitations and stratifying the results by study design, this study established a reliable foundation for clinical application. Standardized long-term studies are essential to confirm these findings and elucidate dose-response relationships. PROSPERO registration No. [CRD42024540181].

BackgroundChronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden.ObjectiveThis systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma.MethodsPubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation.ResultsA total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied.ConclusionsIn patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894

ObjectiveTo investigate the effectiveness of videoconferencing exercise interventions for people with chronic diseases.DesignSystematic review incorporating meta-analysis.Data sourcesPubMed, Cinahl, MEDLINE, Web of Science, Embase and Scopus.Eligibility criteriaThe current literature was searched...

Examine effectiveness of respiratory rehabilitation and moderating factors on lung function and exercise capacity in post-COVID-19 patients. Meta-analysis. R software 4.0.2 assessed the effectiveness of respiratory rehabilitation adopting the random-effects model and presenting standardised mean differences (SMDs). Heterogeneity was determined by Cochran's Q and I2 . The Cochrane Risk of Bias 2.0 and MINORS evaluated quality of the included studies. A comprehensive search was undertaken in Cochrane, Embase, Ovid-MEDLINE, Scopus, NCBI SARS-CoV-2 Resources, ProQuest, Web of Science and CINAHL until March 2022. Of the 5703 identified studies, 12 articles with 596 post-COVID-19 patients were included. Eleven of our twelve studies had moderate to high quality and one study had high risk of bias assessed with MINORS and RoB 2 tool. Overall, respiratory rehabilitation was effective in improving forced expiratory volume in 1 s (1.14; 95%CI 0.39-1.18), forced vital capacity (0.98; 95%CI 0.39-1.56), total lung capacity (0.83; 95%CI 0.22-1.44), 6-minute walk distance (1.56; 95%CI 1.10-2.02) and quality of life (0.99; 95%CI 0.38-1.60). However, no significant differences were observed for ratio of the forced expiratory volume in 1 s to the forced vital capacity of the lungs, anxiety and depression. Respiratory rehabilitation for post-COVID-19 patients was effective in those without comorbidities, performed four types of exercise programs, frequency ≥3 times/week and rehabilitation time 6 weeks. Respiratory rehabilitation improved lung function, exercise capacity and quality of life in post-COVID-19 patients. The findings suggest rehabilitation programs for post-COVID-19 patients should use multiple respiratory exercise programs with frequency of ≥3 times per week for longer than 6 weeks. These findings will help improve the implementation of respiratory rehabilitation programs for post-COVID-19 patients. Our findings can be used to develop patient-centred respiratory rehabilitation interventions by nurses and clinicians for post-COVID-19 patients. PRISMA guideline was followed. No patient or public contribution.

