Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 26 appraisals
Cancer causes & control : CCC
Post-diagnosis physical activity in relation to mortality among gynecological cancer survivors
PURPOSE: Physical activity may play a supportive role in cancer survivorship. However, evidence on the association between post-diagnosis physical activity and mortality among women with gynecological cancer remains limited and inconsistent. METHODS: We conducted a systematic review of the literature published between 1949 and January 2026. Eligible observational studies were identified, and random-effects meta-analyses were performed to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between post-diagnosis physical activity and all-cause mortality among women diagnosed with gynecological cancer. RESULTS: A total of ten eligible studies on endometrial, ovarian, and cervical cancer were included, collectively reporting 3,867 deaths. High levels of post-diagnosis physical activity, compared with low levels, were associated with lower mortality (HR: 0.65; 95% CI 0.54-0.78). This inverse relationship was evident in both endometrial and ovarian cancer survivors (endometrial cancer: HR: 0.60; 95% CI 0.43-0.83; ovarian cancer: HR: 0.71; 95% CI 0.58-0.86). Medium levels of physical activity tended to be inversely associated with mortality (HR: 0.88; 95% CI 0.76-1.02). CONCLUSION: Higher levels of physical activity after a gynecological cancer diagnosis were associated with improved survival. The results suggest that physical activity may represent a modifiable lifestyle factor with the potential to improve long-term outcomes among gynecological cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: This supports the potential value of integrating physical activity into survivorship care, although further high-quality prospective studies are needed to strengthen causal inference.
6 July 2026
Read appraisal →Journal of medical Internet research
Physical Activity Interventions Using Digital Health Interventions for Cancer-Related Fatigue in People With a History of Cancer: Scoping Review
BACKGROUND: Although exercise has been proven effective in alleviating cancer-related fatigue (CRF), traditional face-to-face programs may not be accessible due to physical, temporal, or geographical barriers. Digital health interventions (DHIs) offer scalable alternatives for promoting physical activity; however, evidence synthesizing DHI-based physical activity interventions specifically targeting CRF and their intervention characteristics remains limited. OBJECTIVE: This scoping review aimed to map the types of digital health-based physical activity interventions for managing CRF, to summarize the key characteristics of DHI modalities and CRF outcomes, and to identify knowledge gaps for future research. METHODS: A systematic literature search was conducted across 4 databases (PubMed, EMBASE, Cochrane, and PsycINFO) up to December 2025. Inclusion criteria comprised experimental studies involving adults with a history of cancer, digital exercise interventions, a control group, and fatigue outcomes. Screening and data extraction followed the Joanna Briggs Institute Manual for Evidence Synthesis and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review) standards. The protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD42022304285). Interventions were classified using the Evidence Standards Framework (ESF). RESULTS: Thirty-three studies comprising 3443 participants were included, representing 32 interventions. Most were randomized controlled trials (n=30, 91%). Interventions were delivered primarily via mobile apps (11/32, 34%) and wearable devices (8/32, 25%), followed by web-based platforms, videoconferencing, exergaming, and augmented reality. Eighteen interventions (reported in 19 studies) demonstrated statistically significant between-group CRF reductions, predominantly at immediate postintervention assessments. Evidence for sustained benefit beyond 12 months was limited, and only one study evaluated ultra-long-term outcomes, which did not demonstrate maintained improvement. Populations with breast cancer accounted for the largest proportion of participants. Fatigue measurement tools varied substantially, potentially contributing to heterogeneity in effect estimates. Most interventions were classified as ESF tier C, indicating a predominant focus on clinical outcome improvement rather than individual-level self-management and system-level implementation. Wearable device-based interventions showed the highest proportion of significant CRF improvement, whereas mobile app-based interventions reported both significant and nonsignificant results. DHIs lasting more than 12 weeks appeared to be associated with more effective CRF outcomes compared to shorter programs. Direct comparisons between in-person and digital delivery were scarce. CONCLUSIONS: Digital health-based physical activity interventions can reduce CRF in people with a history of cancer, with wearable device and longer-duration interventions showing the most favorable outcomes. However, the current evidence is concentrated in populations with breast cancer, and system-level integration remains unexplored. Future research should prioritize diverse populations with cancer, longer follow-up periods, standardized fatigue measurement, and systematic examination of specific intervention components that contribute to CRF reduction. Ultimately, advancing from individual efficacy trials toward scalable, workflow-integrated digital solutions will be key to sustainable CRF management across diverse oncology settings.
29 June 2026
Read appraisal →JMIR formative research
User Perspectives on a Clinical Decision Tool to Support Individualized Exercise Prescriptions for Breast Cancer Survivors Not Meeting Exercise Guidelines: Cross-Sectional Survey
BACKGROUND: More than 80% of breast cancer survivors do not meet the recommended levels of exercise, and <50% of health care providers promote exercise as part of survivorship care. Patient-provider communication may enhance exercise engagement by increasing patients' understanding of exercise benefits and linking patients to resources, such as rehabilitation and exercise programs. OBJECTIVE: This study aimed to explore perspectives on a novel clinical decision tool designed to support individualized exercise discussions and prescriptions among breast cancer survivors who do not meet exercise guidelines and health care providers who primarily treat such survivors. METHODS: We conducted a cross-sectional online survey among US breast cancer survivors and health care providers. Participants were (1) female breast cancer survivors aged ≥35 years engaging in ≤150 minutes/week of moderate-intensity aerobic exercise or ≤2 days/week of muscle-strengthening exercise and (2) health care providers who had cared for breast cancer survivors within the past 12 months and reported below-average guideline adherence among their patients. Respondents reviewed a paper draft of a web-based clinical decision prototype tool for supporting individualized exercise discussions and prescriptions based on patients' demographic, clinical, and contextual characteristics. We assessed perceived usefulness, potential uses (eg, counseling), preferred timing of access within clinical encounters, and preferences for tool characteristics (inputs/outputs). RESULTS: The analytic sample comprised 26 breast cancer survivors and 69 health care providers. The survivors' median age was 48 (IQR 37-65) years. Providers included patient navigators/social workers/nurses (29/69, 42.0%), breast oncologists (13/69, 18.8%), and occupational/physical therapists (12/69, 17.4%). The majority of providers (62/69, 89.9%, 95% CI 80.2%-95.8%) and survivors (23/26, 88.5%, 95% CI 69.8%-97.6%) reported that they would find the tool useful. Similarly, 85.5% of providers (59/69, 95% CI 75.0%-92.8%) and 84.6% of survivors (22/26, 95% CI 65.1%-95.6%) reported that the tool would increase their confidence to discuss exercise in a clinical setting. Both groups preferred that survivors access the tool with staff after a medical appointment (survivors: 20/26, 76.9%, 95% CI 56.4%-91.0%; providers: 58/67, 86.6%, 95% CI 76.0%-93.7%). Both groups also endorsed treatment history and readiness to exercise to consider as key inputs and improved quality of life and reduced treatment-related side effects as exercise benefits to communicate as tool outputs. CONCLUSIONS: The prototype tool concept was well received, with high endorsement of individual characteristics to consider and clinical benefits of exercise to communicate. Findings will inform refinement of the tool and future implementation testing in an understudied population of breast cancer survivors.
