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      Effectiveness and safety of structured exercise vs. no exercise for asymptomatic aortic aneurysm: systematic review and meta-analysis Translated title: Efetividade e segurança de exercícios estruturados versus sem exercício em pacientes assintomáticos com aneurisma de aorta: revisão sistemática e metanálise

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          Abstract

          We conducted a systematic review to compare the effectiveness and safety of exercise versus no exercise for patients with asymptomatic aortic aneurysm. We followed the guidelines set out in the Cochrane systematic review handbook. We searched Medline, Embase, CENTRAL, LILACS, PeDRO, CINAHL, clinicaltrials.gov, ICTRP, and OpenGrey using the MeSH terms “aortic aneurysm” and “exercise”. 1189 references were identified. Five clinical trials were included. No exercise-related deaths or aortic ruptures occurred in these trials. Exercise did not reduce the aneurysm expansion rate at 12 weeks to 12 months (mean difference [MD], −0.05; 95% confidence interval [CI], −0.13 to 0.03). Six weeks of preoperative exercise reduced severe renal and cardiac complications (risk ratio, 0.54; 95% CI, 0.31–0.93) and the length of intensive care unit stay (MD, −1.00; 95% CI, −1.26 to −0.74). Preoperative and postoperative forward walking reduced the length of hospital stay (MD, −0.69; 95% CI, −1.24 to −0.14). The evidence was graded as ‘very low’ level.

          Resumo

          Foi realizada revisão sistemática para comparar a efetividade e a segurança de exercícios versus não exercícios em pacientes assintomáticos com aneurisma de aorta. Usamos os termos MeSH aortic aneurysm e exercise para as bases MEDLINE, Embase, CENTRAL, LILACS, PeDRO, CINAHL, clinicaltrials.gov, International Clinical Trials Registry Platform (ICTRP) e OpenGrey. Foram obtidas 1.189 referências. Cinco ensaios clínicos foram incluídos. Não houve morte ou rotura associada ao exercício. Além disso, este não reduziu a velocidade de crescimento do aneurisma em 12 semanas a 12 meses [diferença de médias (DM) −0,05; intervalo de confiança de 95% (IC95%) −0,13 a 0,03]. Seis semanas de exercícios pré-operatórios reduziram complicações clínicas renais e cardíacas (razão de risco 0,54; IC95% 0,31–0,93) e a permanência em unidade de terapia intensiva (DM −1,00; IC95% −1,26 a −0,74). Caminhadas nos períodos pré e pós-operatório reduziram a permanência hospitalar. A evidência foi classificada como de muito baixa qualidade.

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          Rayyan—a web and mobile app for systematic reviews

          Mourad Ouzzani, Hossam Hammady, Zbys Fedorowicz … (2017)
          Background Synthesis of multiple randomized controlled trials (RCTs) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions. Filtering of searches is time consuming, and no single method fulfills the principal requirements of speed with accuracy. Automation of systematic reviews is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making. We developed Rayyan (http://rayyan.qcri.org), a free web and mobile app, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. For the beta testing phase, we used two published Cochrane reviews in which included studies had been selected manually. Their searches, with 1030 records and 273 records, were uploaded to Rayyan. Different features of Rayyan were tested using these two reviews. We also conducted a survey of Rayyan’s users and collected feedback through a built-in feature. Results Pilot testing of Rayyan focused on usability, accuracy against manual methods, and the added value of the prediction feature. The “taster” review (273 records) allowed a quick overview of Rayyan for early comments on usability. The second review (1030 records) required several iterations to identify the previously identified 11 trials. The “suggestions” and “hints,” based on the “prediction model,” appeared as testing progressed beyond five included studies. Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements. The survey respondents reported 40% average time savings when using Rayyan compared to others tools, with 34% of the respondents reporting more than 50% time savings. In addition, around 75% of the respondents mentioned that screening and labeling studies as well as collaborating on reviews to be the two most important features of Rayyan. As of November 2016, Rayyan users exceed 2000 from over 60 countries conducting hundreds of reviews totaling more than 1.6M citations. Feedback from users, obtained mostly through the app web site and a recent survey, has highlighted the ease in exploration of searches, the time saved, and simplicity in sharing and comparing include-exclude decisions. The strongest features of the app, identified and reported in user feedback, were its ability to help in screening and collaboration as well as the time savings it affords to users. Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of reviewers.
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            Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

            David Moher, Alessandro Liberati, Jennifer Tetzlaff … (2010)
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              American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.