Background Patients with advanced lung cancer have a high symptom burden, which is often complicated by coexisting conditions. These issues, combined with the indirect effects of cancer treatment, can cumulatively lead patients to continued deconditioning and low exercise capacity. This is a concern as exercise capacity is considered a measure of whole body health, and is critical in a patient's ability to participate in life activities and tolerate difficult treatments. There is evidence that exercise training improves exercise capacity and other outcomes, such as muscle force and health-related quality of life (HRQoL), in cancer survivors. However, the effectiveness of exercise training on these outcomes in people with advanced lung cancer is currently unclear. Objectives The primary aim of this review was to investigate the effects of exercise training on exercise capacity in adults with advanced lung cancer. Exercise capacity was defined as the six-minute walk distance (6MWD; in meters) measured during a six-minute walk test (6MWT; i.e. how far an individual can walk in six minutes on a flat course), or the peak oxygen uptake (i.e. VO₂peak) measured during a maximal incremental cardiopulmonary exercise test (CPET).The secondary aims were to determine the effects of exercise training on the force-generating capacity of peripheral muscles, disease-specific global HRQoL, physical functioning component of HRQoL, dyspnoea, fatigue, feelings of anxiety and depression, lung function, level of physical activity, adverse events, performance status, body weight and overall survival in adults with advanced lung cancer. Search methods We searched CENTRAL, MEDLINE (via PubMed), Embase (via Ovid), CINAHL, SPORTDiscus, PEDro, and SciELO on 7 July 2018. Selection criteria We included randomised controlled trials (RCTs) which compared exercise training versus no exercise training in adults with advanced lung cancer. Data collection and analysis Two review authors independently screened the studies and selected those for inclusion. We performed meta-analyses for the following outcomes: exercise capacity, disease-specific global HRQoL, physical functioning HRQoL, dyspnoea, fatigue, feelings of anxiety and depression, and lung function (forced expiratory volume in one second (FEV1)). Two studies reported force-generating capacity of peripheral muscles, and we presented the results narratively. Limited data were available for level of physical activity, adverse events, performance status, body weight and overall survival. Main results We identified six RCTs, involving 221 participants. The mean age of participants ranged from 59 to 70 years; the sample size ranged from 20 to 111 participants. Overall, we found that the risk of bias in the included studies was high, and the quality of evidence for all outcomes was low.Pooled data from four studies demonstrated that, on completion of the intervention period, exercise capacity (6MWD) was significantly higher in the intervention group than the control group (mean difference (MD) 63.33 m; 95% confidence interval (CI) 3.70 to 122.96). On completion of the intervention period, disease-specific global HRQoL was significantly better in the intervention group compared to the control group (standardised mean difference (SMD) 0.51; 95% CI 0.08 to 0.93). There was no significant difference between the intervention and control groups in physical functioning HRQoL (SMD 0.11; 95% CI -0.36 to 0.58), dyspnoea (SMD -0.27; 95% CI -0.64 to 0.10), fatigue (SMD 0.03; 95% CI -0.51 to 0.58), feelings of anxiety (MD -1.21 units on Hospital Anxiety and Depression Scale; 95% CI -5.88 to 3.45) and depression (SMD -1.26; 95% CI -4.68 to 2.17), and FEV1 (SMD 0.43; 95% CI -0.11 to 0.97). Authors' conclusions Exercise training may improve or avoid the decline in exercise capacity and disease-specific global HRQoL for adults with advanced lung cancer. We found no significant effects of exercise training on dyspnoea, fatigue, feelings of anxiety and depression, or lung function. The findings of this review should be viewed with caution because of the heterogeneity between studies, the small sample sizes, and the high risk of bias of included studies. Larger, high-quality RCTs are needed to confirm and expand knowledge on the effects of exercise training in this population.

Patients with advanced lung cancer have a high symptom burden, which is often complicated by coexisting conditions. These issues, combined with the indirect effects of cancer treatment, can cumulatively lead patients to continued deconditioning and low exercise capacity. This is a concern as exercise capacity is considered a measure of whole body health, and is critical in a patient's ability to participate in life activities and tolerate difficult treatments. There is evidence that exercise training improves exercise capacity and other outcomes, such as muscle force and health-related quality of life (HRQoL), in cancer survivors. However, the effectiveness of exercise training on these outcomes in people with advanced lung cancer is currently unclear. The primary aim of this review was to investigate the effects of exercise training on exercise capacity in adults with advanced lung cancer. Exercise capacity was defined as the six-minute walk distance (6MWD; in meters) measured during a six-minute walk test (6MWT; i.e. how far an individual can walk in six minutes on a flat course), or the peak oxygen uptake (i.e. VO₂peak) measured during a maximal incremental cardiopulmonary exercise test (CPET).The secondary aims were to determine the effects of exercise training on the force-generating capacity of peripheral muscles, disease-specific global HRQoL, physical functioning component of HRQoL, dyspnoea, fatigue, feelings of anxiety and depression, lung function, level of physical activity, adverse events, performance status, body weight and overall survival in adults with advanced lung cancer. We searched CENTRAL, MEDLINE (via PubMed), Embase (via Ovid), CINAHL, SPORTDiscus, PEDro, and SciELO on 7 July 2018. We included randomised controlled trials (RCTs) which compared exercise training versus no exercise training in adults with advanced lung cancer. Two review authors independently screened the studies and selected those for inclusion. We performed meta-analyses for the following outcomes: exercise capacity, disease-specific global HRQoL, physical functioning HRQoL, dyspnoea, fatigue, feelings of anxiety and depression, and lung function (forced expiratory volume in one second (FEV1)). Two studies reported force-generating capacity of peripheral muscles, and we presented the results narratively. Limited data were available for level of physical activity, adverse events, performance status, body weight and overall survival. We identified six RCTs, involving 221 participants. The mean age of participants ranged from 59 to 70 years; the sample size ranged from 20 to 111 participants. Overall, we found that the risk of bias in the included studies was high, and the quality of evidence for all outcomes was low.Pooled data from four studies demonstrated that, on completion of the intervention period, exercise capacity (6MWD) was significantly higher in the intervention group than the control group (mean difference (MD) 63.33 m; 95% confidence interval (CI) 3.70 to 122.96). On completion of the intervention period, disease-specific global HRQoL was significantly better in the intervention group compared to the control group (standardised mean difference (SMD) 0.51; 95% CI 0.08 to 0.93). There was no significant difference between the intervention and control groups in physical functioning HRQoL (SMD 0.11; 95% CI -0.36 to 0.58), dyspnoea (SMD -0.27; 95% CI -0.64 to 0.10), fatigue (SMD 0.03; 95% CI -0.51 to 0.58), feelings of anxiety (MD -1.21 units on Hospital Anxiety and Depression Scale; 95% CI -5.88 to 3.45) and depression (SMD -1.26; 95% CI -4.68 to 2.17), and FEV1 (SMD 0.43; 95% CI -0.11 to 0.97). Exercise training may improve or avoid the decline in exercise capacity and disease-specific global HRQoL for adults with advanced lung cancer. We found no significant effects of exercise training on dyspnoea, fatigue, feelings of anxiety and depression, or lung function. The findings of this review should be viewed with caution because of the heterogeneity between studies, the small sample sizes, and the high risk of bias of included studies. Larger, high-quality RCTs are needed to confirm and expand knowledge on the effects of exercise training in this population.