11 June 2026
Read appraisal →Acta oncologica (Stockholm, Sweden)
Change in skeletal muscle mass during systemic cancer treatment: a systematic review and meta-analysis
BACKGROUND AND PURPOSE: Loss of skeletal muscle mass (SMM) is common during systemic cancer treatment, but the magnitude and variability across cancer and treatment types remain uncertain. We aimed to describe changes in SMM during systemic cancer treatment supported by pooled quantitative estimates. PATIENTS/MATERIAL AND METHODS: We systematically searched PubMed, Embase, and Web of Science until April 2025 for longitudinal studies reporting SMM during chemotherapy and/or immunotherapy (± targeted therapy) in patients with cancer (PROSPERO CRD42022308388). Standardized mean changes (SMC) were pooled in random-effects meta-analyses using the restricted maximum-likelihood estimator with Hartung-Knapp adjustment. Heterogeneity was assessed using I². Risk of bias was assessed with the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: Seventy-eight studies (n = 10,502; 52% male; median age 64 years [interquartile range, IQR: 34-77]) were included. Meta-analysis across cancers showed an association between systemic cancer treatment and decline in SMM (59 studies; n = 6,373; SMC = -0.24, 95% confidence interval [CI]: -0.29 to -0.20; I² = 92%), corresponding to -5% over a median interval of 90 (IQR: 71-129) days among studies (62%) reporting assessment intervals. Declines were most pronounced during chemotherapy (± targeted therapy). INTERPRETATION: Declines in SMM are frequently observed during systemic cancer treatment, particularly during chemotherapy (± targeted therapy), although effect sizes were generally small per Cohen's thresholds. However, substantial heterogeneity limits interpretation of a single pooled estimate. Prospective studies with standardized methods are needed to clarify trajectories, mechanisms and clinical implications of SMM loss.
28 May 2026
Read appraisal →JMIR mHealth and uHealth
mHealth-Supported Exercise Rehabilitation to Reverse Frailty After Autologous Transplantation in Multiple Myeloma: Randomized Controlled Trial
BACKGROUND: Frailty is highly prevalent in survivors of multiple myeloma (MM) after autologous hematopoietic cell transplantation and is associated with poor functional recovery and adverse clinical outcomes. Although exercise is known to improve physical function, traditional center-based rehabilitation models are often inaccessible to this population during early posttransplant recovery. Mobile health (mHealth)-supported exercise may offer a scalable alternative; however, evidence in hematologic malignancies remains limited. OBJECTIVE: This study aimed to evaluate the effects of a 16-week mHealth-supported exercise rehabilitation program on frailty phenotype and physical function in survivors of MM within 180 days after autologous hematopoietic cell transplantation. METHODS: In this single-center randomized controlled trial, participants who self-reported as prefrail or frail were randomized 1:1 to an mHealth-supported exercise group (n=16) or usual care control (n=16). Remote assessments were conducted at baseline (week 0), midpoint (week 9), and follow-up (week 17). The intervention consisted of 8 weeks of supervised tele-exercise (3 sessions/week, 50 minutes/session), followed by 8 weeks of independent home-based exercise using the same mHealth platform. Exercise intensity was prescribed using a repetitions-in-reserve-based rating of perceived exertion approach with symptom-guided progression. The primary outcome was change in the 5-component Fried frailty phenotype score (0-5). Secondary outcomes included Short Physical Performance Battery components, chair stand time, gait speed, and handgrip strength. Intention-to-treat analyses were conducted using generalized estimating equations to evaluate between-group differences over time. RESULTS: Participants had a mean age of 64.6 (SD 7.1) years and were enrolled a mean of 136 (SD 36.3) days posttransplant. At baseline, 94% (30/32) of participants were classified as frail. Adherence to the supervised sessions was 85% (326/384 sessions), and adherence during the unsupervised phase was 78% (298/384 sessions). The exercise group demonstrated a significantly greater reduction in frailty score compared with control from baseline to week 17 (P<.001). Between-group difference estimates showed a clinically meaningful improvement favoring exercise at both week 9 and week 17 (P<.001). Chair stand time improved significantly in the exercise group compared with control, with faster completion times observed at week 9 and sustained through week 17 (P=.002). Improvements in other Short Physical Performance Battery components and handgrip strength favored the exercise group but did not reach statistical significance. No serious adverse events occurred. CONCLUSIONS: A 16-week mHealth-supported, progressively prescribed exercise rehabilitation program was feasible, safe, and effective in reversing frailty phenotype and improving functional mobility in survivors of MM early after autologous transplantation. This approach provides a scalable model for delivering structured rehabilitation during a high-risk recovery window. Larger trials incorporating attention-matched controls and longer follow-up are warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT05142371; https://clinicaltrials.gov/study/NCT05142371.
22 May 2026
Read appraisal →The Journal of clinical endocrinology and metabolism
Lifestyle intervention before and during fertility treatment in women with obesity or with overweight and PCOS-a RCT
CONTEXT: Lifestyle interventions are recommended for women with obesity and infertility, but trial evidence is scarce, and studies have not investigated interventions that continue during fertility treatment. OBJECTIVE: Evaluate effectiveness of a lifestyle intervention compared with usual care on fertility outcomes in women with obesity and infertility. DESIGN: The Obesity-Fertility randomized controlled trial (RCT), at an academic fertility clinic, included 127 women aged 18 to 40 years with infertility and obesity (body mass index ≥30 kg/m2, or ≥27 kg/m2 with polycystic ovary syndrome [PCOS]), excluding those unlikely to conceive naturally. The intervention group (IG) received a 6-month lifestyle intervention alone (individual follow-up with a dietician and kinesiologist, and group sessions) before adding fertility treatments. The control group (CG) received usual fertility care directly. Rate of live birth conceived within 18 months of randomization was analyzed. RESULTS: Compared to CG, the IG lost more weight (-3.21% ± 4.73% vs -0.40% ± 3.66%, P = .003) and waist circumference (-2.62 ± 4.46 cm vs -0.23 ± 3.81 cm, P = .01) at 6 months. The live-birth rate was 44.4% in the IG (n = 63) vs 35.9% in the CG (n = 64) (risk ratio [RR] = 1.24 [95% CI 0.81-1.90]). In IG vs CG, clinical pregnancy rates were 52.4% vs 37.5% (RR = 1.40 [0.94-2.07]) and natural pregnancy rates were 27.0% vs 12.5% (RR = 2.16 [1.01-4.64]). CONCLUSION: Compared with usual care, a lifestyle intervention alone for 6 months and then combined with fertility treatments did not increase the 18-month rate of pregnancies leading to a live birth, but significantly increased natural pregnancy rates, potentially reducing the need for costly assisted reproduction in this population.
