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      Influence of exercise type and duration on cardiorespiratory fitness and muscular strength in post-menopausal women: a systematic review and meta-analysis

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          Abstract

          Background and aim

          Both cardiorespiratory fitness (CRF) and muscular strength are reported to decrease with age and menopause, which considered to be risk for cardiovascular diseases (CVDs). Previous relevant meta-analyses are inconclusive on the beneficial effects of exercise, particularly in post-menopausal women. In this systematic review and meta-analysis, we investigated the effects of exercise modalities on CRF and muscular strength in post-menopausal women, and identified the effective exercise type and duration.

          Methods

          A comprehensive search was conducted on PubMed, Web of Science, CINAHL, and Medline to identify the randomized controlled trials, which evaluated exercise effect on CRF, lower- and upper-body muscular strength, and/or handgrip strength in post-menopausal women and compared the results with control. Standardized mean differences (SMD), weighted mean differences (WMD), and 95% confidence intervals (95% CIs) were calculated using random effects models.

          Results

          A total of 129 studies comprising 7,141 post-menopausal women with mean age and BMI ranging from ∼53 to 90 years and 22 to 35 kg/m 2, respectively, were included in the meta-analysis. Overall, exercise training effectively increased CRF (SMD: 1.15; 95% CI: 0.87, 1.42; p = 0.001), lower-body muscular strength (SMD: 1.06; 95% CI: 0.90, 1.22; p = 0.001), upper-body muscular strength (SMD: 1.11; 95% CI: 0.91, 1.31; p = 0.001), and handgrip strength (WMD: 1.78 kg; 95% CI: 1.24, 2.32; p = 0.001) in post-menopausal women. These increments were found to be irrespective of ages and intervention durations. Regarding exercise type, aerobic, resistance, and combined training significantly increased CRF and lower-body muscular strength, while resistance and combined training effectively increased handgrip strength. However, only resistance training increased the upper-body muscular strength in women.

          Conclusion

          Our findings suggest that exercise training is effective in increasing CRF and muscular strength in post-menopausal women, which might be cardioprotective. Both aerobic and resistance training alone or in combination increased CRF and lower-body muscular strength, but only resistance training increased upper-body strength in women.

          Systematic Review Registration

          https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=283425, identifier: CRD42021283425.

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          Most cited references60

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          Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range

          Background In systematic reviews and meta-analysis, researchers often pool the results of the sample mean and standard deviation from a set of similar clinical trials. A number of the trials, however, reported the study using the median, the minimum and maximum values, and/or the first and third quartiles. Hence, in order to combine results, one may have to estimate the sample mean and standard deviation for such trials. Methods In this paper, we propose to improve the existing literature in several directions. First, we show that the sample standard deviation estimation in Hozo et al.’s method (BMC Med Res Methodol 5:13, 2005) has some serious limitations and is always less satisfactory in practice. Inspired by this, we propose a new estimation method by incorporating the sample size. Second, we systematically study the sample mean and standard deviation estimation problem under several other interesting settings where the interquartile range is also available for the trials. Results We demonstrate the performance of the proposed methods through simulation studies for the three frequently encountered scenarios, respectively. For the first two scenarios, our method greatly improves existing methods and provides a nearly unbiased estimate of the true sample standard deviation for normal data and a slightly biased estimate for skewed data. For the third scenario, our method still performs very well for both normal data and skewed data. Furthermore, we compare the estimators of the sample mean and standard deviation under all three scenarios and present some suggestions on which scenario is preferred in real-world applications. Conclusions In this paper, we discuss different approximation methods in the estimation of the sample mean and standard deviation and propose some new estimation methods to improve the existing literature. We conclude our work with a summary table (an Excel spread sheet including all formulas) that serves as a comprehensive guidance for performing meta-analysis in different situations. Electronic supplementary material The online version of this article (doi:10.1186/1471-2288-14-135) contains supplementary material, which is available to authorized users.
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            Cochrane Handbook for Systematic Reviews of Interventions

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              Estimating the mean and variance from the median, range, and the size of a sample

              Background Usually the researchers performing meta-analysis of continuous outcomes from clinical trials need their mean value and the variance (or standard deviation) in order to pool data. However, sometimes the published reports of clinical trials only report the median, range and the size of the trial. Methods In this article we use simple and elementary inequalities and approximations in order to estimate the mean and the variance for such trials. Our estimation is distribution-free, i.e., it makes no assumption on the distribution of the underlying data. Results We found two simple formulas that estimate the mean using the values of the median (m), low and high end of the range (a and b, respectively), and n (the sample size). Using simulations, we show that median can be used to estimate mean when the sample size is larger than 25. For smaller samples our new formula, devised in this paper, should be used. We also estimated the variance of an unknown sample using the median, low and high end of the range, and the sample size. Our estimate is performing as the best estimate in our simulations for very small samples (n ≤ 15). For moderately sized samples (15 70), the formula range/6 gives the best estimator for the standard deviation (variance). We also include an illustrative example of the potential value of our method using reports from the Cochrane review on the role of erythropoietin in anemia due to malignancy. Conclusion Using these formulas, we hope to help meta-analysts use clinical trials in their analysis even when not all of the information is available and/or reported.
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                Author and article information

                Contributors
                Journal
                Front Cardiovasc Med
                Front Cardiovasc Med
                Front. Cardiovasc. Med.
                Frontiers in Cardiovascular Medicine
                Frontiers Media S.A.
                2297-055X
                09 May 2023
                2023
                : 10
                : 1190187
                Affiliations
                [ 1 ]Department of Physical Education and Sport Sciences, Faculty of Humanities, University of Kashan , Kashan, Iran
                [ 2 ]Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan , Guilan, Iran
                [ 3 ]Department of Exercise Physiology and Corrective Exercises, Faculty of Sport Sciences, Urmia University , Urmia, Iran
                [ 4 ]Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas , Las Vegas, NV, United States
                [ 5 ]Department of Emergency, Jinhua Guangfu Oncology Hospital , Jinhua, China
                [ 6 ]Institute of Human Movement and Sports Engineering, College of Physical Education and Health Sciences, Zhejiang Normal University , Jinhua, China
                Author notes

                Edited by: Guido Iaccarino, University of Naples Federico II, Italy

                Reviewed by: Olga Scudiero, University of Naples Federico II, Italy Ting-Heng Chou, Nationwide Children's Hospital, United States

                Article
                10.3389/fcvm.2023.1190187
                10204927
                37229231
                81d3d4b6-0605-4236-8aa3-b7fd38ce9600
                © 2023 Khalafi, Sakhaei, Habibi Maleki, Rosenkranz, Pourvaghar, Fang and Korivi.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 20 March 2023
                : 21 April 2023
                Page count
                Figures: 5, Tables: 0, Equations: 0, References: 63, Pages: 0, Words: 0
                Funding
                Funded by: Science and Technology Research Plan/Public Health and Reproductive Health
                Award ID: 2021-4-228
                This study was supported by the Public Welfare Project of Jinhua City, Science and Technology Research Plan/Public Health and Reproductive Health, and the grant number is 2021-4-228.
                Categories
                Cardiovascular Medicine
                Systematic Review
                Custom metadata
                General Cardiovascular Medicine

                aerobic training,resistance training,cardiorespiratory fitness,muscular strength,postmenopausal women

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