Wellness Check: Exercise

2 Minute Medicine is pleased to announce that we are launching Wellness Check, a new series dedicated to exploring new research evidence focused on wellness. Each week, we will report on articles examining different aspects of wellness, including (but not limited to) nutrition, sleep, reproductive health, substance use and mental health. This week, we explore the latest evidence-based updates in exercise. 

Exercise and dance may reduce cravings associated with methamphetamine abuse in women

1. In this randomized controlled trial, dance and exercise interventions reduced subjective drug cravings compared to the control group.

2. Compared to the control group, the dance and exercise interventions showed a stronger preference for non-drug rewards (high calorie foods).

Evidence Rating Level: 2 (Good)

Methamphetamine is a popular drug used among women for its particular effect on weight loss and in controlling symptoms of depression. Currently, no approved drug exists to control methamphetamine use disorder. Though traditional exercise has been known to reduce drug abuse, dancing is being increasingly used as an intervention for its unique ability to incorporate rhythmic motor coordination, emotion and social interaction. Therefore, the purpose of this study was to investigate the effects of moderate-intensity dance and aerobic exercise on drug craving, prefrontal neural activation to food cues, appetite, and food reward in women with methamphetamine dependence.

From 120 assessed women individuals, 39 were included and were randomized to either the dance group (35-minute dance) (n=20) or exercise group (35-minute treadmill) (n=19), which were counterbalanced to a control (reading control session). Participants were recruited from the Drug Rehabilitation Bureau of the Mo Ganshan in Zheijiang, China and were eligible if they met criteria for methamphetamine dependence, did not exercise regularly and did not receive detoxification treatment for more than 3 months. Both the dance and exercise groups performed the intervention for 25 minutes at a similar heart rate. Study outcomes were assessed using various tools to measure feelings of appetite, drug craving and prefrontal cortical activity.

In this study, results showed that in comparison to the control group, both interventions reduced subjective drug cravings and increased preferences for high-calorie foods. Those who performed moderate exercise additionally showed a greater activation in the left dorsolateral prefrontal cortex when viewing high calorie foods compared to control. This study was limited by the inability to maintain a consistent heart rate during dancing as opposed to the treadmill. Nonetheless, these results highlight the potential therapeutic utility of exercise interventions for methamphetamine dependence.

Initial therapy with non-pharmacological agents may be preferable for lower back pain

1. Among non-pharmacological interventions; pain and disability reduction were best achieved by manual therapy, heat wrap, and exercise at immediate (<1 week) follow-up.

2. Among pharmacological findings, pain and disability reduction were best achieved by non-steroidal anti-inflammatory (NSAID) medications and muscle relaxants at immediate-term follow-up.

Evidence Rating Level: 1 (Excellent)

Non-specific low back pain (NS-LBP) is a prevalent condition that places a huge morbidity burden on society. Though most guidelines agree on the first line of care during an acute episode (reassurance, advice, encouragement to engage in light activity), the relative effects of second line options are uncertain. Consequently, the present study sought to determine the efficacy of available treatments on pain and disability outcomes in those suffering from NS-LBP.

From 6779 identified articles, 46 trials were included (8765 participants) since the inception date up to October 2020. To be eligible, studies needed to study various pharmacological and non-pharmacological interventions on disability and pain intensity in patients experiencing NS-LBP less than 6 weeks (acute) or 6-12 weeks (subacute). Risk of bias was assessed using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Study outcomes assessed pain intensity and disability, as well as occurrence of adverse events.

Results demonstrated that among non-pharmacological interventions; pain and disability reduction were best achieved by manual therapy, heat wrap and exercise at immediate (<1 week) follow-up. Among pharmacological interventions, pain and disability reduction were best achieved by non-steroidal anti-inflammatory (NSAID) medications and muscle relaxants at immediate-term follow-up. Mild or moderate adverse events were reported in patients treated with steroids, NSAIDs, or opioids.  This study was limited by the discrepancies in classification systems which have changed with time which may have influenced treatment guidelines. However, given that this Is the largest network meta-analysis to date on the topic, the present study paves the way for future research questions to be answered in the treatment of NS-LBP.

Increased cardiorespiratory fitness may lower high blood pressure in children

1. Higher cardiorespiratory fitness was associated with a decreased probability of high blood pressure, lowered insulin resistance and improved liver function in children with excess adiposity

2. Irrespective of adiposity status, higher cardiorespiratory fitness decreased blood pressure and increased kidney function

Evidence Rating Level: 2 (Good)

Children with high blood pressure (HBP) are more likely to experience cardiovascular disease compared to normotensive controls. Unlike in adults, there currently exists low quality evidence surrounding the relationship of cardiorespiratory fitness (CRF) and lowering HBP. As a result, the present study sought to evaluate the relationship between CRF with blood pressure status in children with normal adiposity and excessive adiposity (NA and EA).

This cross-sectional cohort study included 211 children (7-10 yrs old; EA=39, NA=172) from the Arkansas Active Kids (AAK) study. 69% of children in the EA group had HBP compared to 24% in the NA group. Children were excluded if they had severe persistent asthma, metabolic/endocrine diseases, were on hormonal replacement therapy, cancer, autoimmune diseases or bleeding disorders. Children attended a one visit study where clinical markers (plasma lipids, estimated glomerular filtration rate, alanine aminotransferase, and insulin resistance) were obtained. Study outcomes assessed the relationship between CRF and blood pressure, cardiovascular disease risk factors, and kidney function. CRF was measured using a pediatric cycle ergometer and body composition was measured using dual-energy x-ray absorptiometry.

Results showed that for children with EA, higher CRF was protective against HBP, insulin resistance and liver injury. In addition, children with NA and EA both experienced improved blood pressure percentiles and kidney function with higher CRF. This study was limited by the cross-sectional design which may have overestimated blood pressure in certain cases. However, given that this study assessed blood pressure using the most updated guidelines, the present findings suggest that greater emphasis could be placed in increasing CRF in children where HBP is a concern.

Higher proportions time spent in physical activity decreased all-cause mortality

1. In this compositional analysis, results suggested that in a 24hr period, replacing sedentary time with physical activity of any intensity was associated with decreased all-cause mortality.

2. The results of this study did not find any clear indication that time spent asleep was associated with all-cause mortality.

Evidence Rating Level: 1 (Excellent)

There is currently a lack of evidence on the joint association of physical activity, sedentary activity and sleep with health outcomes. Given that there are only 24 hours in a day, there is a lack of data surrounding how to best utilize those hours with the aforementioned behaviors to optimize health. As a result, the purpose of the present study was to perform a federated pooled analysis of prospective cohorts to investigate the influence of time spent in each behavior on all-cause mortality.

The present pooled compositional analysis included 6 English prospective studies (130 239 participants) from database inception until February 2018. Studies were included if they examined the influence of time spent engaging in sedentary behavior (SD), low intensity physical exercise (LIPA) and moderate to vigorous exercise (MVPA) using a body sensor on all-cause mortality using Cox regression analysis. The study analysis was conducted according to Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Day composition was defined as the amount of time spent in MVPA, LIPA, SB and sleep.

Results showed that day compositions with higher MVPA were associated with a lower risk of all-cause mortality. Higher LIPA and lower sedentary time was also associated with a lower risk of all-cause mortality, specifically in studies which examined this relationship using a hip accelerometer. Interestingly, there was no clear indication that time spent asleep was associated with all-cause mortality. This study was limited by the lack of adjustment for several confounders such as body mass index and fitness levels. However, the study’s compositional analysis design ensured that the interaction between all variables were properly accounted for.

Image: PD

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