BackgroundPrevious literature lacks summative information on the mental health benefits achieved from different forms of walking.ObjectiveThe aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety.MethodsThis was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool.ResultsThis review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD −0.591, 95% CI −0.778 to −0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD −0.446, 95% CI −0.628 to −0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD −1.863, 95% CI −2.764 to −0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD −0.442, 95% CI −0.604 to −0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD −0.126, 95% CI −0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD −0.053, 95% CI −0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69).ConclusionsVarious forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future.

Pulmonary rehabilitation (PR) is a cornerstone of chronic obstructive pulmonary disease (COPD) management; however, access to traditional center-based PR (CBPR) remains limited. Digital and remote models, collectively termed pulmonary telerehabilitation (Tele-PR), have increasingly been used, but their heterogeneity in technology use, supervision, and interaction mode may influence effectiveness and sustainability. This systematic review and meta-analysis aimed to compare the effectiveness and adherence of Tele-PR with those of CBPR in adults with COPD while systematically evaluating the impacts of supervision intensity and delivery models on key clinical outcomes. This review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and PRISMA-S (Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension) guidelines. PubMed, Embase, the Cochrane Library, and the Web of Science were searched from inception to December 10, 2025, to identify randomized controlled trials comparing Tele-PR or home-based PR (HBPR) with CBPR in adults with COPD. Random effects meta-analyses were conducted using the Hartung-Knapp-Sidik-Jonkman method. Between-study heterogeneity was assessed using τ², I², and 95% prediction intervals. Risk of bias was evaluated with the Cochrane Risk of Bias 2 tool, and certainty of evidence was graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Seventeen randomized controlled trials involving 1658 participants were included. After intervention, Tele-PR and CBPR showed comparable average effects on exercise capacity by 6-minute walk distance (k=9; n=950, 57.3%; mean difference -5.37 m, 95% CI -15.68 to 4.95; P=.26; τ²=103.97; I²=28.2%; 95% prediction intervals=-32.73 to 22.27). Although pooled effects were not statistically significant, substantial heterogeneity was observed across remote delivery models. Subgroup analyses linked digitally supported, synchronously supervised Tele-PR to less between-study variance across several outcomes, indicating greater consistency in treatment effects across different settings while revealing that low-technology HBPR yielded more variable outcomes, particularly in symptom burden. At long-term follow-up (≥6 mo), between-group differences in functional and symptom outcomes diminished, and short-term gains in exercise capacity did not consistently translate into increased daily physical activity. Certainty of evidence ranged from moderate to very low, mainly downgraded for performance bias, inconsistency across intervention models, and imprecision. Tele-PR may achieve short-term clinical outcomes comparable to CBPR. Distinct from prior reviews, we stratified remote programs by delivery models and supervision, identifying digitally supported Tele-PR and low-technology HBPR as 2 clinically distinct paradigms with differing consistency of effects. We further propose a structured "supervision gradient" to interpret model-dependent variability in effects across Tele-PR approaches, providing a context-sensitive framework for evidence-informed, model-specific implementation. Future remote rehabilitation should integrate real-time professional supervision and long-term behavioral maintenance to sustain benefits. Tele-PR may be particularly valuable for expanding PR access, while CBPR remains essential for patients requiring close in-person supervision or complex multidisciplinary care.