19 May 2026
Read appraisal →PloS one
Effect of intra-dialytic pedaling exercise on dialysis adequacy: A randomized controlled trial
BACKGROUND: In patients with chronic kidney disease undergoing hemodialysis, physical activity and rehabilitation are crucial for preventing declines in muscle strength and functional capacity. This study aimed to assess the impact of physical activity during hemodialysis on dialysis adequacy in patients undergoing hemodialysis. METHODS: This randomized controlled trial (RCT) investigated the impact of pedaling exercise on dialysis effectiveness in 84 hemodialysis patients at hospitals in Bushehr. Participants were randomly assigned to either an experimental group (n = 42) that performed 30 minutes of pedaling exercise during their 4-hour dialysis sessions or a control group (n = 42) that received routine hemodialysis. Dialysis adequacy was assessed by comparing pre- and post-dialysis blood samples obtained from the arterial line. A conservative intradialytic exercise protocol, blood samples, and patient weight were measured using a calibrated digital scale. Data analysis was performed using SPSS version 24 software. RESULTS: The experimental and control groups were similar in demographic characteristics, except for age (X2 = -3.84, p = 0.001) and education levels (X2 = 10.100, p = 0.006). While there was no significant difference in weight between the groups before and after the intervention (t = 0.223, p = 0.82 before; t = 0.203, p = 0.84 after), both groups showed a substantial weight reduction overall (p < 0.0001). There were no statistically significant differences in weight change (t = 0.80, p = 0.25), BUN (t = 0.13, p = 1.52), or Kt/V (t = 1.62, p = 0.11) between the experimental and control groups. CONCLUSION: This study found that incorporating pedaling exercise during hemodialysis did not significantly improve dialysis effectiveness, as measured by weight change, BUN levels, or Kt/V. While both groups showed weight loss, there were no statistically significant differences between them. However, the study was limited by its small sample size and the specific exercise protocol employed. Further research with larger cohorts and a broader range of physical activities is needed to determine whether physical activity during hemodialysis can improve dialysis adequacy and overall patient outcomes. TRIAL REGISTRATION: IRCT code number 20150529022466N15 and trial Code of Ethics IR.BPUMS.REC.1398.130E.
16 May 2026
Read appraisal →BMC endocrine disorders
Effects of digital and remote exercise interventions on HbA1c in type 2 diabetes: a systematic review and network meta-analysis
BACKGROUND: To compare the effects of different digitally and remotely deliveredexercise interventions on glycated hemoglobin (HbA1c) in adults with type 2diabetes mellitus (T2DM) using a network meta-analysis (NMA), and to clarifythe relative effectiveness of distinct delivery models. METHODS: A systematic review and network meta-analysis of randomized controlledtrials was conducted following PRISMA-NMA guidelines and prospectivelyregistered in PROSPERO (CRD420261288210). Major databases were searched frominception to November 11, 2025. Exercise-centered digital and remoteinterventions were categorized as digital exercise interventions (DEX),structured exercise prescription (SEP), multi-behavior lifestyle interventions(MBLI), and tele-exercise/tele-rehabilitation (TEX). The primary outcome waschange in HbA1c. RESULTS: Fifty-four RCTs were included. Compared with control, TEX demonstratedthe greatest reduction in HbA1c (MD -0.51%, 95% CrI -0.88 to -0.14), followedby MBLI (MD -0.32%, 95% CrI -0.51 to -0.13). SEP showed a non-significanttrend, and DEX did not significantly reduce HbA1c. SUCRA rankings favored TEX(0.87), followed by MBLI (0.66), SEP (0.62), and DEX (0.24). Subgroup analysessuggested that HbA1c reductions with TEX and MBLI were more evident among olderadults (≥60 years) and those with longer diabetes duration（>10 years）;however, network inconsistency was detected in these subgroups, and findingsshould be interpreted cautiously. CONCLUSIONS: Digitally and remotelydelivered exercise interventions differ in their effectiveness for HbA1ccontrol in T2DM. Interventions incorporating ongoing professional supervisionare associated with the most consistent glycemic benefits, whereas largelyautomated approaches show limited effects, highlighting the importance ofdelivery structure and supervision intensity.
15 May 2026
Read appraisal →Scientific reports
Exploring the psychological and physiological effects of a virtual reality-based bicycle exercise in hemodialysis patients: a randomized controlled trial
This study aimed to evaluate the efficacy of a virtual reality (VR)-based bicycle exercise in psychological distress (depression and anxiety) and selected biochemical parameters among patients receiving maintenance hemodialysis (MHD). A total of 70 patients from the dialysis station at Changzhou Medical District of the No. 904th Hospital were randomly allocated into study group(VR-based bicycle exercise, n = 35) and control group(routine nursing care, n = 35). The depression and anxiety levels were assessed by Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS) respectively. Physiological indicators, including serum creatinine (Scr) and blood urea nitrogen (BUN) levels, were also analyzed. Following the intervention, the study group exhibited significant reductions in SDS and SAS scores (both P < 0.05). The levels of Scr and BUN in peripheral blood were also observed to be significantly decreased in study group (P < 0.05). Correlation analysis revealed a significant positive correlation between SAS/SDS scores with both Scr and BUN levels (P < 0.05 or P < 0.01). Furthermore, regression models identified SAS scores as significant predictors of Scr and BUN levels, accounting for 27.8% and 31.9% of their variance, respectively (P < 0.05 or P < 0.01). VR-based bicycle exercise can improve psychological well-being, and was associated with beneficial changes in pre-dialysis serum biomarkers (Scr and BUN) in MHD patients. This integrated intervention represents a promising non-pharmacological strategy to complement standard care in MHD patients.
