Explore the vast range of titles available.

Exercise is effective for prevention and management of acute and chronic health conditions. However, trial descriptions of exercise interventions are often suboptimal, leaving readers unclear about the content of effective programmes. To address this, the 16-item internationally endorsed Consensus on Exercise Reporting Template (CERT) was developed. The aim is to present the final template and provide an Explanation and Elaboration Statement to operationalise the CERT. Development of the CERT was based on the EQUATOR Network methodological framework for developing reporting guidelines. We used a modified Delphi technique to gain consensus of international exercise experts and conducted 3 sequential rounds of anonymous online questionnaires and a Delphi workshop. The 16-item CERT is the minimum data set considered necessary to report exercise interventions. The contents may be included in online supplementary material, published as a protocol or located on websites and other electronic repositories. The Explanation and Elaboration Statement is intended to enhance the use, understanding and dissemination of the CERT and presents the meaning and rationale for each item, together with examples of good reporting. The CERT is designed specifically for the reporting of exercise programmes across all evaluative study designs for exercise research. The CERT can be used by authors to structure intervention reports, by reviewers and editors to assess completeness of exercise descriptions and by readers to facilitate the use of the published information. The CERT has the potential to increase clinical uptake of effective exercise programmes, enable research replication, reduce research waste and improve patient outcomes.

BackgroundLow back pain is one of the leading causes of disability worldwide. Exercise therapy is widely recommended to treat persistent non-specific low back pain. While evidence suggests exercise is, on average, moderately effective, there remains uncertainty about which individuals might benefit the most from exercise.MethodsIn parallel with a Cochrane review update, we requested individual participant data (IPD) from high-quality randomised clinical trials of adults with our two primary outcomes of interest, pain and functional limitations, and calculated global recovery. We compiled a master data set including baseline participant characteristics, exercise and comparison characteristics, and outcomes at short-term, moderate-term and long-term follow-up. We conducted descriptive analyses and one-stage IPD meta-analysis using multilevel mixed-effects regression of the overall treatment effect and prespecified potential treatment effect modifiers.ResultsWe received IPD for 27 trials (3514 participants). For studies included in this analysis, compared with no treatment/usual care, exercise therapy on average reduced pain (mean effect/100 (95% CI) −10.7 (−14.1 to –7.4)), a result compatible with a clinically important 20% smallest worthwhile effect. Exercise therapy reduced functional limitations with a clinically important 23% improvement (mean effect/100 (95% CI) −10.2 (−13.2 to –7.3)) at short-term follow-up. Not having heavy physical demands at work and medication use for low back pain were potential treatment effect modifiers—these were associated with superior exercise outcomes relative to non-exercise comparisons. Lower body mass index was also associated with better outcomes in exercise compared with no treatment/usual care. This study was limited by inconsistent availability and measurement of participant characteristics.ConclusionsThis study provides potentially useful information to help treat patients and design future studies of exercise interventions that are better matched to specific subgroups.Protocol publication https://doi.org/10.1186/2046-4053-1-64

BackgroundCardiorespiratory fitness (CRF) is an important marker of current and future health status. The primary aim of our study was to evaluate the impact of a time-efficient school-based intervention on older adolescents’ CRF.MethodsTwo-arm cluster randomised controlled trial conducted in two cohorts (February 2018 to February 2019 and February 2019 to February 2020) in New South Wales, Australia. Participants (N=670, 44.6% women, 16.0±0.43 years) from 20 secondary schools: 10 schools (337 participants) were randomised to the Burn 2 Learn (B2L) intervention and 10 schools (333 participants) to the control. Teachers in schools allocated to the B2L intervention were provided with training, resources, and support to facilitate the delivery of high-intensity interval training (HIIT) activity breaks during curriculum time. Teachers and students in the control group continued their usual practice. The primary outcome was CRF (20 m multi-stage fitness test). Secondary outcomes were muscular fitness, physical activity, hair cortisol concentrations, mental health and cognitive function. Outcomes were assessed at baseline, 6 months (primary end-point) and 12 months. Effects were estimated using mixed models accounting for clustering.ResultsWe observed a group-by-time effect for CRF (difference=4.1 laps, 95% CI 1.8 to 6.4) at the primary end-point (6 months), but not at 12 months. At 6 months, group-by-time effects were found for muscular fitness, steps during school hours and cortisol.ConclusionsImplementing HIIT during curricular time improved adolescents’ CRF and several secondary outcomes. Our findings suggest B2L is unlikely to be an effective approach unless teachers embed sessions within the school day.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12618000293268).

