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This prospectively registered systematic review and meta-analysis examines whether exercise (EX) training has an additive effect to osteoanabolic and/or antiresorptive pharmacological therapy (PT) in people with osteoporosis on bone mineral density (BMD), bone turnover markers (BTMs), fracture healing, and fractures. Four databases (inception to 6 May 2022), 5 trial registries, and reference lists were searched. Included were randomized controlled trials comparing the effect of EX + PT vs. PT with regard to BMD, BTM, fracture healing, and fractures. Risk of bias was assessed using the Cochrane RoB2 and certainty of evidence by the GRADE approach. Random-effects meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustment was used to estimate standardized mean differences and 95% confidence intervals. Out of 2593 records, five RCTs with 530 participants were included. Meta-analysis showed with very low certainty evidence and wide confidence intervals that EX + PT compared to PT had larger effect sizes for BMD at 12 months at the hip (SMD [95%CI]: 0.18 [− 1.71; 2.06], n = 3 studies), tibia (0.25 [− 4.85; 5.34], n = 2), lumbar spine (0.20 [− 1.15; 1.55], n = 4), and forearm (0.05 [− 0.35; 0.46], n = 3), but not femoral neck (− 0.03 [− 1.80; 1.75], n = 3). Furthermore, no improvement was revealed for BTM such as bone ALP (− 0.68 [− 5.88; 4.53], n = 3), PINP (− 0.74 [− 10.42; 8.93], n = 2), and CTX-I (− 0.69 [− 9.61; 8.23], n = 2), but with very wide confidence intervals. Three potentially relevant ongoing trials were identified via registries. No data were found for fracture healing or fracture outcomes. It remains unclear whether EX has an additive impact to PT in people with osteoporosis. High-quality, adequately powered, targetted RCTs are required. Protocol Registration: PROSPERO CRD42022336132. [ABSTRACT FROM AUTHOR]

Low back pain is a leading cause of disability worldwide and adults with chronic low back pain (≥12weeks) commonly experience sleep impairments (e.g., insomnia, sleep disturbance). This study examined the effects of non-pharmacological interventions on sleep in adults with chronic low back pain. Six databases (PubMed, CINAHL, SPORTDiscus, PsycINFO, EMBASE, CENTRAL) were searched from inception to 2 June 2021 for randomised controlled trials. Pairwise random-effect meta-analysis estimated standardised mean difference (Hedges' g) at end-of-intervention follow-up. Nineteen studies (participants: 1348) were included. When compared to control, non-pharmacological interventions improved sleep (g [95%CI]: −0.33 [-0.56, −0.11], p = 0.004, small effect, I2 = 59.3%; n = 879; studies: n = 13; GRADE: low). This small improvement in sleep was associated with a moderate reduction in pain intensity (−0.69 [-1.00, −0.38], p < 0.001, I2 = 75.3%; n = 812; studies: n = 12; GRADE: very low) and no changes in back-related disability (−0.50 [-1.13, 0.14], p = 0.129, I2 = 91.4%; n = 517; studies: n = 6; GRADE: low). Notably, all eligible studies reported interventions primarily aimed to reduce pain, although our search criteria were not limited to pain interventions. Key limitations were data paucity and high risk of bias. Future research should investigate sleep-based interventions (i.e., those purposely designed to improve sleep) using subjective and objective measures across a range of sleep domains (CRD42021275227). [ABSTRACT FROM AUTHOR]

Unpaid caregivers often experience sleep impairments as an unintended consequence of providing care. This systematic review and meta-analysis investigated the efficacy of interventions to improve sleep in unpaid caregivers. Six databases were searched from journal inception to 7-Sep-2021 to identify randomised controlled trials. Random-effects meta-analyses estimated mean differences (MD) at end-of-intervention. Twenty-one studies were identified (15 eligible for meta-analysis). Compared to control, interventions improved sleep quality (Pittsburgh Sleep Quality Index; 12 studies, 1153 participants, MD = −1.66, 95% CI [−2.91, −0.41], p = 0.009, I 2 = 90.51%, GRADE = low), and total sleep time (hours; two studies, 122 participants, MD = 0.45, 95% CI [0.42, 0.48], p = 0.003, I 2 = 0.00%, GRADE = low), but not sleeping problems (sleep item on Symptom Distress Scale of the Omega Screening Questionnaire; two studies, 529 participants, MD = −0.06, 95% CI [−0.69, 0.58], p = 0.458, I 2 = 0.01%, GRADE = low). There is low quality evidence that interventions improve sleep quality in unpaid caregivers compared to control. Limitations include the lack of evidence for specific intervention modes and limited use of objective sleep measures. Future research should explore potential effect modifiers such as care recipient condition (CRD42021278670). [ABSTRACT FROM AUTHOR]