15 May 2026
Read appraisal →JMIR research protocols
Technology-Based Prehabilitation for Patients With Cancer Before Elective Treatment: Protocol for a Scoping Review
BACKGROUND: Advances in cancer treatment have improved survival rates; however, patients continue to experience significant treatment-related side effects, leading to reduced quality of life. Prehabilitation is an intervention that occurs before treatment and can improve patients' functional capacity, recovery, and well-being through exercise, nutrition, and psychological support. Typical hospital-based prehabilitation is not accessible to all patients due to geographical, socioeconomic, and time-related barriers. Technology-based approaches, including eHealth and mobile health (mHealth) interventions, may overcome these barriers by enabling remote, patient-centered delivery. However, the current evidence base is heterogeneous and lacks synthesis regarding feasibility, acceptability, and outcomes. OBJECTIVE: This protocol for a scoping review aims to outline how we will systematically map and synthesize the evidence on technology-based prehabilitation interventions for people with cancer to identify intervention designs, assess feasibility and accessibility, and highlight knowledge gaps to guide future research and practice. METHODS: The review will follow the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. A 3-step search strategy will be applied across multiple databases and gray literature sources. Eligible studies will include adults (aged ≥18 years) with a cancer diagnosis who are scheduled for elective treatment (surgery, radiotherapy, chemotherapy, immunotherapy, or hormone therapy). Interventions must involve eHealth or mHealth approaches supporting unimodal or multimodal prehabilitation activities such as exercise, nutrition, psychological support, or lifestyle modification. Outcomes of interest include functional fitness, quality of life, psychological well-being, treatment preparedness, recovery, adherence, and feasibility. Two independent reviewers will conduct title, abstract, and full-text screening, with disagreements resolved through discussion or consultation with a third reviewer. Data will be charted and presented in tables and figures and as a narrative synthesis. Critical appraisal using JBI tools will contextualize methodological quality but not exclude studies. Risk of bias will be assessed using the Cochrane Risk of Bias Tool for Randomized Trials version 2 (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions version 2 (ROBINS-I V2) tool. This will not be used to exclude studies, but to determine the quality of articles included. RESULTS: The search strategy has been pilot tested and finalized. Database searches are scheduled to commence in March 2026, with study selection and screening anticipated to be completed by April 2026. Data analysis and synthesis are expected to begin in May 2026, and final results will be available by October 2026. CONCLUSIONS: This protocol outlines a rigorous and transparent approach to mapping the current evidence on technology-based prehabilitation in cancer care. By systematically characterizing intervention features, outcome domains, and evidence gaps, the review will provide an up-to-date evidence map to guide future research priorities, inform clinical implementation, and support the development of more standardized and inclusive prehabilitation pathways.
14 May 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Oral antipyretics for fatigue alleviation and exercise enhancement in adults with multiple sclerosis: a systematic review and meta-analysis
AIMS: This review aims to explore the potential role of oral antipyretics (aspirin (ASA)/ acetaminophen), commonly known for fever and pain control, in managing fatigue, temperature regulation, and exercise capacity in patients with Multiple Sclerosis (MS), with a focus on nursing implications for symptom management. DESIGN: A systematic review of existing clinical studies assessing the effects of aspirin/ acetaminophen on MS-related fatigue, thermoregulation, and exercise performance. DATA SOURCES: Electronic databases including Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PubMed, Scopus, Web of Science, Wiley, Google Scholar, and ClinicalTrials.gov were searched up to March 2024. REVIEW METHODS: Quality assessment was conducted using the Cochrane risk of bias tool 2. to evaluate the methodological rigor of included studies. Outcomes analyzed included clinically assessed fatigue scores, exercise endurance, and post-exercise thermoregulation, with attention to potential risks associated with aspirin use. RESULTS: After assessment of 57 reports for eligibility, only seven studies met inclusion criteria; results indicated that aspirin pretreatment significantly improved Time to Exhaustion (TTE) in heat-sensitive MS patients (p = 0.013), though one study reported no significant effect. Aspirin reduced post-exercise temperature rise by 56%, but this was not statistically significant in one trial (p = 0.178), while another showed significant reductions (p = 0.002). CONCLUSION: Aspirin and acetaminophen may offer benefits in alleviating fatigue, enhancing thermoregulation, and improving exercise endurance in MS patients. These findings suggest that nurses should consider the potential role of aspirin in symptom management, with further research needed to confirm efficacy and safety. IMPACT: This review highlights a potential adjunct therapy for nurses to incorporate into comprehensive MS care, emphasizing symptom control and quality of life improvements. PATIENT OR PUBLIC CONTRIBUTION: Not applicable. TRIAL REGISTRATION: This review is PROSPERO registered having ID CRD420251000875.
14 May 2026
Read appraisal →Journal of medical Internet research
Effectiveness of mHealth Interventions Aimed at Promoting Physical Activity and Reducing Sedentary Behavior on Work-Related Outcomes Among Workers: Systematic Review
BACKGROUND: Mobile health (mHealth) technologies have gained popularity and may play a key role in promoting health-related behaviors. However, the impact of mHealth interventions on work-related outcomes remains unclear. OBJECTIVE: We aimed to provide an overview of the effectiveness of mHealth interventions designed to encourage physical activity and decrease sedentary behavior on work-related outcomes. METHODS: A search was conducted in MEDLINE, Web of Science Core Collection, the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, and Ichushi-Web for all publications up to September 12, 2025, without language or date restrictions. We included studies which (1) investigated the impact of mHealth interventions promoting physical activity and reducing sedentary behavior on work-related outcomes such as absenteeism, presenteeism, work productivity, work performance, and workability; (2) were designed as a randomized controlled trial or nonrandomized study of interventions; (3) were conducted among workers; and (4) were published as full-text original articles in Japanese or English. Two researchers independently conducted the screening of titles and abstracts, followed by a full-text review to confirm study eligibility and extract the data. We assessed the risk of bias using the Cochrane Collaboration Risk of Bias tool for randomized trials (RoB 2) and the Risk Of Bias In Nonrandomized Studies of Interventions (ROBINS-I). Findings were narratively synthesized. RESULTS: In total, 4022 records were identified from databases and other sources. After removing duplicates, 3631 studies were screened, and 17 studies (12 randomized controlled trials and 5 nonrandomized studies of interventions) met the inclusion criteria. Of the 17 eligible studies with 18,805 participants, 12 showed a favorable effect direction on ≥1 work-related outcome, but the majority exhibited a high or critical risk of bias, raising concerns about the quality of the research. There was considerable heterogeneity across studies. CONCLUSIONS: Scientific evidence suggests that health promotion efforts that incorporate mHealth components to encourage physical activity and reduce sedentary behavior may have a favorable impact on work-related outcomes. However, the low methodological quality of the studies and their high heterogeneity due to the participant characteristics, intervention content, use of diverse work-related assessment tools, and different follow-up periods make it difficult to draw definitive conclusions about the effectiveness of the interventions. This review is the first to comprehensively synthesize evidence on the impact of mHealth interventions on work-related outcomes, extending prior reviews that primarily focused on traditional workplace-based interventions without mHealth components. This review also contributes to the field by offering guidance for future studies, including the potential value of megastudy designs that evaluate multiple interventions within the same population over the same period on the same outcomes. As a practical implication, these findings suggest that mHealth technologies may serve as a complementary strategy for supporting occupational health and productivity.
