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Background Step-count monitors (pedometers, body-worn trackers and smartphone applications) can increase walking, helping to tackle physical inactivity. We aimed to assess the effect of step-count monitors on physical activity (PA) in randomised controlled trials (RCTs) amongst community-dwelling adults; including longer-term effects, differences between step-count monitors, and between intervention components. Methods Systematic literature searches in seven databases identified RCTs in healthy adults, or those at risk of disease, published between January 2000–April 2020. Two reviewers independently selected studies, extracted data and assessed risk of bias. Outcome was mean differences (MD) with 95% confidence intervals (CI) in steps at follow-up between treatment and control groups. Our preferred outcome measure was from studies with follow-up steps adjusted for baseline steps (change studies); but we also included studies reporting follow-up differences only (end-point studies). Multivariate-meta-analysis used random-effect estimates at different time-points for change studies only. Meta-regression compared effects of different step-count monitors and intervention components amongst all studies at ≤4 months. Results Of 12,491 records identified, 70 RCTs (at generally low risk of bias) were included, with 57 trials (16,355 participants) included in meta-analyses: 32 provided change from baseline data; 25 provided end-point only. Multivariate meta-analysis of the 32 change studies demonstrated step-counts favoured intervention groups: MD of 1126 steps/day 95%CI [787, 1466] at ≤4 months, 1050 steps/day [602, 1498] at 6 months, 464 steps/day [301, 626] at 1 year, 121 steps/day [− 64, 306] at 2 years and 434 steps/day [191, 676] at 3–4 years. Meta-regression of the 57 trials at ≤4 months demonstrated in mutually-adjusted analyses that: end-point were similar to change studies (+ 257 steps/day [− 417, 931]); body-worn trackers/smartphone applications were less effective than pedometers (− 834 steps/day [− 1542, − 126]); and interventions providing additional counselling/incentives were not better than those without (− 812 steps/day [− 1503, − 122]). Conclusions Step-count monitoring leads to short and long-term step-count increases, with no evidence that either body-worn trackers/smartphone applications, or additional counselling/incentives offer further benefit over simpler pedometer-based interventions. Simple step-count monitoring interventions should be prioritised to address the public health physical inactivity challenge. Systematic review registration PROSPERO number CRD42017075810 .

Type 2 diabetes (T2D) is more common in certain ethnic groups. This systematic review compares mortality risk between people with T2D from different ethnic groups and includes recent larger studies. We searched nine databases using PRISMA guidelines (PROSPERO CRD42022372542). We included community-based prospective studies among adults with T2D from at least two different ethnicities. Two independent reviewers undertook screening, data extraction and quality assessment using the Newcastle-Ottawa Scale. The primary outcome compared all-cause mortality rates between ethnic groups (hazard ratio (HR) with 95% confidence intervals). From 30,825 searched records, we included 13 studies (7 meta-analysed), incorporating 573,173 T2D participants; 12 were good quality. Mortality risk was lower amongst people with T2D from South Asian [HR 0.68 (0.65-0.72)], Black [HR 0.82 (0.77-0.87)] and Chinese [HR 0.57 (0.46-0.70)] ethnicity compared to people of White ethnicity. Narrative synthesis corroborated these findings but demonstrated that people of indigenous Māori ethnicity had greater mortality risk compared to European ethnicity. People with T2D of South Asian, Black and Chinese ethnicity have lower all-cause mortality risk than White ethnicity, with Māori ethnicity having higher mortality risk. Factors explaining mortality differences require further study, including understanding complication risk by ethnicity, to improve diabetes outcomes.

