title: Exercise versus no exercise for the occurrence, severity and duration of acute respiratory infections.
abstract: BACKGROUND
  Acute respiratory infections (ARIs) last for less than 30 days and are the most common acute diseases affecting people worldwide. Exercise has been shown to improve health generally and may be effective in reducing the occurrence, severity and duration of acute respiratory infections.
  
  
  OBJECTIVE
  To evaluate the effectiveness of exercise for altering the occurrence, severity or duration of acute respiratory infections.
  
  
  METHODS
  We searched CENTRAL (2014, Issue 6), MEDLINE (1948 to July week 1, 2014), EMBASE (2010 to July 2014), CINAHL (1981 to July 2014), LILACS (1982 to July 2014), SPORTDiscus (1985 to July 2014), PEDro (searched on 11 July 2014), OTseeker (searched on 11 July 2014), the WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (searched on 11 July 2014).
  
  
  METHODS
  Randomised controlled trials (RCTs) and quasi-RCTs of exercise for ARIs in the general population.
  
  
  METHODS
  Two review authors independently extracted data from the included trials using a standard form. We contacted trial authors to request missing data. One review author entered data and a second review author checked this. There were sufficient differences in the populations trialled and in the nature of the interventions to use the random-effects model (which makes fewer assumptions than the fixed-effect model) in the analysis.
  
  
  RESULTS
  We included 11 trials involving 904 adults, published between 1990 and 2014. Eight studies were conducted in the USA, and one each in Canada, Spain and Turkey. Sample sizes ranged from 20 to 154 participants aged between 18 and 85 years old. The proportion of female participants varied between 52% and 100%. The duration of follow-up in the studies varied from seven days to 12 months. The exercise type most prescribed for the intervention was aerobic (walking in 70% of the studies, or bicycle riding or treadmill) at least five times a week. Duration was 30 to 45 minutes at moderate intensity. Participants were supervised in 90% of the studies.For four of the primary outcomes the results did not differ significantly and all were low-quality evidence (number of ARI episodes per person per year, rate ratio 0.91 (95% confidence interval (CI) 0.59 to 1.42); proportion of participants who experienced at least one ARI over the study period, risk ratio 0.76 (95% CI 0.57 to 1.01); severity of ARI symptoms, mean difference (MD) -110 (95% CI -324 to 104); and number of symptom days in the follow-up period, MD -2.1 days (95% CI -4.4 to 0.3)). However, one primary outcome, the number of symptom days per episode of illness, was reduced in those participants who exercised (MD -1.1 day, 95% CI -1.7 to -0.5, moderate-quality evidence).We found no significant differences for the secondary outcomes (laboratory parameters (blood lymphocytes, salivary secretory immunoglobulin and neutrophils); quality of life outcomes; cost-effectiveness and exercise-related injuries).There was good adherence to the intervention with no difference between the exercise and non-exercise groups.We rated the quality of evidence for the primary outcomes as low for most outcomes using the GRADE criteria: allocation concealment was not reported and there was a lack of blinding; in addition, there was imprecision (the CI is very wide because of a small number of participants) and inconsistency, which may be due to differences in study design.
  
  
  CONCLUSIONS
  We cannot determine whether exercise is effective at altering the occurrence, severity or duration of acute respiratory infections. One analysis of four trials suggests that the number of days of illness per episode of infection might be reduced by exercise. The small size of the studies, risk of bias and heterogeneous populations trialled all contribute to the uncertainty. Larger studies, with less risk of bias from patient selection, blinding of outcomes assessors, reporting of all outcomes measured and with registration of study protocols, are required to settle the question.
authors.affiliation: Laboratory of Evidence-Based Practice, Universidade do Extremo Sul Catarinense, Av. Universitária, 1105, Predio S, LABEPI, Criciuma, Santa Catarina, Brazil, 88806-000.
authors.forename: Antonio Jose
authors.initials: AJ
authors.lastname: Grande
authors.forename: Justin
authors.initials: J
authors.lastname: Keogh
authors.forename: Tammy C
authors.initials: TC
authors.lastname: Hoffmann
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Beller
authors.forename: Chris B
authors.initials: CB
authors.lastname: Del Mar
mesh_terms: D000208:Acute Disease; D001642:Bicycling; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D016138:Walking