ObjectiveThis systematic review assessed the completeness of accelerometer reporting in physical activity (PA) intervention studies and assessed factors related to accelerometer reporting.DesignThe PubMed database was used to identify manuscripts for inclusion. Included studies were PA interventions that used accelerometers, were written in English and were conducted between 1 January 1998 and 31 July 2014. 195 manuscripts from PA interventions that used accelerometers to measure PA were included. Manuscript completeness was scored using 12 questions focused on 3 accelerometer reporting areas: accelerometer information, data processing and interpretation and protocol non-compliance. Variables, including publication year, journal focus and impact factor, and population studied were evaluated to assess trends in reporting completeness.ResultsThe number of manuscripts using accelerometers to assess PA in interventions increased from 1 in 2002 to 29 in the first 7 months of 2014. Accelerometer reporting completeness correlated weakly with publication year (r=0.24, p<0.001). Correlations were greater when we assessed improvements over time in reporting data processing in manuscripts published in PA-focused journals (r=0.43, p=0.002) compared to manuscripts published in non-PA-focused journals (r=0.19, p=0.021). Only 7 of 195 (4%) manuscripts reported all components of accelerometer use, and only 132 (68%) reported more than half of the components.ConclusionsAccelerometer reporting of PA in intervention studies has been poor and improved only minimally over time. We provide recommendations to improve accelerometer reporting and include a template to standardise reports.

ObjectiveTo evaluate extracorporeal shockwave therapy (ESWT) in treating Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT).DesignSystematic review.Eligibility criteriaRandomised and non-randomised studies assessing ESWT in patients with AT, GTPS, MTSS, PT and PHT were included. Risk of bias and quality of studies were evaluated.ResultsModerate-level evidence suggests (1) no difference between focused ESWT and placebo ESWT at short and mid-term in PT and (2) radial ESWT is superior to conservative treatment at short, mid and long term in PHT. Low-level evidence suggests that ESWT (1) is comparable to eccentric training, but superior to wait-and-see policy at 4 months in mid-portion AT; (2) is superior to eccentric training at 4 months in insertional AT; (3) less effective than corticosteroid injection at short term, but ESWT produced superior results at mid and long term in GTPS; (4) produced comparable results to control treatment at long term in GTPS; and (5) is superior to control conservative treatment at long term in PT. Regarding the rest of the results, there was only very low or no level of evidence. 13 studies showed high risk of bias largely due to methodology, blinding and reporting.ConclusionLow level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation.

ObjectivesTo assess if a multi-strategy intervention effectively increased weekly minutes of structured physical activity (PA) implemented by classroom teachers at 12 months and 18 months.MethodsA cluster randomised controlled trial with 61 primary schools in New South Wales Australia. The 12-month multi-strategy intervention included; centralised technical assistance, ongoing consultation, principal’s mandated change, identifying and preparing school champions, development of implementation plans, educational outreach visits and provision of educational materials. Control schools received usual support (guidelines for policy development via education department website and telephone support). Weekly minutes of structured PA implemented by classroom teachers (primary outcome) was measured via teacher completion of a daily log-book at baseline (October–December 2017), 12-month (October–December 2018) and 18-month (April–June 2019). Data were analysed using linear mixed effects regression models.ResultsOverall, 400 class teachers at baseline, 403 at 12 months follow-up and 391 at 18 months follow-up provided valid primary outcome data. From baseline to 12-month follow-up, teachers at intervention schools recorded a greater increase in weekly minutes of PA implemented than teachers assigned to the control schools by approximately 44.2 min (95% CI 32.8 to 55.7; p<0.001) which remained at 18 months, however, the effect size was smaller at 27.1 min (95% CI 15.5 to 38.6; p≤0.001).ConclusionA multi-strategy intervention increased mandatory PA policy implementation. Some, but not all of this improvement was maintained after implementation support concluded. Further research should assess the impact of scale-up strategies on the sustainability of PA policy implementation over longer time periods.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12617001265369).

Sierra Leone is the most severely affected country by an unprecedented outbreak of Ebola virus disease (EVD) in West Africa. Although successfully contained, the transmission dynamics of EVD and the impact of interventions in the country remain unclear. We established a database of confirmed and suspected EVD cases from May 2014 to September 2015 in Sierra Leone and mapped the spatiotemporal distribution of cases at the chiefdom level. A Poisson transmissionmodel revealed that the transmissibility at the chiefdom level, estimated as the average number of secondary infections caused by a patient per week, was reduced by 43% [95% confidence interval (CI): 30%, 52%] after October 2014, when the strategic plan of the United Nations Mission for Emergency Ebola Response was initiated, and by 65% (95% CI: 57%, 71%) after the end of December 2014, when 100% case isolation and safe burials were essentially achieved, both compared with before October 2014. Population density, proximity to Ebola treatment centers, cropland coverage, and atmospheric temperature were associated with EVD transmission. The household secondary attack rate (SAR) was estimated to be 0.059 (95% CI: 0.050, 0.070) for the overall outbreak. The household SAR was reduced by 82%, from 0.093 to 0.017, after the nationwide campaign to achieve 100% case isolation and safe burials had been conducted. This study provides a complete overview of the transmission dynamics of the 2014–2015 EVD outbreak in Sierra Leone at both chiefdom and household levels. The interventions implemented in Sierra Leone seem effective in containing the epidemic, particularly in interrupting household transmission.