ObjectiveTo identify randomised controlled trials (RCTs) of physical activity (PA) interventions with objective PA outcomes in adults and to evaluate whether intervention effects were sustained beyond 12 months.DesignSystematic review and meta-analysis.Data sourcesSeven databases (Medline, Embase, PsycINFO, Web of Science, Cochrane library, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and ASSIA (Applied Social Sciences Index and Abstracts)) were searched from January 2000 until December 2019.Eligibility criteriaRCTs reporting objective PA outcomes beyond 12 months with community-based participants aged ≥18 years were included; those where controls received active interventions, including advice to increase PA levels, were excluded.Data extraction and synthesisTwo independent reviewers completed extraction of aggregate data and assessed risk of bias. Meta-analyses used random-effects models at different follow-up points. Primary outcomes were daily steps and weekly minutes of moderate-to-vigorous PA (MVPA).ResultsOf 33 282 records identified, nine studies (at generally low risk of bias) were included, five in meta-analyses with 12 months to 4 year follow-up. We observed 12 month increases for intervention vs control participants in steps/day (mean difference (MD)=554 (95% CIs: 384 to 724) p<0.0001, I2=0%; 2446 participants; four studies) and weekly MVPA minutes (MD=35 (95% CI: 27 to 43) p<0.0001, I2=0%; 2647 participants; four studies). Effects were sustained up to 4 years for steps/day (MD=494 (95% CI: 251 to 738) p<0.0001, I2=0%; 1944 participants; four studies) and weekly MVPA minutes (MD=25 (95% CI: 13 to 37) p<0.0001, I2=0%; 1458 participants; three studies).ConclusionsThere are few PA interventions with objective follow-up beyond 12 months, more studies are needed. However, this review provided evidence of PA intervention effects beyond 12 months and sustained up to 4 years for both steps/day and MVPA. These findings have important implications for potential long-term health benefits.PROSPERO registration numberCRD42017075753.

IntroductionBoth stable chronic obstructive pulmonary disease (COPD) and acute exacerbations represent leading causes of death, disability and healthcare expenditure. They are complex, heterogeneous and their mechanisms are poorly understood. The role of respiratory viruses has been studied extensively but is still not adequately addressed clinically. Through a rigorous evidence update, we aim to define the prevalence and clinical burden of the different respiratory viruses in stable COPD and exacerbations, and to investigate whether viral load of usual respiratory viruses could be used for diagnosis of exacerbations triggered by viruses, which are currently not diagnosed or treated aetiologically.Methods and analysisBased on a prospectively registered protocol, we will systematically review the literature using standard methods recommended by the Cochrane Collaboration and the Grading of Recommendations Assessment, Development and Evaluation working group. We will search Medline/PubMed, Excerpta Medica dataBASE (EMBASE), the Cochrane Library, the WHO’s Clinical Trials Registry and the proceedings of relevant international conferences on 2 March 2020. We will evaluate: (A) the prevalence of respiratory viruses in stable COPD and exacerbations, (B) differences in the viral loads of respiratory viruses in stable COPD vs exacerbations, to explore whether the viral load of prevalent respiratory viruses could be used as a diagnostic biomarker for exacerbations triggered by viruses and (C) the association between the presence of respiratory viruses and clinical outcomes in stable COPD and in exacerbations.Ethics and disseminationEthics approval is not required since no primary data will be collected. Our findings will be presented in national and international scientific conferences and will be published in peer reviewed journals. Respiratory viruses currently represent a lost opportunity to improve the outcomes of both stable COPD and exacerbations. Our work aspires to ‘demystify’ the prevalence and clinical burden of viruses in stable COPD and exacerbations and to promote clinical and translational research.PROSPERO registration numberCRD42019147658.

People of South Asian and Black ethnicity have a higher prevalence of type 2 diabetes (T2D) compared to people of White ethnicity. T2D is a leading cause of mortality worldwide, however, rigorous investigation including the most recent studies comparing mortality in different ethnic groups has not been conducted. This systematic review and meta-analysis aim to compare mortality risk in people with T2D between different ethnic groups. This systematic review follows PRISMA guidelines (PROSPERO:CRD42022372542). Nine databases were searched for community-based studies among T2D adults from ≥2 ethnicities. Studies published between January, 2000 and May, 2024 and containing ≥100 participants in each reported ethnic group were included. Two independent reviewers undertook title/abstract and full-text screening, data extraction, quality assessment (using Newcastle-Ottawa Scale) and data synthesis with group consensus to resolve any conflicts. The primary outcome compared all-cause mortality rates between ethnic groups (hazard ratio [HR] with 95% confidence intervals). From 33 922 records screened, 13 studies met inclusion criteria and 7 were meta-analysed. The 13 studies incorporated 593 058 T2D participants and 12/13 were of good quality. Overall mortality risk was lower amongst people with T2D from South Asian (HR 0·68 [95% CI 0·65–0·72]; 4 studies), Black (0·82 (0·77–0·87]; 5 studies) and Chinese (0·57 [0·46–0·70]; 2 studies) ethnicity compared to people of White ethnicity. Narrative synthesis corroborated quantitative findings and highlighted that people of indigenous Māori ethnicity had greater mortality risk compared to people of European ethnicity. People with T2D of South Asian, Black and Chinese ethnicity have a lower risk of all-cause mortality compared to those of White ethnicity, whilst Māori ethnicity have higher mortality risk. Risk factors or clinical management could explain differences in T2D mortality risk especially when comparing T2D complications by ethnicity, thus need further scrutiny to improve overall diabetes outcomes. No funding was received.