Approaches for boosting self-confidence of clinical nursing students: A systematic review and meta-analysis

Background Exercise-based cardiovascular rehabilitation (CR) improves exercise capacity (EC), lowers cardiovascular risk profile and increases physical functioning in the short term. However, uptake of and adherence to a physically active lifestyle in the long run remain problematic. Home-based (HB) exercise programmes have been introduced in an attempt to enhance long-term adherence to recommended levels of physical activity (PA). The current systematic review and meta-analysis aimed to compare the longer-term effects of HB exercise programmes with usual care (UC) or centre-based (CB) CR in patients referred for CR. Design Systematic review and meta-analysis. Methods Non-randomised controlled trials (RCTs) or randomised trials comparing the effects of HB exercise programmes with UC or CB rehabilitation on EC and/or PA, with a follow-up period of ≥12 months and performed in coronary artery disease patients, were searched in four databases (PubMed, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Central Register of Controlled trials (CENTRAL)) from their inception until September 7, 2016. Standardised mean differences (SMDs) were calculated and pooled by means of random effects models. Risk of bias, publication bias and heterogeneity among trials were also assessed. Results Seven studies could be included in the meta-analysis on EC, but only two studies could be included in the meta-analysis on PA (total number of 1440 patients). The results showed no significant differences in EC between HB rehabilitation and UC (SMD 0.10, 95% confidence interval (CI) -0.13 to 0.33). There was a small but significant difference in EC in favour of HB compared to CB rehabilitation (SMD 0.25, 95% CI 0.02-0.48). No differences were found for PA (SMD 0.37, 95% CI -0.18 to 0.92). Conclusions HB exercise is slightly more effective than CB rehabilitation in terms of maintaining EC. The small number of studies warrants the need for more RCTs evaluating the long-term effects of different CR interventions on EC and PA behaviour, as this is the ultimate goal of CR.

