Cargando…
Interventions to prevent and treat sarcopenia in a surgical population: a systematic review and meta-analysis
BACKGROUND: The aim of this systematic review was to summarize the results of trials evaluating interventions for the reduction of sarcopenia in patients undergoing surgery. METHODS: Searches were conducted using the Cochrane Central Register of Controlled Trials, MEDLINE and Embase. RCTs evaluating...
Autores principales: | , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226286/ https://www.ncbi.nlm.nih.gov/pubmed/34169312 http://dx.doi.org/10.1093/bjsopen/zraa069 |
_version_ | 1783712256942407680 |
---|---|
author | Tomassini, S Abbasciano, R Murphy, G J |
author_facet | Tomassini, S Abbasciano, R Murphy, G J |
author_sort | Tomassini, S |
collection | PubMed |
description | BACKGROUND: The aim of this systematic review was to summarize the results of trials evaluating interventions for the reduction of sarcopenia in patients undergoing surgery. METHODS: Searches were conducted using the Cochrane Central Register of Controlled Trials, MEDLINE and Embase. RCTs evaluating exercise, dietary or pharmacological interventions to address sarcopenia in the perioperative period were included. Treatment effect estimates were expressed as standardized mean differences (MDs) with confidence intervals, and heterogeneity was expressed as I(2) values. RESULTS: Seventy trials including 3402 participants were selected for the data synthesis. Exercise interventions significantly increased muscle mass (MD 0.62, 95 per cent c.i. 0.34 to 0.90; P < 0.001), muscle strength (MD 0.55, 0.39 to 0.71; P < 0.001), measures of gait speed (MD 0.42, 0.05 to 0.79; P = 0.03), and reduced time for completion of set exercises (MD −0.76, −1.12 to −0.40; P < 0.001) compared with controls. Subgroup analysis showed that interventions in the early postoperative period were more likely to have a positive effect on muscle mass (MD 0.71, 0.35 to 1.07; P < 0.001) and timed tests (MD −0.70, −1.10 to −0.30; P = 0.005) than preoperative interventions. Treatment effects on muscle mass (MD 0.09, −0.31 to 0.49; P = 0.66) and strength (MD 0.46, −0.01 to 0.92; P = 0.05) were attenuated by the presence of cancer. Results of analyses restricted to nine trials at low risk of allocation concealment bias and fourteen trials at low risk of attrition bias were comparable to those of the primary analysis. Risk-of-bias assessment showed that most trials were at high risk of incomplete outcome and attrition bias, thus reducing the estimate of certainty of the evidence according to the GRADE assessment tool. CONCLUSION: Exercise interventions appear beneficial in reducing the impact of sarcopenia. Because of the high risk of bias and low certainty of the current evidence, large RCTs using standardized measures of muscle mass should be undertaken. |
format | Online Article Text |
id | pubmed-8226286 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-82262862021-06-28 Interventions to prevent and treat sarcopenia in a surgical population: a systematic review and meta-analysis Tomassini, S Abbasciano, R Murphy, G J BJS Open Systematic Review BACKGROUND: The aim of this systematic review was to summarize the results of trials evaluating interventions for the reduction of sarcopenia in patients undergoing surgery. METHODS: Searches were conducted using the Cochrane Central Register of Controlled Trials, MEDLINE and Embase. RCTs evaluating exercise, dietary or pharmacological interventions to address sarcopenia in the perioperative period were included. Treatment effect estimates were expressed as standardized mean differences (MDs) with confidence intervals, and heterogeneity was expressed as I(2) values. RESULTS: Seventy trials including 3402 participants were selected for the data synthesis. Exercise interventions significantly increased muscle mass (MD 0.62, 95 per cent c.i. 0.34 to 0.90; P < 0.001), muscle strength (MD 0.55, 0.39 to 0.71; P < 0.001), measures of gait speed (MD 0.42, 0.05 to 0.79; P = 0.03), and reduced time for completion of set exercises (MD −0.76, −1.12 to −0.40; P < 0.001) compared with controls. Subgroup analysis showed that interventions in the early postoperative period were more likely to have a positive effect on muscle mass (MD 0.71, 0.35 to 1.07; P < 0.001) and timed tests (MD −0.70, −1.10 to −0.30; P = 0.005) than preoperative interventions. Treatment effects on muscle mass (MD 0.09, −0.31 to 0.49; P = 0.66) and strength (MD 0.46, −0.01 to 0.92; P = 0.05) were attenuated by the presence of cancer. Results of analyses restricted to nine trials at low risk of allocation concealment bias and fourteen trials at low risk of attrition bias were comparable to those of the primary analysis. Risk-of-bias assessment showed that most trials were at high risk of incomplete outcome and attrition bias, thus reducing the estimate of certainty of the evidence according to the GRADE assessment tool. CONCLUSION: Exercise interventions appear beneficial in reducing the impact of sarcopenia. Because of the high risk of bias and low certainty of the current evidence, large RCTs using standardized measures of muscle mass should be undertaken. Oxford University Press 2021-06-24 /pmc/articles/PMC8226286/ /pubmed/34169312 http://dx.doi.org/10.1093/bjsopen/zraa069 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Systematic Review Tomassini, S Abbasciano, R Murphy, G J Interventions to prevent and treat sarcopenia in a surgical population: a systematic review and meta-analysis |
title | Interventions to prevent and treat sarcopenia in a surgical population: a systematic review and meta-analysis |
title_full | Interventions to prevent and treat sarcopenia in a surgical population: a systematic review and meta-analysis |
title_fullStr | Interventions to prevent and treat sarcopenia in a surgical population: a systematic review and meta-analysis |
title_full_unstemmed | Interventions to prevent and treat sarcopenia in a surgical population: a systematic review and meta-analysis |
title_short | Interventions to prevent and treat sarcopenia in a surgical population: a systematic review and meta-analysis |
title_sort | interventions to prevent and treat sarcopenia in a surgical population: a systematic review and meta-analysis |
topic | Systematic Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226286/ https://www.ncbi.nlm.nih.gov/pubmed/34169312 http://dx.doi.org/10.1093/bjsopen/zraa069 |
work_keys_str_mv | AT tomassinis interventionstopreventandtreatsarcopeniainasurgicalpopulationasystematicreviewandmetaanalysis AT abbascianor interventionstopreventandtreatsarcopeniainasurgicalpopulationasystematicreviewandmetaanalysis AT murphygj interventionstopreventandtreatsarcopeniainasurgicalpopulationasystematicreviewandmetaanalysis |