12 May 2026
Read appraisal →European heart journal. Cardiovascular Imaging
Additive prognostic value of functional performance to coronary artery anatomy: the ISCHEMIA trial.
AIMS: To assess whether baseline functional performance assessed by exercise treadmill stress testing (EST) has additive value to coronary computed tomography angiography (CCTA) for risk stratification among patients with chronic coronary disease (CCD) and moderate or severe ischaemia. METHODS AND RESULTS: We performed a subgroup analysis of the ISCHEMIA trial including participants who underwent EST and CCTA. EST data and severity of coronary artery disease (CAD) on CCTA were evaluated by core laboratories, blinded to clinical data and results of the other tests. The primary outcome for this analysis was all-cause death. Secondary outcomes were cardiovascular death, cardiovascular death or myocardial infarction (MI), MI and a composite of cardiovascular death, MI, or hospitalization for heart failure, unstable angina, or resuscitated cardiac arrest. EST and the number of vessels diseased on CCTA were both interpretable in 1864 patients (median age 62 years, IQR 55-68, 83% males). During a median follow-up of 3.1 years, 69 patients died. Higher peak metabolic equivalents (METs) achieved on the qualifying stress test was associated with lower all-cause death (HR 0.86, 95% CI 0.76-0.98; P = 0.025). The addition of peak METs to CAD severity improved the predictive ability of the all-cause death and CV death models by 10-20% and 8-13% respectively, depending on the metrics used for CCTA. Adding peak METs to CCTA anatomical models resulted in better prediction of MI by 11-17%, cardiovascular death or MI by 10-14%, and 5-component composite outcome by 12-16%. CONCLUSION: Peak METs on EST, a marker of functional performance, added prognostic value to models including CCTA anatomical findings in patients with CCD and moderate or severe ischaemia.
3 May 2026
Read appraisal →JMIR formative research
Exploring User Experiences of an Augmented Reality Smartphone App Prescribing Exercise for Children and Young People With Cancer: Results From a Qualitative Study
BACKGROUND: Mobile health (mHealth), and specifically smartphone apps, have grown exponentially in both functionality and accessibility and are becoming an important component of health care. Research exploring the use of mHealth for managing or treating chronic diseases, such as cancer, has shown promising effects. Yet, comparatively little work has examined how such technologies can enhance exercise interventions for young people with cancer. To optimize the effectiveness of mHealth in these contexts, it is essential to build a stronger evidence base on user experience. OBJECTIVE: This study aimed to investigate how healthy children and young people engaged with an augmented reality (AR) app developed specifically for children and young people undergoing cancer treatment, and to identify design features that may support engagement and behavior change in the intended clinical population. METHODS: School and university students, aged 8-21 years, were eligible to participate in the study. Practical workshops allowed participants to engage with the AR exercise app before taking part in focus groups to explore user experiences. Data were analyzed using qualitative content analysis, which also involved a critical friend approach using 2 researchers (HM and KS). Suggested improvements were mapped against the motivational affordances' taxonomy. RESULTS: A total of 39 participants aged 8-21 years took part in the focus group study. Participants found the demonstrations and varied exercises useful but expressed some concerns regarding data safety and functionality of the novel AR avatar. It was proposed that additional educational components, challenges, and rewards, as well as a customizable avatar, social support features, and audio instructions for a more inclusive design would be desirable and could enhance user experience. When mapped against the motivational affordances taxonomy, the suggested improvements aligned primarily with mechanisms of user education, challenges, feedback, cooperation, and comparison. CONCLUSIONS: This study provides an understanding of how apps that prescribe exercise can be optimized to enhance motivation and user experience. By assessing feedback and suggestions for improvements, the findings highlight key design features that may support engagement. While this initial work focused on healthy, age-matched participants, further evidence specifically in children and young people with a childhood cancer diagnosis is needed.
26 Apr 2026
Read appraisal →European journal of preventive cardiology
Comparison of patient characteristics and health outcomes between self-selected centre-based cardiac rehabilitation and hybrid cardiac telerehabilitation: a prospective cohort study
AIMS: Data on self-selected modes of delivery of cardiac rehabilitation (CR) are limited. This study compared centre-based CR (cbCR) with hybrid cardiac telerehabilitation (hCTR) in terms of patient characteristics, change in physical and mental functioning, and achievement of guideline-directed treatment targets. METHODS AND RESULTS: From May 2022 to December 2023, consecutive patients with cardiovascular diseases were enrolled at a tertiary centre into a 3 month cbCR or hCTR programme based on shared decision-making. Changes in exercise capacity, anxiety, depression, and health-related quality of life (hrQoL) scores from admission to the discharge visit were compared between CR modalities. The achievement of two-step blood pressure and LDL-cholesterol (LDL-C) goals, as well as the HbA1c goal in patients with diabetes at the discharge visit, was compared between CR modalities. Out of 1292 patients screened, 406 (21% females, age 60.4 ± 12.7 years) were eligible and completed the study. Of those, 72% chose cbCR and 28% chose hCTR. Patients in hCTR were 3 years younger and exhibited higher baseline peak VO2 (91 vs. 80% of predicted), better hrQoL, and lower depression and anxiety scores. No significant differences were found in improvements in physical or mental functioning or in meeting blood pressure and HbA1c targets between the two groups. A smaller proportion of hCTR participants achieved the LDL-C Step I target (56 vs. 69% in cbCR). CONCLUSION: Overall, hCTR attracted slightly younger patients with better baseline health, but both modalities showed similar effects on most health outcomes. Centre-based cardiac rehabilitation was associated with tighter lipid control, which could be related to more intense counselling or patient preference. Outpatient cardiovascular rehabilitation was equally effective when performed with thrice weekly supervised exercise training sessions or partly performed at home while monitored with fitness trackers and a biosensor vest. Patients who self-select digitally monitored home training were slightly younger, fitter, and had better quality of life with lower levels of anxiety and depression. Blood lipid control, weight loss, and smoking cessation therapies need to be enhanced by tighter control and more intensive medical therapy particularly in patients choosing to perform part of the exercise sessions at home.
