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How many steps a day to reduce the risk of all-cause mortality? A dose-response meta-analysis Dear Editor, Free, accessible, and without requiring high levels of fitness, special skills, or equipment, walking is the most popular physical activity worldwide [1].Step counts are easily measured and interpreted, which makes them an ideal candidate for interventions, clinical advice, and public health guidelines. Several studies, including a recent meta-analysis [2], have found a consistent inverse relationship between steps and all-cause mortality. While existing studies assume a linear relationship between step counts and mortality [2], evidence implies that the relationship could be nonlinear [3]. Considering that the shape of the relationship and the "optimal dose" remained unknown, we conducted a dose-response meta-analysis between daily step counts and all-cause mortality.

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OBJECTIVE We aimed to examine the dose-response associations between the number of steps per day and all-cause mortality among adults with prediabetes and diabetes. RESEARCH DESIGN AND METHODS This prospective study used data from 1,194 U.S. adults with prediabetes and 493 with diabetes for whom accelerometer-derived steps per day could be retrieved. Mortality was ascertained through the National Death Index (February 25, 2019). Splines were used to assess the dose-response associations between steps per day and all-cause mortality. RESULTS Over ∼9 years of follow-up, 200 adults with prediabetes and 138 with diabetes died. Nonlinear associations akin to an L shape were observed. We estimated an optimal dose of ∼10,000 steps per day to reduce the risk of all-cause mortality for both individuals with prediabetes and those with diabetes. CONCLUSIONS Accumulating more steps per day up to ∼10,000 steps per day may lower the risk of all-cause mortality of adults with prediabetes and diabetes.

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El objetivo de este estudio fue conocer qué investigaciones de carácter longitudinal se han llevado a cabo que hayan analizado variables relacionadas con el sobrepeso, la obesidad y el sedentarismo en edad escolar, y qué datos se pueden extraer de las mismas. Se revisaron las siguientes bases de datos: MEDLINE (PubMed), Scopus, SportDiscus y WOS (Web of Science). Dicha revisión fue realizada siguiendo el modelo PICOs, y a partir de él, se constituyó el protocolo de búsqueda utilizando términos que definan o representen a niños y jóvenes en edad escolar, que puedan presentar o no sobrepeso u obesidad y sedentarismo. Siguiendo el procedimiento Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), de los 2237 estudios encontrados tan solo 28 cumplieron todos los criterios, por lo que fueron analizados en su totalidad para poder ser incluidos en la revisión. La calidad metodológica de los estudios se evaluó mediante la escala Newcastle-Otawa. De los 28 estudios seleccionados finalmente, 13 tenían una calidad metodológica buena, mientras que los 15 restantes tenían una calidad aceptable. Tras realizar la revisión, se puede concluir que el sedentarismo se ve aumentado paulatinamente con la edad mientras que la actividad física decrece, y consecuentemente, esta situación hace que el sobrepeso y la obesidad se vean incrementadas.  Abstract: The objective of this study was to find out what longitudinal researches have been carried out that have analyzed variables related to overweight, obesity and sedentary lifestyle in school age, and what data can be extracted from them. A systematic review of the MEDLINE (PubMed), Scopus, SportDiscus and WOS (Web of Science) databases was carried out following the PICOs model, using terms that define or represent children and young people of school age, who may or may not be overweight or obese. Following the PRISMA procedure, of the 2237 studies found only 28 met all the criteria and were therefore analyzed in their entirety for inclusion in the review. The methodological quality of the studies was assessed using the Newcastle-Otawa scale. Of the 28 studies finally selected, 13 were of good methodological quality, while the remaining 15 were of acceptable quality. After review was conducted, it can be concluded that sedentary lifestyle is gradually increased with age while physical activity decreases, and consequently, this situation causes overweight and obesity increase.

ObjectiveTo identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults.DesignSystematic review and Bayesian model-based network meta-analysis.Data sourcesFour databases were searched from inception to 20 June 2022.Eligibility criteria for selecting studiesRandomised controlled trials that assessed the effectiveness of a physical activity-based intervention on at least one functional outcome in people aged ≥50 years hospitalised due to an acute medical condition were included. Pooled effect estimates (ie, standardised mean differences for functional capacity and the ratio of means for adverse events) were calculated using random treatment effects network meta-analysis models.ResultsNineteen studies (3842 participants) met the inclusion criteria. Approximately 100 Metabolic Equivalents of Task per day (METs-min/day) (~40 min/day of light effort or ~25 min/day of moderate effort activities) was the minimal dose to improve the functional capacity of acute hospitalised older adults (standardised mean difference (SMD)=0.28, 95% credible interval (CrI) 0.01 to 0.55). The optimal dose was estimated at 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72). Ambulation was deemed the most efficient intervention, and the optimal dose was reached at 143 METs-min/day (~50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16), showing a high evidential power (87.68%). The minimal effective ambulation dose was estimated at 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41). Physical activity interventions resulted in a decrease in the rate of adverse events compared with usual care at discharge (ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days).ConclusionsThis meta-analysis yielded low to moderate evidence supporting the use of in-hospital supervised physical activity programmes in acutely hospitalised older adults. As little as ~25 min/day of slow-paced walking is sufficient to improve functional capacity and minimise adverse events in this population.Trial registration numberPROSPERO CRD42021271999.

BackgroundThe long-term impact of cancer treatment is associated with respiratory dysfunction and physical fitness impairment. Although inspiratory muscle training (IMT) has been shown as an effective exercise therapy in cancer survivors, there is no evidence on the optimal dose, application moment nor specific population effects of this intervention. The main objective of this meta-analysis is to analyse the effects of IMT on pulmonary function, physical fitness and quality of life (QoL) in cancer survivors.MethodsThis systematic review and meta-analysis was preregistered in the International Prospective Register of Systematic Reviews (PROSPERO) register and conducted according to the Preferred Reporting for Systematic Reviews and Meta-analysis statement. We used a Bayesian multilevel random-effects meta-analysis model to pool the data. Multilevel metaregression models were used to examine the conditional effects of our covariates. Convergence and model fit were evaluated through specific model parameters. Sensitivity analyses removing influential cases and using a frequentist approach were carried out.ResultsPooled data showed that IMT intervention is effective to improve pulmonary function (standardised mean difference=0.53, 95% credible interval 0.13 to 0.94, SE=0.19). However, IMT did not present statistically significant results on physical fitness and QoL. Metaregression analyses found that the type of cancer, the moment of application and the evaluation tool used had significant moderation effects on pulmonary function.ConclusionIMT could be an important part in the management of side effects suffered by cancer survivors. Considering the current evidence, this intervention is highly recommended in patients diagnosed with oesophageal and lung cancers. IMT may provide superior benefits before the biological treatment and after the surgery.PROSPERO registration number304909.