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Trials with different times of exercise exposure were included in order to compare, in a subgroup analysis, the results of brief programs (eight weeks or less) against longer programs (more than eight weeks). We defined the threshold as eight weeks because programs of at least this duration could have positive and chronic effects on the cardiovascular system. Shorter programs may have acute but not durable effects ( Kelley 2005 ; Thomas 2006 ).

People who:

were 18 years of age or older;

had a 10-year Framingham risk score equal to or greater than 10% over 10 years, or for whom it was possible to calculate the average 10-year Framingham risk score with data from the aggregated published data. In trials where such data were insufficient, alternative inclusion criteria were having two or more cardiovascular risk factors;

did not have a history of cardiovascular events (acute myocardial infarction or stroke).

Exercise interventions were defined as predetermined programs of planned, structured, and repetitive physical activity performed regularly. Exercise could be aerobic or resistance training.

Aerobic exercise is defined as any activity that uses large muscle groups, can be maintained continuously, and is rhythmic in nature. Resistance training is defined as any exercise that causes the muscles to contract against an external resistance with the expectation of increases in strength, tone, mass, or endurance.

The exercise prescriptions included specific recommendations for the type, intensity, frequency, and duration of physical activity with specific fitness or health objectives. Studies involving dietary or medication changes were eligible for inclusion only if the same treatments were applied to both the intervention and control groups.

The review included studies involving the following comparisons:

exercice intervention versus no exercise (control);

exercise and diet versus diet alone;

exercise and medication versus medication alone;

exercise and any other intervention versus that intervention alone.

All-cause mortality and CVD-related mortality

Incidence of acute myocardial infarction

Incidence of stroke

Total CVD risk (difference of changes in the 10-year Framingham score or any other validated score)

Total cholesterol

HDL and LDL cholesterol

Blood pressure

Body mass index (BMI)

Smoking cessation

Exercise capacity (VO 2 max, calories,or meters in six minutes walking test)

Quality of life (Short Form-36 (SF-36) questionnaire or others)

Adverse events

We conducted a systematic search for RCTs in electronic databases (from their inception to the latest available entry date) on 26 November 2013:

Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 10 of 12) in The Cochrane Library ;

MEDLINE (Ovid) (1946 to week 2 November 2013);

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Article Text

Obstetrics and gynaecology
Research
Providing immediate neonatal care and resuscitation at birth beside the mother: clinicians’ views, a qualitative study

Objectives The aims of this study were to assess clinicians’ views and experiences of providing immediate neonatal care at birth beside the mother, and of using a mobile trolley designed to facilitate this bedside care.

Design Qualitative interview study with semistructured interviews.

Results The results were analysed using thematic analysis.

Setting A large UK maternity unit.

Participants Clinicians (n=20) from a range of disciplines who were present when the trolley was used to provide neonatal care at birth at the bedside. Five clinicians provided/observed advanced resuscitation by the bedside.

Results Five themes were identified: (1) Parents’ involvement, which included ‘Contact and involvement’, ‘Positive emotions for parents’ and ‘Staff communication’; (2) Reservations about neonatal care at birth beside the mother, which included ‘Impact on clinicians’ and ‘Impact on parents’; (3) Practical challenges in providing neonatal care at the bedside, which included ‘Cord length’ and ‘Caesarean section’; (4) Comparison of the trolley with usual resuscitation equipment and (5) Training and integration of bedside care into clinical routine, which included ‘Teething problems’ and ‘Training’.

Conclusions Overall, most clinicians were positive about providing immediate neonatal care at the maternal bedside, particularly in terms of the clinicians’ perceptions of the parents’ experience. Clinicians also perceived that their close proximity to parents improved communication. However, there was some concern about performing more intensive interventions in front of parents. Providing immediate neonatal care and resuscitation at the bedside requires staff training and support.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

http://dx.doi.org/10.1136/bmjopen-2015-008494

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Strengths and limitations of this study

This is the first in-depth study of clinicians’ experiences of immediate newborn care and resuscitation at the maternal bedside. Use of in-depth qualitative methods allowed a detailed exploration of these experiences.

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