Physical Activity Guidelines Advisory Committee Report
Part F. Appendix F.1: Phase 2 Literature Review
Literature reviews for Phase 2 were conducted based on additional
requests from members of the Federal Advisory Committee. The following
describes the process used to support the abstraction of articles from the
Phase 2 literature searches.
Staffing
Staffing in Phase 2 was less than in Phase 1. The life-stage approach to
staffing teams was abandoned and replaced with a Centers for Disease Control
and Prevention (CDC) Physical Activity Guidelines Advisory Committee (PAGAC)
subcommittee liaison system. Because the PAGAC adopted the conceptual framework
and divided into 10 subcommittees (all-cause mortality, cardiorespiratory
health, metabolic health, energy balance, musculoskeletal health, functional
health, cancer, mental health, adverse events, and youth) the CDC and PAGAC
decided that a staff member from CDC would be assigned to support each
subcommittee in addressing questions about the literature search and the CDC
database. This support would include initiating additional literature
reviews.
Abstractor Training: Phase 2 "Booster"
Sessions
The CDC internal team held the first "booster" training session before
the beginning of Phase 2 abstractions. This mandatory session was offered to
those 24 abstractors who were the most accurate and productive from Phase 1.
The purpose of this training session was to provide additional training on the
essential abstraction components to improve the accuracy of the
abstractions.
The first Phase 2 booster session was co-taught by three CDC team
members. Immediately after the session, abstractors were sent two scientific
articles to abstract to become recertified. Only 8 of 24 abstractors passed
recertification. Given the 33% pass rate, the CDC team decided that an
additional training session was needed.
Of the 16 abstractors who did not pass recertification, 13 attended the
second booster training session. An additional training session (at three times
throughout the day) was offered and each session was co-taught by CDC staff.
Again, after the training, abstractors were sent two scientific papers to
abstract. Once the abstraction was approved by the quality control team, the
abstractor could begin abstracting. Of the initial 24 abstractors who entered
Phase 2, 19 abstractors passed recertification training.
Additional Research Questions for Phase
2
Again, the literature search for Phase 2 was guided by members of the
PAGAC. The additional research questions from each subcommittee are provided
below.
All Cause Mortality
The All-cause Mortality subcommittee had no additional research
questions.
Cardiorespiratory Health
During Phase 2, an additional search for subclinical outcomes was
conducted, yielding 206 papers. Inclusion criteria from the subcommittee chair,
William Kraus, were to include a study design of a randomized control trial
with 25 or more participants per arm or a prospective cohort study with at
least 2,000 participants. Using these inclusion criteria, 4 of the 206 papers
collected were abstracted.
For peripheral arterial disease, a consultant (Brian Duscha) for the
cardiovascular subcommittee identified two papers on this health outcome. One
paper was published in the "out of date range" (published in 1993), and the
other paper (Gardner et al.) was abstracted.
Musculoskeletal Health
Phase 2 additional research questions were the following:
Bone Questions
- Is there evidence that physical activity reduces the incidence of
osteoporotic fractures?
- Is there evidence that fracture incidence is influenced by the
type or dose (intensity, frequency, duration) of physical activity?
- Is there evidence that physical activity reduces the incidence
of osteoporotic fractures in women and men?
- Is there evidence that physical activity reduces risk for
osteoporosis by increasing, or slowing the decline, in bone mineral density
(BMD) or bone mineral content (BMC)?
- Is there evidence for benefits of physical activity on BMD or
BMC in children/adolescents, adults, postmenopausal women or elderly men?
- Is there evidence that BMD and BMC are influenced by the type or
dose (intensity, frequency, duration) of physical activity?
Joint Questions
- Is there evidence that physical activity reduces or increases the
incidence of osteoarthritis (OA)?
- Is there evidence that physical activity is harmful or beneficial
for adults with OA or other rheumatic conditions?
Muscle Questions
- Is there evidence that physical activity preserves muscle
quantity?
- Is there evidence that muscle mass is influenced by the type or
dose of physical activity?
- Is there evidence that physical activity preserves muscle
quantity in women and men?
- Is there evidence that physical activity preserves muscle quality
(defined by force production characteristics and by metabolic
characteristics)?
A search initiated by the Musculoskeletal subcommittee search was
conducted. No systematic review was conducted by CDC. The purpose of this
search was to identify studies that formed a narrative discussion about
physical activity and muscle fitness benefits.
Metabolic Health
For Phase 2 additional research questions, the Metabolic Health
subcommittee abstracted articles on two additional outcomes: (1)
insulin/glucose and (2) gestational diabetes. No further searches that resulted
in additional abstractions were done for this group.
Cancer
For Phase 1, the Cancer subcommittee ended up having 16 additional Phase
1 papers identified and abstracted. Twenty-nine papers were identified for
Phase 2; of those, 6 were excluded and 7 were already in the database, leaving
16 additional papers that were identified, abstracted, and included.
Phase 2 searches examined the effects of physical activity in cancer
survivors with respect to fatigue, lymphedema, strength, flexibility, and body
mass index.
Fatigue
- 4 identified, 2 excluded, 2 abstracted
Lymphedema
- 4 identified, 1 excluded, 1 duplicate, 2 abstracted
Strength/flexibility
- 7 identified, 1 excluded, 6 abstracted
Body mass index
- 16 identified, 3 excluded, 5 abstracted, 7 already abstracted, 1
duplicate
Functional Health
The Functional Health subcommittee had no additional research questions
during Phase 2.
Energy Balance
The Energy Balance subcommittee had no additional research questions
during Phase 2.
Mental Health
The Mental Health subcommittee had no additional research questions
during Phase 2.
Youth
For Phase 2, the Youth subcommittee conducted additional literature
searches on the following health outcomes: cardiorespiratory fitness, bone
density, muscle strength, metabolic syndrome or its components (e.g.,
hypertension, blood lipids), body composition, depression, anxiety, and
self-concept.
Adverse Events
For Phase 2, the Adverse Events subcommittee had two additional outcomes
abstracted: (1) health care cost/medical expenditures and (2) upper respiratory
tract infection. No further searches that resulted in additional abstractions
were done for this group.
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