              Carol Ewing Garber, Bryan Blissmer, Michael R. Deschenes … (2011)
              The purpose of this Position Stand is to provide guidance to professionals who counsel and prescribe individualized exercise to apparently healthy adults of all ages. These recommendations also may apply to adults with certain chronic diseases or disabilities, when appropriately evaluated and advised by a health professional. This document supersedes the 1998 American College of Sports Medicine (ACSM) Position Stand, "The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults." The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults. The ACSM recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for ≥30 min·d on ≥5 d·wk for a total of ≥150 min·wk, vigorous-intensity cardiorespiratory exercise training for ≥20 min·d on ≥3 d·wk (≥75 min·wk), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of ≥500-1000 MET·min·wk. On 2-3 d·wk, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle-tendon groups (a total of 60 s per exercise) on ≥2 d·wk is recommended. The exercise program should be modified according to an individual's habitual physical activity, physical function, health status, exercise responses, and stated goals. Adults who are unable or unwilling to meet the exercise targets outlined here still can benefit from engaging in amounts of exercise less than recommended. In addition to exercising regularly, there are health benefits in concurrently reducing total time engaged in sedentary pursuits and also by interspersing frequent, short bouts of standing and physical activity between periods of sedentary activity, even in physically active adults. Behaviorally based exercise interventions, the use of behavior change strategies, supervision by an experienced fitness instructor, and exercise that is pleasant and enjoyable can improve adoption and adherence to prescribed exercise programs. Educating adults about and screening for signs and symptoms of CHD and gradual progression of exercise intensity and volume may reduce the risks of exercise. Consultations with a medical professional and diagnostic exercise testing for CHD are useful when clinically indicated but are not recommended for universal screening to enhance the safety of exercise.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Vasc Bras
                Journal ID (iso-abbrev): J Vasc Bras
                Journal ID (publisher-id): jvb
                Title: Jornal Vascular Brasileiro
                Publisher: Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)
                ISSN (Print): 1677-5449
                ISSN (Electronic): 1677-7301
                Publication date (Electronic, pub): 08 May 2020
                Publication date (Electronic, collection): 2020
                Volume: 19
                Electronic Location Identifier: e20190086
                Affiliations
                [1 ] originalUniversidade Federal de Uberlândia – UFU, Departamento de Cirurgia, Uberlândia, MG, Brasil.
                [2 ] originalUniversidade Federal de São Paulo – UNIFESP, Departamento de Medicina, São Paulo, SP, Brasil.
                Author notes

                Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

                Correspondence Vladimir Tonello de Vasconcelos Universidade Federal de São Paulo – UNIFESP, Departamento de Medicina Rua Borges Lagoa, 754 CEP 04038-001 - São Paulo (SP), Brasil Tel.: +55 (11) 5576-4848 E-mail: vtvascon@ 123456hotmail.com

                Author information RAO -Professor, Vascular Surgery, Universidade Federal de Uberlândia; post-graduation student, Universidade Federal de São Paulo (UNIFESP). EN - Cardiologist, post-graduation student, Universidade Federal de São Paulo (UNIFESP). VTV and JCCBS - Professor, Vascular Surgery, Universidade Federal de São Paulo (UNIFESP). RR - Professor, Evidence Based Medicine, Universidade Federal de São Paulo (UNIFESP).

                Author contributions Conception and design: RAO, RR, JCCBS Analysis and interpretation: RAO, EN, VTV, RR, JCCBS Data collection: RAO, EN, VTV Writing the article: RAO, VTV, RR, JCCBS Critical revision of the article: RAO, VTV, RR, JCCBS Final approval of the article*: RAO, EN, VTV, RR, JCCBS Statistical analysis: RAO, VTV, RR, JCCBS Overall responsibility: RAO, EN, VTV, RR, JCCBS *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

                Author information
                http://orcid.org/0000-0002-9469-9291
                http://orcid.org/0000-0002-3868-9507
                http://orcid.org/0000-0002-8305-6522
                http://orcid.org/0000-0002-9522-1871
                http://orcid.org/0000-0002-7617-0167
                Article
                Publisher ID: jvbAR20190086 Other ID: 00403
                DOI: 10.1590/1677-5449.190086
                PMC ID: 8202166
                SO-VID: b55863ca-e9f1-431b-8d09-e0a34211066c
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 August 2019
                Date accepted : 01 October 2019
                Page count
                Figures: 5, Tables: 8, Equations: 0, References: 50
                Categories
                Subject: Review Article

                Keywords: aortic aneurysm,abdominal aortic aneurysm,exercise,postoperative complications,aneurismas de aorta,aneurismas de aorta abdominal,exercícios,complicações pós-operatórias
                Data availability:
                Keywords: aortic aneurysm, abdominal aortic aneurysm, exercise, postoperative complications, aneurismas de aorta, aneurismas de aorta abdominal, exercícios, complicações pós-operatórias

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