This study addresses the persistent issue of stunted growth among children below the age of five in Aceh Province, Indonesia, despite the government’s ongoing efforts to combat it through various policies. Employing qualitative methods such as interviews, document analysis, and observations, the research explores the discrepancy between the intended policy framework and the on-ground implementation of interventions. While some indicators align with national targets, specific and sensitive intervention indicators often fall short, emphasizing the need for more focused and aligned efforts in policy implementation. The study underscores the urgency for stringent budgetary monitoring, increased collaboration among stakeholders, and a targeted approach to enhance the efficacy and coverage of stunting reduction programs in Aceh. Ultimately, it highlights the necessity for better policy alignment and implementation to mitigate the challenge of stunting among children in the province.

Social skills training (SST) programs for nonclinical children and adolescents are known to have positive effects on social skills, but it remains unclear how distinct training components are related to program effects. This multilevel meta-analysis examines how psychoeducation (i.e., exercises aimed at the transfer of knowledge), psychophysical components (i.e., physical exercises aimed at improving self-confidence and trust in others), skill-building components (i.e., exercises aimed at improving interpersonal skills), and cognitive-emotional components (i.e., exercises aimed at changing emotions and cognitions) are independently related to SST program effects. We extracted data from 97 articles describing 839 effect sizes. Training content data were extracted from 60 corresponding SST programs. Our results showed that SST programs had a positive effect on the development of interpersonal skills and emotional skills in nonclinical samples: d = .369, 95% CI [.292, .447], p < .001. This effect was positively influenced by the inclusion of psychoeducation and skill-building components. The inclusion of psychophysical components and the number of cognitive-emotional components did not influence program effects. For psychoeducation and skill-building components, we observed a curvilinear relationship between intensity and effect size: programs including three to six psychoeducational exercises yielded larger effect sizes compared to programs with more or fewer psychoeducational exercises, and programs with 11 to 20 skill-building exercises outperformed programs with more or fewer skill-building exercises. These findings are an indication that psychoeducational components and skill-building components are related to larger SST program effects, granted that the dosage is right.

Background Effective support interventions to manage the transition to home after stroke are still mostly unknown. Aim The purpose of this systematic review was to investigate the effectiveness of support interventions at transition from organised stroke services to independent living at home. Methods The Cochrane Central Register of Controlled Trials, six databases including MEDLINE and Embase, trial registries, grey literature, and Google Scholar were all searched, up to June 2021. We included randomised controlled trials enrolling people with stroke to receive either standard care or any type of support intervention from organised stroke services to home. The primary outcome was functional status. Two authors determined eligibility, extracted data, evaluated risk of bias (ROB2), and verified the evidence (GRADE). Where possible we performed meta-analyses using Risk Ratios (RR) or Mean Differences (MD). Results We included 17 studies. Support interventions led to important improvements in functional status, as determined by the Barthel Index up, to 3-months (MD 7.87 points, 95%CI:6.84 to 19.16; 620 participants; five studies; I 2  = 77%). Results showed modest but significant functional gains in the medium to long-term (6–12 month follow up, MD 2.91 points, 95%CI:0.03 to 5.81; 1207 participants; six studies; I 2  = 84%). Certainty of evidence was low. Support interventions may enhance quality of life for up to 3-months (MD 1.3,95% CI:0.84 to 1.76), and reduce depression (SMD -0.1,95% CI:-0.29 to − 0.05) and anxiety (MD -1.18,95% CI:-1.84 to − 0.52) at 6–12 months. Effects on further secondary outcomes are still unclear. Conclusions Incorporating support interventions as people who have experienced a stroke transition from hospital to home can improve functional status and other outcomes. Due to study heterogeneity, the essential components of effective transition of care interventions are still unknown. Adoption of core outcome sets in stroke research would allow for greater comparison across studies. Application of a development and evaluation framework engaging stakeholders would increase understanding of priorities for stroke survivors, and inform the key components of an intervention at transition from hospital-to-home. Trial registration CRD42021237397 - https://www.crd.york.ac.uk/prospero