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      Effects of Combined Exercise and Low Carbohydrate Ketogenic Diet Interventions on Waist Circumference and Triglycerides in Overweight and Obese Individuals: A Systematic Review and Meta-Analysis

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          Abstract

          (1) Background: The purpose of this meta-analysis was to investigate the effects of combined exercise and low carbohydrate ketogenic diet interventions (CELCKD) for overweight and obese individuals. (2) Methods: Relevant studies were searched by using the MEDLINE and EMBASE databases up to October 2020. Study Inclusion and Exclusion Criteria: Inclusion criteria were reporting effects of the CELCKD for overweight and obese individuals from randomized controlled trials. Studies that did not match the inclusion criteria were excluded. The methods for CELCKD and outcomes of selected studies were extracted. The effect sizes for interventions that included cardiorespiratory fitness, body composition, fasting glucose, and lipid profiles were calculated by using the standardized mean difference statistic. (3) Results: A total of seven studies and 278 overweight and obese individuals were included. The average intervention of selected studies consisted of moderate to vigorous intensity, 4 times per week for 9.2 weeks. Participating in CELCKD interventions was decreased triglycerides ( d = −0.34, CI; −0.68–−0.01, p = 0.04) and waist circumference ( d = −0.74, 95% confidence interval [CI]; −1.28–−1.20, p = 0.01), while cardiovascular fitness, body composition, fasting glucose, total cholesterol, high density lipoprotein (HDL) cholesterol, and low density lipoprotein (LDL) cholesterol were not statistically different after the interventions. No adverse side effects were reported. (4) Conclusions: Participation in interventions by overweight and obese individuals had beneficial effects including decreased waist circumference and triglycerides. Longer term intervention studies with homogenous control groups may be needed.

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          The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

          Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate
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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.

            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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              The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

              Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement-a reporting guideline published in 1999-there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (www.prisma-statement.org) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                19 January 2021
                January 2021
                : 18
                : 2
                : 828
                Affiliations
                [1 ]Graduate School of Education, Chung-Ang University, Seoul 06974, Korea; hslee@ 123456cau.ac.kr
                [2 ]Sports Medicine and Science, Global Campus, Kyung Hee University, Seoul 17104, Korea
                Author notes
                [* ]Correspondence: jalee@ 123456khu.ac.kr ; Tel.: +82(31)-201-2738
                Author information
                https://orcid.org/0000-0003-3901-3311
                https://orcid.org/0000-0002-9221-0405
                Article
                ijerph-18-00828
                10.3390/ijerph18020828
                7835865
                33478022
                4a83cfe8-293b-4a75-9f1c-f27dbd2f5294
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 26 November 2020
                : 11 January 2021
                Categories
                Review

                Public health
                exercise,ketogenic diet,obesity,meta-analysis
                Public health
                exercise, ketogenic diet, obesity, meta-analysis

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