23 Apr 2026
Read appraisal →Journal of rehabilitation medicine
Does aerobic exercise affect memory, attention, working memory, and fatigue after acquired brain injury? A single-blinded, randomized controlled pilot study.
OBJECTIVE: To explore potential effects of aerobic exercise on cognitive function, fatigue, and neuroplasticity after stroke or traumatic brain injury. DESIGN: A randomized controlled pilot study. SUBJECTS/PATIENTS: Twelve participants, 10 men and 2 women aged 16-65 years diagnosed with acquired brain injury (moderate to severe stroke or traumatic brain injury), enrolled in an outpatient rehabilitation programme at least 3 months post-injury. METHODS: The intervention group (n = 6) participated in 30 min of aerobic exercise 3-4 times/week for 8 weeks during their outpatient rehabilitation. The control group (n = 6) received routine physical therapy. In addition, both groups received rehabilitation according to their rehabilitation plan. Neuropsychological and endurance testing was performed before and after the intervention and at a 3-month follow-up. Functional magnetic resonance imaging was performed before and after the intervention. RESULTS: Preliminary findings show no significant difference between the groups regarding cognitive variables, fatigue, or neuroplasticity. However, working memory/executive demanding processing speed, measured with the Paced Auditory Serial Addition Test, improved significantly (p = 0.042) in the aerobic exercise group and there were trends of improvements on several other executive tests in the aerobic exercise group. Automatic visual search speed improved in the control group (p = 0.027). CONCLUSION: The question of whether aerobic exercise promotes cognition and fatigue after brain injury remains unanswered. This randomized controlled pilot study and its preliminary findings indicate greater improvements in executive processing speed in the aerobic exercise group, while more automatized attention speed improved more in the control group. The experiences from this study might facilitate the design of future studies on this intriguing topic. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT07429526.
17 Apr 2026
Read appraisal →Renal failure
Benefits of physical exercises in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials
Physical exercise has been proven to be beneficial for chronic kidney disease (CKD) patients; however, there is a lack of a comprehensive summary of existing literature, especially the results from randomized controlled trials (RCTs). We had conducted a systematic review and meta-analysis to evaluate the benefits of physical exercise in chronic kidney disease. Outcomes were classified into all-cause mortality, cardiovascular, pulmonary, and renal outcomes, inflammatory indices, laboratory tests, and physical indices. The risk of bias was assessed using the Cochrane criteria. Relative risk ratios with 95% confidence intervals (CIs) for categorical variables, and weighted mean difference or standardized mean differences with 95% CIs for continuous variables were pooled using a random-effects model. Publication bias was assessed using Funnel plot analysis and Egger's Test. At last, 82 studies were included, and the results of the meta-analysis show that the physical exercises can significantly reduce all-cause mortality, particularly in dialysis dependent patients. Cardiovascular function, reflected by 6-minute walk test and blood pressure and pulmonary function, reflected by peak oxygen uptake, forced expiratory volume in 1 second, and forced vital capacity, all improved after physical exercise interventions. Physical exercises helped to increase the dialysis adequacy and preserve the residual renal function. C-reactive protein and interleukin-6 levels decreased, and hemoglobin and albumin levels increased upon physical exercise interventions. The fat mass decreased after physical exercise interventions in non-dialysis patients. We concluded that physical exercise is beneficial for CKD patients, independent of the modes or locations of exercise.
16 Apr 2026
Read appraisal →Open heart
Chronotype-aligned exercise timing in middle-aged adults at cardiometabolic risk: a randomised controlled trial
OBJECTIVE: To investigate whether aligning exercise timing with chronotype enhances cardiometabolic and sleep-related benefits in sedentary adults with cardiovascular risk factors. METHODS: In this 12-week randomised controlled trial conducted in Lahore, Pakistan (January-June 2025), 150 sedentary adults (aged 40-60) with at least one cardiovascular risk factor were recruited and categorised as morning-type or evening-type using the Morningness-Eveningness Questionnaire and validated by 48 hour core body temperature monitoring. Participants were randomised into a chronotype-aligned exercise (CAE) group exercising at their preferred time, or a chronotype-misaligned exercise (CME) group exercising at their non-preferred time. Moderate-intensity aerobic training (5 sessions/week, 40 min/session) was supervised. Primary outcomes included systolic and diastolic blood pressure (BP) and heart rate variability (RMSSD); secondary outcomes included peak oxygen consumption (VO₂ peak), low density lipoprotein (LDL), fasting glucose and sleep quality (PSQI), assessed pre- and post-intervention. RESULTS: Of 150 randomised participants, 134 completed the study (CAE: n=64; CME: n=70). CAE led to significantly greater improvements in systolic BP (-10.8 vs -5.5 mm Hg, p=0.002), diastolic BP, RMSSD, VO₂ peak, LDL, fasting glucose and PSQI scores compared with CME. Repeated measures analysis of variance (ANOVA) revealed significant group×time interactions across all outcomes (eg, systolic BP: η²=0.095, p=0.005). The reduction in systolic BP in the CAE group was substantial and significantly greater than in the CME group. CONCLUSION: Aligning exercise timing with individual chronotype significantly enhances cardiometabolic and sleep-related outcomes in at-risk adults. Chronotype-based exercise prescriptions may offer a cost-effective, personalised approach to improving cardiovascular health.
16 Apr 2026
Read appraisal →Blood advances
MPN-FIT: a randomized controlled pilot trial of supervised exercise in myeloproliferative neoplasms
Myeloproliferative neoplasms (MPN) are associated with a high symptom burden and impaired quality of life (QoL), often unaided by available treatments. Physical activity has demonstrated benefits in other cancers; however, its potential has yet to be explored in MPN. This randomized controlled trial aimed to evaluate the feasibility, acceptability, and efficacy of a supervised exercise program for patients with MPN based on longitudinal assessment of symptom burden, QoL, and clinical/inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, ferritin, lactate dehydrogenase [LDH], and serum cytokines). Patients with MPN (n = 55) were randomized 3:2 to a 12-week home-based exercise intervention (flexibility/resistance/aerobics) supervised by a kinesiologist vs waitlist control. Measures included patient-reported outcome questionnaires, peripheral blood sampling, and postintervention interviews with participants. Forty-seven patients completed the trial (FIT group, n = 26; control group, n = 21). Median age was 66 years (range, 27-86), and 60% were female. All feasibility benchmarks were met, with 88% of participants satisfied and 92% with intent to continue an exercise program on a regular basis. A significant reduction in LDH was observed in FIT patients compared with controls (-14.5 U/L vs +4.0 U/L; P = .03). Patients interviewed described positive effects of the intervention on symptoms and would unanimously recommend the program to others with MPN. In this pilot study, supervised exercise was feasible, acceptable, and showed potential benefits on inflammatory/disease markers.