Effective pain management for rib fractures is crucial to prevent pulmonary complications and facilitate recovery. UGPB has emerged as a promising regional analgesic technique for these patients. This systematic review with meta-analysis aims to evaluate the effectiveness of UGPB compared with standard care for managing pain associated with rib fractures. In this review, the term UGPB serves as an umbrella term for various UGPBs, with the erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) being the two specific techniques evaluated in the included studies. This study conducted a comprehensive search of electronic databases including PubMed, Embase, Cochrane Library, Web of science and China National Knowledge Infrastructure (CNKI) up to 31 March 2026. Eligibility criteria were established based on the inclusion of adult patients diagnosed with rib fractures treated with UGPB versus standard care. The primary outcome was pain intensity, assessed using a Visual Analog Scale (VAS) or Numeric Rating Scale (NRS). Secondary outcomes included total amount of analgesic consumption, respiratory function (PaO₂ and PaCO₂ via arterial blood gas analysis), and adverse events. Risk of bias was assessed using the Cochrane Risk of Bias (RoB 2) tool. The certainty of evidence for primary outcomes was assessed using the GRADE framework. Continuous outcomes were pooled as standardized mean differences (SMD) with 95% confidence intervals using a random-effects model; heterogeneity was assessed via I². Nine randomized controlled trials (RCTs) involving 664 participants were included. Most studies raised some concerns regarding risk of bias, primarily related to the randomization process, allocation concealment, or blinding of participants and personnel; four studies were judged to be at high overall risk of bias, and none at low risk. The pooled data from 7 studies (423 participants) showed that UGPB significantly reduced pain scores (SMD = -0.44, 95% CI: -0.72 to -0.16; I² = 51%; p < 0.01). A leave-one-out sensitivity analysis for pain scores (excluding one study at a time from the 7 included studies) yielded SMDs ranging from - 0.49 to -0.38 (all p < 0.05) and I² ranging from 45% to 58%, confirming the robustness of this finding. For respiratory parameters, based on 3 studies (198 participants) there were no significant differences in PaCO₂ levels (SMD = -0.02, 95% CI: -0.56 to 0.61; I² = 75%; p = 0.95). PaO₂ levels remained stable (SMD = 0.04, 95% CI: -0.24 to 0.32; I² = 0%; p = 0.78). The effect on analgesic consumption, from 7 studies (546 participants), was not significant (SMD = -0.09, 95% CI: -1.61 to 1.43; I² = 96%; p = 0.91). The certainty of evidence was low for pain scores and very low for analgesic consumption and blood gas parameters according to GRADE. UGPB reduces pain scores in patients with rib fractures, with a small-to-moderate effect size (SMD = -0.44, 95% CI: -0.72 to -0.16), and does not appear to compromise respiratory function based on stable PaCO₂ and PaO₂ levels. However, given the concerns regarding risk of bias and heterogeneity, these findings should be interpreted cautiously. High heterogeneity in analgesic consumption and other outcomes underscores the need for further high-quality research to standardize protocols and optimize the use of UGPB in clinical practice. CRD420251077539 (registered 20 June 2025).

BACKGROUND Parkinson disease (PD) presents motor and nonmotor challenges that significantly affect quality of life. Telemedicine has emerged as a promising approach to deliver interventions, including exercise performed through remote equipment (e-Exercise), cognitive behavioral training sessions conducted remotely (e-Cognitive), and consultations conducted through remote devices (e-Visits), yet their comparative effectiveness remains unclear. OBJECTIVE This paper aimed to evaluate the effectiveness of telemedicine interventions on motor and nonmotor outcomes in PD and compare the efficacy of e-Exercise, e-Cognitive, and e-Visits. METHODS A systematic review and network meta-analysis were conducted by searching PubMed, MEDLINE, Embase, Cochrane CENTRAL, and Web of Science through November 2024. Randomized controlled trials comparing telemedicine interventions with usual care were included. Outcomes assessed included total motor symptoms, quality of life, cognitive function, depressive and anxiety symptoms, fear of falling, 6-minute walk test, walking velocity, balance ability, and timed up and go. Two investigators independently performed study selection, data extraction, and risk-of-bias assessment using the Cochrane risk of bias 2 tool. Data synthesis included (1) pairwise meta-analyses using random-effects models to calculate standardized mean differences (SMDs) and mean differences; and (2) Bayesian network meta-analysis integrating direct and indirect comparisons to rank intervention efficacy, with transitivity and inconsistency evaluated. Evidence quality was graded using GRADE (Grading of Recommendations, Assessment, Development and Evaluation), incorporating risk of bias, heterogeneity (&lt;i&gt;I&lt;/i&gt;²&amp;gt;50% indicating substantial heterogeneity), precision, and publication bias (Egger test). Statistical heterogeneity was quantified by τ² and &lt;i&gt;I&lt;/i&gt;². RESULTS A total of 23 studies involving 1330 participants were included. Pairwise meta-analyses demonstrated that telemedicine significantly improved total motor symptoms (SMD=–0.61, 95% CI –1.19 to –0.4), cognitive function (SMD=0.58, 95% CI 0.15-1.01), depressive symptoms (SMD=–0.46, 95% CI –0.88 to –0.04), anxiety symptoms (SMD=–0.57, 95% CI –1.10 to –0.03), fear of falling (SMD=–0.48, 95% CI –0.77 to –0.19), and 6-minute walk test performance (mean difference=18.98, 95% CI 16.06-21.90 meters). The network meta-analysis revealed that e-Exercise was most effective for improving total motor symptoms (SMD=–1.01, 95% credible interval [CrI] –1.96 to –0.05) and 6-minute walk test performance. e-Cognitive was most effective for enhancing quality of life (SMD=0.39, 95% CrI 0.06-0.73) and cognitive function (SMD=1.02, 95% CrI 0.38-1.66), and reducing depressive (SMD=–1.28, 95% CrI –1.61 to –0.96) and anxiety symptoms (SMD=–1.07, 95% CrI –1.40 to –0.75). e-Visits had a limited impact across outcomes. Evidence quality was moderate or high for motor symptoms, quality of life, and depression, but low or very low for other outcomes. CONCLUSIONS Telemedicine is effective for improving motor and nonmotor outcomes in PD. e-Exercise is optimal for motor function and physical performance, while e-Cognitive is most effective for psychological and cognitive challenges. These findings highlight the importance of tailoring telemedicine programs to address specific therapeutic needs in PD management. CLINICALTRIAL PROSPERO CRD42024628687; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024628687

