title: Eccentric exercise in adults with cardiorespiratory disease: a systematic review.
abstract: OBJECTIVE
  To determine if eccentric exercise is effective, tolerable and safe for adults with chronic cardiorespiratory disease.
  
  
  METHODS
  We searched electronic databases from inception until January 2015 (Medline, CINAHL, Embase, SportDiscus, PEDro, Cochrane Central and AMED) supplemented by citation tracking and reference list scanning.
  
  
  METHODS
  Included articles had to report effects of eccentric exercise, alone or as a primary component of intervention, of any intensity and duration, on adults with chronic cardiorespiratory disease. Trials needed to be reported as full text in a peer-reviewed journal and include control data (randomised, quasi-randomised and single group cross-over design trials). Any outcomes or comparison interventions were accepted. Methodological rigor was assessed using the PEDro scale.
  
  
  RESULTS
  Of 22 potentially relevant articles, 10 met inclusion criteria. They reported results from seven trials with a total of 112 participants across the diseases. PEDro scores were low (median 3). Eccentric exercise increased strength and mobility to comparable levels as concentric exercise, however, it did so with lower oxygen consumption (effect size as large as d = -3.07 (-4.12, -1.80)), and four-fold power output (effect size d = -3.60 (-5.03, -1.66)). There were no adverse events reported for eccentric exercise. Pain was avoided with familiarisation sessions and individual exercise prescription.
  
  
  CONCLUSIONS
  Eccentric exercise is beneficial and at least comparable with traditional exercise in improving walking and strength for people with chronic cardiorespiratory disease. It was well tolerated and we identified no safety concerns for the use of this intervention for this population.
authors.affiliation: Physiotherapy, Northern Health, Epping, Australia rachel.ellis2@nh.org.au.
authors.forename: Rachel
authors.initials: R
authors.lastname: Ellis
authors.affiliation: Department of Physiotherapy, La Trobe University, Melbourne, Australia Allied Health, Northern Health, Epping, Australia.
authors.forename: Nora
authors.initials: N
authors.lastname: Shields
authors.affiliation: Medicine, Northern Health, Epping, Australia.
authors.forename: Kwang
authors.initials: K
authors.lastname: Lim
authors.affiliation: Department of Physiotherapy, La Trobe University, Melbourne, Australia.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Dodd
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D006333:Heart Failure / Q000534:rehabilitation*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*
keywords: Eccentric exercise; chronic heart failure; chronic obstructive pulmonary disease (COPD); coronary artery disease; systematic review