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Rationale: Exercise interventions and policies are widely prescribed in both sport and healthcare. Research investigating exercise interventions and policies is generally conducted using an Evidence‐Based framework, placing an emphasis on evidence gathered from randomised controlled trials (RCTs). Aims and objectives: To explore the idea that, in addition to the assessment of evidence from RCTs when investigating exercise interventions, mechanistic studies ought to also be assessed and considered. Methods: This article assesses the rationale supporting the use of RCTs as evidence for exercise interventions, and the use of evidence of mechanisms in establishing efficacy, determining external validity, and tailoring interventions. Results and conclusions: The article argues that evidence from mechanistic studies ought to be considered alongside evidence from RCTs because: as RCTs investigating exercise interventions tend to be of low quality, mechanistic studies ought to be used to reinforce the evidence base; further, evidence from mechanistic studies is highly useful for both questions of extrapolation and implementation. This article argues for this on theoretical grounds, and also draws on a number of case studies. [ABSTRACT FROM AUTHOR]

Rationale: Evidence‐based medicine (EBM), the dominant approach to assessing the effectiveness of clinical and public health interventions, focuses on the results of association studies. EBM+ is a development of EBM that systematically considers mechanistic studies alongside association studies. Aims and objectives: To explore examples of the importance of mechanistic evidence to coronavirus research. Methods: We have reviewed the mechanistic evidence in four major areas that are relevant to the management of COVID‐19. Results and conclusions: (a) Assessment of combination therapy for MERS highlights the need for systematic assessment of mechanistic evidence. (b) That hypertension is a risk factor for severe disease in the case of SARS‐CoV‐2 suggests that altering hypertension treatment might alleviate disease, but the mechanisms are complex, and it is essential to consider and evaluate multiple mechanistic hypotheses. (c) Confidence that public health interventions will be effective requires a detailed assessment of social and psychological components of the mechanisms of their action, in addition to mechanisms of disease. (d) In particular, if vaccination programmes are to be effective, they must be carefully tailored to the social context; again, mechanistic evidence is crucial. We conclude that coronavirus research is best situated within the EBM+ evaluation framework. [ABSTRACT FROM AUTHOR]

Some philosophers have argued that evidence of underlying mechanisms does not provide evidence for the effectiveness of a medical intervention. One such argument appeals to the unreliability of mechanistic reasoning. However, mechanistic reasoning is not the only way that evidence of mechanisms might provide evidence of effectiveness. A more reliable type of reasoning may be distinguished by appealing to recent work on evidential pluralism in the epistemology of medicine. A case study from virology provides an example of this so‐called reinforced reasoning in medicine. It is argued that in this case study, the available evidence of underlying mechanisms did in fact play a role in providing evidence in favour of a medical intervention. This paper therefore adds a novel and recent case study to the literature in support of evidential pluralism in medicine. [ABSTRACT FROM AUTHOR]

Rationale: Exercise interventions and policies are widely prescribed in both sport and healthcare. Research investigating exercise interventions and policies is generally conducted using an Evidence-Based framework, placing an emphasis on evidence gathered from randomised controlled trials (RCTs)., Aims and Objectives: To explore the idea that, in addition to the assessment of evidence from RCTs when investigating exercise interventions, mechanistic studies ought to also be assessed and considered., Methods: This article assesses the rationale supporting the use of RCTs as evidence for exercise interventions, and the use of evidence of mechanisms in establishing efficacy, determining external validity, and tailoring interventions., Results and Conclusions: The article argues that evidence from mechanistic studies ought to be considered alongside evidence from RCTs because: as RCTs investigating exercise interventions tend to be of low quality, mechanistic studies ought to be used to reinforce the evidence base; further, evidence from mechanistic studies is highly useful for both questions of extrapolation and implementation. This article argues for this on theoretical grounds, and also draws on a number of case studies., (© 2022 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)