14 Apr 2026
Read appraisal →Journal of neurology
Effect of exercise training on clinical and physiological variables in adults with myotonic dystrophy type 1: a systematic review and meta-analysis
Myotonic dystrophy type 1 (DM1) is a progressive neuromuscular disorder characterized by muscle weakness, fatigue, reduced endurance, and impaired quality of life. This systematic review and meta-analysis aimed to evaluate the effects of exercise training on clinical and physiological outcomes in adults with DM1. Six databases were searched for studies published between 2003 and 2023. Randomized controlled trials, quasi-experimental studies, and longitudinal cohort studies involving adults with DM1 undergoing aerobic or resistance training were included, and risk of bias was assessed. Meta-analyses used standardized mean differences with fixed- or random-effects models based on heterogeneity. Fourteen studies were included. Most studies demonstrated low risk of bias. Only one study reported any adverse events, and the incidence of these events was similar in occurrence between the intervention and standard care only groups. Meta-analysis demonstrated a moderate improvement in strength (p = 0.022). Endurance showed a large but non-significant pooled effect (p = 0.14). Meta-analyses for fatigue (p = 0.49) and sleep (p > 0.05) were inconclusive. Narrative synthesis indicated improvements in most clinical and physiological outcomes, while sleep outcomes showed minimal or inconsistent changes across studies. Exercise training appears safe and provides moderate benefits for strength and selected clinical and physiological outcomes in adults with DM1. Future well-powered trials with standardized protocols are needed to optimize exercise prescription.
12 Apr 2026
Read appraisal →PloS one
Effects of scapular-focused movement-based exercises on sports performance of athletes with scapular dyskinesis: A systematic review
BACKGROUND: Scapular dyskinesis is a common dysfunction among athletes, particularly in overhead sports, leading to pain, reduced range of motion (ROM), and impaired performance. Movement-based exercises are increasingly used to address these issues, but their overall impact on sports performance remains unclear. OBJECTIVE: This systematic review aims to evaluate the effects of movement-based exercises on sports performance in athletes with scapular dyskinesis. METHOD: A comprehensive search was conducted in Web of Science, Scopus, and PubMed up to July 30, 2025, following PRISMA guidelines. Data were extracted and assessed for risk of bias using RoB-2 and ROBINS-I tools. A narrative synthesis was performed due to study heterogeneity. RESULTS: Fourteen studies (8 RCTs and 6 non-RCTs) involving 412 participants with a mean age of 23.8 years assessed movement-based interventions lasting from a single session to 24 weeks, primarily focusing on scapular stabilization, kinetic chain control, and proprioception over 6-8 weeks with around three sessions per week. Moderate-certainty evidence suggests that exercise likely improves shoulder function, disability, and glenohumeral range of motion over 6-12 weeks. However, the evidence for pain reduction and improvement in rotator cuff/scapular strength is of low certainty, showing mixed effects depending on the specific program. Evidence for improvement in scapular kinematics is also of low certainty. Sport-specific performance outcomes, such as throwing velocity, remain highly uncertain due to small sample sizes and conflicting results from RCTs. CONCLUSION: Movement-based exercises may be considered by athletes with scapular dyskinesis to potentially improve shoulder function and glenohumeral range of motion; however, the certainty of evidence for effects on pain relief, strength, and sports performance is very low. Therefore, strong recommendations cannot be made at this stage. More tailored programs and well-structured RCTs are needed to clarify these effects.
11 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
A trifold prehabilitation model prior to induction chemotherapy in patients with leukemia: a randomized controlled trial
PURPOSE: A trifold prehabilitation program that integrates exercise, nutritional support, and psychological care has not yet been incorporated into routine care for leukemia patients prior to induction chemotherapy. This study aimed to evaluate the safety and feasibility of this trifold intervention and to further examine its potential impact on physical fitness, nutritional risk, and psychological health. METHODS: In a single-blind, parallel-group randomized trial, 86 newly diagnosed leukemia patients at a tertiary hospital in China were randomly assigned to a 12-week prehabilitation group (n = 43) or usual care (n = 43). Primary outcomes were recruitment, attrition, and safety. Secondary outcomes included the 6-min walk test (6MWT), exercise self-efficacy, cancer-related fatigue (CRF), anxiety, depression, and nutrition. Assessments occurred at baseline (T0), pre-chemotherapy (T1), and 1 (T2) and 3 months (T3) post-chemotherapy. RESULTS: The recruitment rate was 60.14%, with an attrition rate of 20.93%, and no serious adverse events occurred. Compared with controls, the intervention group showed significantly greater improvements in 6-min walk distance and cancer-related fatigue from T1 to T3 (all p < 0.05). Improvements in exercise self-efficacy were significant at T2 and T3 but not at T1. Nutritional status improved at T3 (p = 0.033). Anxiety and depression levels were consistently lower across all follow-up points (p < 0.01). CONCLUSIONS: This study demonstrates that prehabilitation is safe, feasible, and potentially beneficial for physical, nutritional, and psychological outcomes in leukemia patients. TRIAL REGISTRATION: China Clinical Trials Registration Platform: ChiCTR2500105061, date of registration: June 27, 2025 (retrospectively registered).
10 Apr 2026
Read appraisal →Cell metabolism
Blood-flow restriction resistance training improves skeletal muscle mitochondrial capacity and cardiovascular risk factors in type 2 diabetes.
Impaired muscle strength and mitochondrial functionality are hallmarks of type 2 diabetes (T2D). Conventional combined resistance/endurance exercise training has limited efficacy to simultaneously improve muscle function and metabolism. We examined whether low-load blood-flow restriction training (BFRT) increases both muscle strength and mitochondrial oxidative capacity in T2D. Over 12 weeks, BFRT and conventional resistance training (CREST) similarly improved muscle strength despite lower workload in BFRT. Uniquely, BFRT enhanced muscle and adipose tissue oxidative capacity and increased muscle mitochondrial content. Transcriptomic profiling revealed more pronounced changes, particularly in angiogenesis-linked pathways, upon BFRT. BFRT also preferentially led to reductions in visceral adipose tissue volume and waist circumference, whereas CREST more effectively decreased subcutaneous adipose tissue volume. Both interventions lowered resting heart rate and diastolic blood pressure. These findings position BFRT as a promising low-load exercising strategy to simultaneously improve mitochondrial oxidative capacity, muscle strength, and body composition in individuals with T2D.
