Evidence synthesis research: Applications on Physical Activity and Public Health

• Autores: Daniel Gallardo Gómez
• Directores de la Tesis: Jesús del Pozo Cruz (dir. tes.), Borja del Pozo Cruz (dir. tes.)
• Lectura: En la Universidad de Sevilla ( España ) en 2024
• Idioma: inglés
• Número de páginas: 212
• Enlaces
  • Tesis en acceso abierto en: Idus
• Resumen

  • Evidence synthesis methods (i.e., a part of Health Technology Assessment) can help to determine how effective a particular treatment or drug is, or how people have experienced a particular health condition or treatment. Although these methods have been widely used in medical and social sciences, several procedures can be optimized. This research has investigated the quantitative (statistical) and clinical implications of different evidence synthesis procedures, and aimed to elaborate useful resources for researchers who want to conduct a quantitative evidence synthesis. A fundamental part of this work is the implementation of these methods in Physical Activity and Public Health. Physical activity and exercise are outstanding tools to face some of the most pressing global health concerns of the 21st century, such as mental disorders (e.g., schizophrenia) and conditions (e.g., dementia), and noncommunicable diseases (e.g., type 2 diabetes mellitus). Capitalising in evidence synthesis methods, this research has also investigated the effectiveness of physical activity and exercise on health parameters (e.g., cognitive function, or functional capacity) in specific populations. The methodological work of this research clarifies some key points in evidence synthesis. It was concluded that studies should provide details about the methods used in their syntheses to promote replicability and transparency, since different standardisation and re-expression methods yielded different results. The use of a single scale standard deviation reference for data standardisation was determined to be the less arbitrary procedure in meta-analysis. Also, an important part in evidence synthesis is the re-expression of the effect of a treatment/intervention into scale-specific units to ease the interpretation of a health technology by healthcare professionals who are less familiar with statistics. Physical activity and exercise have demonstrated effectiveness in various health conditions. Clinicians and decision-makers should consider exercise as part of the clinical care pathway of people with schizophrenia, showing effectiveness on negative symptoms (e.g., apathy, or depressive symptoms), and other outcomes. More complex evidence synthesis methods (e.g., dose-response meta-analysis) were applied to provide recommendations with minimum and optimal doses (i.e., energy expenditure) for different types of exercise in older adults, people with diabetes, and acutely hospitalised older adults. In older adults, 170 minutes per week of moderate intensity activity was associated with benefits in the global cognitive function. In people with type 2 diabetes, more physical activity than the currently recommended by the World Health Organization guidelines was deemed necessary to control their glycosylated hemoglobin. These people should do approximately 250 minutes per week of moderate-intensity aerobic physical activity, or 160 minutes per week of vigorous-intensity aerobic physical activity to optimize their glucose levels. In hospital settings, healthcare practitioners should encourage older adults to move, at least, 25 minutes a day of slow walking, and preferably, 50 minutes a day. This information combined with economic, and feasibility assessments, aids policy- and decision-makers to evaluate key dimensions of the implementation of a health technology such as physical activity/exercise programmes in an optimal way.