Physical inactivity is a global public health concern. Systematic reviews indicate that interventions can increase short-term physical activity levels. However, long-term health benefits require sustained physical activity increases and systematic review evidence from interventions with objective measures of physical activity beyond 12 months is lacking. This review aimed to identify and describe randomised trials in adults with objective physical activity measures and follow-up beyond 12 months and evaluate the extent to which intervention effects are sustained beyond 12 months We searched MEDLINE, EMBASE, PsycINFO, Web of Science, Cochrane Library, CINAHL, and ASSIA between Jan 1, 2000, and April 16, 2018, restricting our search to publications in English, with a combination of the key search terms “physical activity”, “objective physical activity measures”, and “randomised controlled trial”. We included trials reporting long-term effects (≥12 months) on objective physical activity (step count and moderate-to-vigorous physical activity) with community-based participants, aged 18 years and older, without specific medical conditions. Studies in which control participants received physical activity interventions were excluded. Two independent reviewers completed data extraction. We did meta-analyses using random effects models and at different follow-up points. Outcomes were daily step counts and weekly minutes of moderate-to-vigorous activity. This study was registered with PROSPERO, CRD42017075753. Of the 17 233 unique records identified by our search, we included nine studies in the review and five in the meta-analyses. Interventions included individual walking programmes, group-based sessions, and a school volunteering programme. Follow-up ranged from 12 months to 4 years. The age range of participants was 18–89 years. We observed physical activity increases at 12 months for intervention group participants versus control participants in steps per day (mean difference 554 steps, 95% CI 384–724, p<0·0001; 2446 participants in four studies) and weekly minutes of moderate-to-vigorous physical activity (35 min, 27–43; p<0·0001; 2647 participants in four studies). This increase was sustained up to 4 years for both steps per day (494 steps, 251–738; p<0·0001; 1944 participants in four studies) and weekly minutes of moderate-to-vigorous physical activity (25 min, 13–37; p<0·0001; 1458 participants in three studies). We found evidence of physical activity intervention effects beyond 12 months, sustained up to 4 years for both steps per day and minutes of moderate-to-vigorous physical activity, with important implications for potential long-term health benefits. However, few physical activity interventions with objective measures had follow-up beyond 12 months. None

IntroductionInhaled corticosteroids (ICS) can improve clinical outcomes in patients with chronic obstructive pulmonary disease (COPD) and eosinophilic airway inflammation, but they also increase the risk of side effects like pneumonia. Blood eosinophils guide ICS use, though evidence is limited. The predictors of treatment REsponse to ICS in COPD: a randomised controlled trials (RCTs) individual participant Data re-Evaluation (ICS-RECODE) research programme will leverage data from large RCTs to identify patients who benefit most from ICS with minimal risk. This protocol details an individual participant data (IPD) meta-analysis, assessing ICS safety, efficacy and treatment×covariate interactions to identify predictors of treatment response.Methods and analysisThis meta-analysis will adhere to Cochrane, IPD handbook and Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance. We will conduct a two-stage IPD meta-analysis of RCTs evaluating the addition of ICS to maintenance COPD treatments. Only RCTs with at least 500 participants across all eligible arms will be included, to allow for treatment×covariate interaction evaluation. Primary outcomes are severe and moderate or severe exacerbation rates; secondary outcomes assess both safety and efficacy. Data from each RCT will be reanalysed using rigorous, consistent statistical methods. Treatment×covariate interactions will be assessed at the RCT level. Trial treatment effects and the coefficients of treatment×covariate interaction analyses will be pooled using random effects model meta-analysis. Risk of bias will be appraised using RoB-2 informed by IPD, and certainty of evidence will be assessed with GRADE and the Instrument to assess the Credibility of Effect Modification Analyses.The ICS-RECODE IPD meta-analysis will make use of the best available data to define evidence-based, precision medicine approaches for ICS use in COPD.Ethics and disseminationThe Health Research Authority approved the ICS-RECODE study, exempting it from ethics review (HRA UK, Reference: 24/HRA/0460). Our findings will be published in peer-reviewed journals and shared with the scientific and broader stakeholder communities.PROSPERO registration numberCRD42024508286.