9 Apr 2026
Read appraisal →Annals of medicine
Intervention components, training dose, and adherence in exercise-based prevention of hamstring strain injury in football: a systematic review and meta-analysis
OBJECTIVE: To quantify associations between exercise-based prevention programmes and hamstring strain injury (HSI) risk in football participants, and whether training dose and adherence modify effects. METHODS: Six databases were searched to 1 October 2025. Randomised and cluster-randomised trials comparing HSI prevention programmes with usual practice or warm-up in football participants were included. Random-effects meta-analysis pooled risk ratios (RRs); subgroup analyses and meta-regression assessed effect modification. RESULTS: Fifteen trials (n = 7,465) were analysed. Programmes reduced HSI risk (RR = 0.51, 95% CI 0.36-0.71), with I²=57% and a prediction interval crossing the null (0.18-1.40). Based on a control event rate of 7.8%, absolute risk reduction was 3.8% (38 fewer HSIs per 1000 participants; 95% CI 23-50 fewer). Effects were stronger for shorter interventions (1-6 months; RR = 0.43) than longer interventions (7-10 months; RR = 0.77; P for interaction=0.04), and for elite/semi-professional players (RR = 0.38) than amateur players (RR = 0.77; P for interaction = 0.02). Training frequency and weekly volume did not modify effects, whereas adherence did. High adherence (≥75%) was associated with lower HSI risk (RR = 0.36, 95% CI 0.28-0.48), whereas low adherence (<75%) showed no clear benefit (RR = 0.92, 95% CI 0.68-1.23; P for interaction <0.00001). Each 10% increase in adherence corresponded to an RR multiplier of 0.83 (approximately 17% lower RR). Certainty of evidence was low. CONCLUSION: Exercise-based programmes reduce HSI risk in football when implementation supports sustained adherence. Effects may be stronger in shorter interventions and elite populations, but evidence remains insufficient to differentiate programme types or components.
8 Apr 2026
Read appraisal →European journal of cardiovascular nursing
Effect of exercise intensity and volume on mortality and hospitalization in patients with coronary artery disease: a systematic review and pairwise and exploratory network meta-analysis
AIMS: To ascertain the impact of varying exercise intensities and volumes on clinical outcomes of patients with coronary artery disease (CAD) via a systematic review and meta-analysis. METHODS AND RESULTS: This study included randomized controlled trials to evaluate the effects of different intensity levels and volumes of exercise training and control interventions on clinical outcomes in patients with CAD. Data from eight databases were screened, extracted, and assessed for quality by two independent reviewers. Included studies were categorized into subgroups based on exercise intensity and volume. A random-effects model was used to conduct a meta-analysis of different outcomes. To further explore the combined effects, an exploratory network meta-analysis was performed, combining exercise intensity and exercise volume. Exercise training reduces the risk of cardiovascular mortality, overall hospitalization and cardiovascular hospitalization. In subgroup analyses, both moderate-intensity and continuous training significantly reduce the risk of overall hospitalization. Furthermore, the network meta-analysis shows that moderate-intensity continuous training (MICT) significantly lowers the risk of overall hospitalization [(risk ratio (RR) = 0.66, 95% confidence interval (CI): 0.47-0.95), surface under the cumulative ranking curve (SUCRA) = 70.6%] and cardiovascular hospitalization (RR = 0.66, 95% CI: 0.44-0.99, SUCRA = 80.1%) compared with usual care. In contrast to usual care, vigorous-intensity continuous training (VICT) lowers the risk of cardiovascular hospitalization (RR = 0.35, 95% CI: 0.14-0.92, SUCRA = 94.1%). CONCLUSION: MICT significantly reduces the risk of overall hospitalization and cardiovascular hospitalization. Although the evidence is limited, VICT appears to reduce the risk of cardiovascular hospitalization. Consequently, it may become an effective exercise-based intervention for preventing such events. REGISTRATION: PROSPERO: CRD42024519198.
5 Apr 2026
Read appraisal →European journal of cardiovascular nursing
Effects of personalized structured telemedicine-based exercise cardiac rehabilitation on health outcomes in patients with coronary heart disease: a systematic review and meta-analysis
AIMS: Despite its proven effectiveness, traditional exercise-based cardiac rehabilitation (exCR) suffers from low participation rates. However, telemedicine-based exCR can overcome access barriers to traditional rehabilitation while providing personalized, structured exercise training and remote monitoring. The aim of this review is to ascertain the efficacy of personalized, structured, telemedicine-based exCR in improving health outcomes in patients with coronary heart disease (CHD). METHODS AND RESULTS: A systematic search was conducted in databases including Cochrane Library, PubMed, Web of Science, Embase, CINAHL, Scopus, Medline, China National Knowledge Infrastructure, Wanfang, VIP, and SINOMED from inception to March 2024 to identify randomized controlled trials (RCTs). The final analysis included 19 RCTs comprising 2219 participants. Among patients with CHD, telemedicine-based exCR demonstrated comparable effects to centre-based exCR across multiple outcomes, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life (all P > 0.05). Notably, when compared with usual care, telemedicine-based exCR showed significant improvements in exercise capacity [standardized mean difference (SMD) = 0.23, 95% CI: (0.12, 0.35), I2 = 34%, P < 0.0001], physical activity level [SMD = 0.32, 95% CI: (0.09, 0.54), I2 = 53%, P = 0.006], diastolic blood pressure [mean difference (MD) = -1.54, 95% CI: (-2.89, -0.20), I2 =8%, P = 0.02], body mass index [MD = -0.54, 95% CI: (-1.94, -0.14), I2 = 4%, P = 0.008], and depression [SMD = -0.27, 95% CI: (-0.42, -0.13), I2 = 33%, P = 0.0002]. CONCLUSION: Telemedicine-based exCR is equally effective as centre-based exCR in improving key health outcomes for patients with CHD, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life. Furthermore, telemedicine-based exCR shows superior effectiveness to usual care, with statistically significant improvements in exercise capacity, physical activity, diastolic blood pressure, and depressive symptoms. REGISTRATION: PROSPERO: CRD42024521465.
5 Apr 2026
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