Sowalertrat, Walit

Abstract Background: The relationships between exercise timing and health outcomes including anthropometric indices, metabolic markers, and sleep health have not been clearly established. To gain better insights, we performed the meta-analysis to determine the effects of morning versus evening exercise on various health outcomes. Methods: We collected studies from MEDLINE, EMBASE, and Cochrane databases from inception to March 2023 to perform a meta-analysis. Exercise is defined as performing activity at least moderate intensity. For the outcomes of interest, the mean differences (MD) were employed using a random-effects model, the generic inverse variance method of DerSimonian and Laird. Results: A total of 716 patients were analyzed from 14 studies including randomized controlled trial and observational studies. We found no significant associations between exercise timing and several health-related parameters. Specifically, the data showed no notable differences in body weight (MD: -0.12 kg [95% CI −0.81 to 0.58]) and BMI (MD: -0.07 kg/m2 [95% CI −0.46 to 0.32]) when comparing morning and evening exercise sessions. Similarly, sleep latency was not significantly affected by exercise timing (MD: -2.24 minutes [95% CI −5.83 to 1.35]). Furthermore, changes in metabolic biomarkers, including LDL (MD: -6.64 mg/dL [95% CI −20.08 to 6.79]) and HDL (MD: 0.09 mg/dL [95% CI 0 to 0.17]), were not significantly associated with the timing of exercise. Conclusion: This meta-analysis found no significant relationship between exercise timing and health outcomes including anthropometric indices, metabolic markers, and sleep health. While considered as hypothesis generating, timing of exercise should equally prune patients’ health outcomes.

AbstractBackgroundLeft bundle branch area pacing (LBBAP) has recently become a promising option for the near‐natural restoration of electrical activation. However, the clinical relevance of therapeutic effects in individuals with heart failure with reduced ejection fraction (HFrEF) and dyssynchrony remains unknown.MethodsMEDLINE, EMBASE, and Cochrane databases were searched from inception until June 2022. Data from each study was combined using a random‐effects model, the generic inverse variance method of DerSimonian and Laird, to calculate standard mean differences and pooled incidence ratio, with 95% confidence intervals (CIs).ResultsA total of 772 HFrEF patients were analyzed from 15 observational studies per protocol. The success rate of LBBAP implantation was 94.8% (95% CI 89.9–99.6, I2 = 79.4%), which was strongly correlated with shortening QRS duration after LBBAP implantation, with a mean difference of −48.10 ms (95% CI −60.16 to −36.05, I2 = 96.7%). Over a period of 6–12 months of follow‐up, pacing parameters were stable over time. There were significant improvements in left ventricular ejection fraction (LVEF), left ventricular end‐systolic volume (LVESV), left ventricular end‐diastolic diameter (LVEDD), and left ventricular end‐diastolic volume (LVEDV) with mean difference of 16.38% (95% CI 13.13–19.63, I2 = 90.2%), −46.23 ml (95% CI −63.17 to −29.29, I2 = 86.82%), −7.21 mm (95% CI −9.71 to −4.71, I2 = 84.6%), and −44.52 ml (95% CI −64.40 to −24.64, I2 = 85.9%), respectively.ConclusionsLBBAP was associated with improvements in both cardiac function and electrical synchrony. The benefits of LBBAP in individuals with HFrEF and dyssynchrony should be further validated by randomized studies.

Background: Left bundle branch area pacing (LBBAP) has recently become a promising option for the near-natural restoration of electrical activation. However, the clinical relevance of therapeutic effects in individuals with heart failure with reduced ejection fraction (HFrEF) and dyssynchrony remains unknown. Methods & Results: MEDLINE, EMBASE, and Cochrane databases were searched from inception until June 2022. Data from each study was combined using a random-effects model, the generic inverse variance method of DerSimonian and Laird, to calculate standard mean differences and pooled incidence ratio, with 95% confidence intervals (CI). A total of 772 HFrEF patients were analyzed from 15 observational studies per protocol. The success rate of LBBAP implantation was 94.8% (95% CI 89.9 to 99.6, I 2 = 79.4%), which was strongly correlated with shortening QRS duration after LBBAP implantation, with a mean difference of −48.10 msec (95% CI −60.16 to −36.05, I 2 = 96.7%). Over a period of 6–12 months of follow-up, pacing parameters were stable over time. There were significant improvements in left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-diastolic volume (LVEDV) with mean difference of 16.38% (95% CI 13.13 to 19.63 I 2 = 90.2 %), −46.23 mL (95% CI −63.17 to −29.29, I 2 = 86.82%), −7.21 mm (95% CI −9.71 to −4.71, I 2 = 84.6%), and −44.52 mL (95% CI −64.40 to −24.64, I 2 = 85.9 %), respectively . Conclusions: LBBAP was associated with improvements in both cardiac function and electrical synchrony. The benefits of LBBAP in individuals with HFrEF and dyssynchrony should be further validated by randomized studies.