BackgroundParkinson disease (PD) presents motor and nonmotor challenges that significantly affect quality of life. Telemedicine has emerged as a promising approach to deliver interventions, including exercise performed through remote equipment (e-Exercise), cognitive behavioral training sessions conducted remotely (e-Cognitive), and consultations conducted through remote devices (e-Visits), yet their comparative effectiveness remains unclear.ObjectiveThis paper aimed to evaluate the effectiveness of telemedicine interventions on motor and nonmotor outcomes in PD and compare the efficacy of e-Exercise, e-Cognitive, and e-Visits.MethodsA systematic review and network meta-analysis were conducted by searching PubMed, MEDLINE, Embase, Cochrane CENTRAL, and Web of Science through November 2024. Randomized controlled trials comparing telemedicine interventions with usual care were included. Outcomes assessed included total motor symptoms, quality of life, cognitive function, depressive and anxiety symptoms, fear of falling, 6-minute walk test, walking velocity, balance ability, and timed up and go. Two investigators independently performed study selection, data extraction, and risk-of-bias assessment using the Cochrane risk of bias 2 tool. Data synthesis included (1) pairwise meta-analyses using random-effects models to calculate standardized mean differences (SMDs) and mean differences; and (2) Bayesian network meta-analysis integrating direct and indirect comparisons to rank intervention efficacy, with transitivity and inconsistency evaluated. Evidence quality was graded using GRADE (Grading of Recommendations, Assessment, Development and Evaluation), incorporating risk of bias, heterogeneity (I²>50% indicating substantial heterogeneity), precision, and publication bias (Egger test). Statistical heterogeneity was quantified by τ² and I².ResultsA total of 23 studies involving 1330 participants were included. Pairwise meta-analyses demonstrated that telemedicine significantly improved total motor symptoms (SMD=–0.61, 95% CI –1.19 to –0.4), cognitive function (SMD=0.58, 95% CI 0.15-1.01), depressive symptoms (SMD=–0.46, 95% CI –0.88 to –0.04), anxiety symptoms (SMD=–0.57, 95% CI –1.10 to –0.03), fear of falling (SMD=–0.48, 95% CI –0.77 to –0.19), and 6-minute walk test performance (mean difference=18.98, 95% CI 16.06-21.90 meters). The network meta-analysis revealed that e-Exercise was most effective for improving total motor symptoms (SMD=–1.01, 95% credible interval [CrI] –1.96 to –0.05) and 6-minute walk test performance. e-Cognitive was most effective for enhancing quality of life (SMD=0.39, 95% CrI 0.06-0.73) and cognitive function (SMD=1.02, 95% CrI 0.38-1.66), and reducing depressive (SMD=–1.28, 95% CrI –1.61 to –0.96) and anxiety symptoms (SMD=–1.07, 95% CrI –1.40 to –0.75). e-Visits had a limited impact across outcomes. Evidence quality was moderate or high for motor symptoms, quality of life, and depression, but low or very low for other outcomes.ConclusionsTelemedicine is effective for improving motor and nonmotor outcomes in PD. e-Exercise is optimal for motor function and physical performance, while e-Cognitive is most effective for psychological and cognitive challenges. These findings highlight the importance of tailoring telemedicine programs to address specific therapeutic needs in PD management.Trial RegistrationPROSPERO CRD42024628687; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024628687

Regardless of the timing of initiation, chronic NIV improves daytime hypercapnia. In addition, in stable COPD, survival seems to be improved and there might be a short term HRQL benefit. In people with persistent hypercapnia after a COPD exacerbation, chronic NIV might prolong admission-free survival without a beneficial effect on HRQL. In stable COPD, future RCTs comparing NIV to a control group receiving standard care might no longer be warranted, but research should focus on identifying participant characteristics that would define treatment success. Furthermore, the optimal timing for initiation of NIV after a severe COPD exacerbation is still unknown.

Objectives. To determine the effects of consuming polyphenol-rich foods, juices and concentrates on recovery from exercise-induced muscle damage (EIMD). Method. Eligibility criteria. Randomised and quasi-randomised placebo-controlled trials with a parallel or cross-over design evaluating the effects of consuming polyphenol-rich foods, juices and concentrates on recovery from EIMD in humans. Eligible studies included at least one of the primary outcome measures: maximal isometric voluntary contraction; MIVC, delayed onset muscle soreness; DOMS, or countermovement jump; CMJ. Information sources. AMED, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, PUBMED, SCOPUS (Elsevier), SPORTDiscus (EBSCO), and the UK Clinical Trials Gateway were searched from inception to September 2020. Risk of bias and quality of evidence. Risk of bias was assessed using Cochrane Risk of Bias 2 tool. Quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework. Synthesis of results. Random effects models were used to determine the effect of polyphenol supplementation on recovery from EIMD. Data are presented as standardised mean differences (SMD) with 95% confidence intervals (CI). Results. Included studies. Twenty-five studies were included; 15 had a parallel, and 10 had a cross-over design. A total of 527 participants (male: n = 425; female: n = 102) were included in the meta-analysis. Synthesis of results. Consumption of polyphenol-rich foods, juices and concentrates accelerated recovery of MIVC immediately post-exercise (SMD = 0.23, 95% CI 0.04, 0.42; p = 0.02; low-quality evidence), 24 h (SMD = 0.39, 95% CI 0.15, 0.62; p = 0.001; low-quality evidence), 48 h (SMD = 0.48, 95% CI 0.28, 0.67; p < 0.001; moderate-quality evidence), 72 h (SMD = 0.29, 95% CI 0.11, 0.46; p = 0.001; low-quality evidence) and 96 h post-exercise (SMD = 0.50, 95% CI 0.16, 0.83; p = 0.004; very low-quality evidence). DOMS was reduced at 24 h (SMD = −0.29, 95% CI −0.47, −0.11; p = 0.002; low-quality evidence), 48 h (SMD = −0.28, 95% CI −0.46, −0.09; p = 0.003; low-quality evidence) and 72 h post-exercise (SMD = −0.46, 95% CI −0.69, −0.24; p < 0.001; very low-quality evidence). CMJ height was greater immediately post-exercise (SMD = 0.27, 95% CI 0.01, 0.53; p = 0.04; low-quality evidence), at 24 h (SMD = 0.47, 95% CI 0.11, 0.83; p = 0.01; very low-quality evidence), 48 h (SMD = 0.58, 95% CI 0.24, 0.91; p < 0.001; very low-quality evidence) and 72 h post-exercise (SMD = 0.57, 95% CI 0.03, 1.10; p = 0.04; very low-quality evidence). Polyphenol supplementation did not alter creatine kinase, c-reactive protein, and interleukin−6 at any time points. At 72 h post-exercise, protein carbonyls (SMD = −0.64, 95% CI −1.14, −0.14; p = 0.01) were reduced. Discussion. Limitations of evidence. Risk of bias was high for 10 studies and moderate for 15. Sensitivity analyses excluding the high risk of bias studies reduced the SMDs for MIVC and DOMS, and for CMJ effects at 24 and 48 h were no longer statistically significant. Interpretation. Consuming polyphenol-rich foods, juices and concentrates accelerated recovery of muscle function while reducing muscle soreness in humans. Maximal benefit occurred 48–72 h post-exercise, however, the certainty of the evidence was moderate to very low. Supplementation could be useful when there is limited time between competitive events and impaired recovery could negatively impact performance.