RATIONALE:The estimated global cost of inactivity is USD (US dollar) 53.8 billion. Exercise is a low-cost, effective, and accessible intervention that can reduce cardiovascular disease risk in sedentary populations. However, nearly one-third of adults do not meet the levels of physical activity recommended by the World Health Organization (WHO). WHO guidelines do not include advice for people who wish to undertake high-intensity interval training (HIIT), because it is unclear whether HIIT is an efficacious and acceptable method for sedentary populations to reduce their risk of cardiometabolic syndrome. As lack of time is the most frequently cited barrier to exercise, and HIIT requires a lower time commitment than moderate-intensity continuous training (MICT), this topic warrants a high-quality, non-biased exploration of the literature. OBJECTIVES:To assess the benefits and harms of high-intensity interval training (HIIT) on cardiometabolic health in healthy, sedentary adults. SEARCH METHODS:We searched CENTRAL, MEDLINE, Embase, Web of Science Core Collection (SCI-Expanded, SSCi, CPCI-S), and two trial registries up to 13 October 2025. ELIGIBILITY CRITERIA:We included randomised control trials (RCTs) that compared HIIT with a non-exercise control (comparison 1) or with MICT (comparison 2) over four weeks or longer in healthy adults (aged 18-64 years) who were sedentary at baseline. We excluded studies of athletes, as we were interested in the benefits of HIIT for public health, not for performance. We also excluded studies of people with overweight (body mass index (BMI) 25-29.9 kg/m²) or obesity (BMI ≥ 30 kg/m²) who were recruited as a result of a medical event or diagnosis. OUTCOMES:Our main outcomes were cardiorespiratory fitness (measured as maximum oxygen consumption (VO2max) or peak oxygen consumption), systolic blood pressure, waist circumference, waist-to-hip ratio, all-cause mortality, circulating triglycerides, and adverse events. RISK OF BIAS:We used the Cochrane risk of bias tool (Rob 2) to assess the risk of bias in the RCTs. SYNTHESIS METHODS:We synthesised results for each outcome using a random-effects meta-analysis. We used GRADE to assess the certainty of the evidence. INCLUDED STUDIES:Our review included 58 RCTs (2075 participants). Thirty-five studies evaluated HIIT versus MICT, and 11 evaluated HIIT versus no exercise. Twelve studies evaluated HIIT versus MICT versus another control (e.g. no exercise, walking); we included these studies in both comparisons in our review where possible. SYNTHESIS OF RESULTS:No studies reported all-cause mortality or adverse events. The certainty of the evidence was downgraded for inconsistency, imprecision, and risk of bias (mainly due to lack of detail on randomisation and no available protocol or trial registration). High-intensity interval training versus non-exercise control HIIT compared with a non-exercise control likely increases cardiorespiratory fitness measured with VO2max (mean difference (MD) 5.98 mL/min/kg, 95% confidence interval (CI) 4.66 to 7.30; 16 studies, 517 participants; moderate-certainty evidence) and reduces waist circumference (MD -3.56 cm, 95% CI -6.14 to -0.98; 8 studies, 270 participants; high-certainty evidence). HIIT compared with a non-exercise control likely results in little to no difference in waist-to-hip ratio (MD -0.01, 95% CI -0.03 to 0.01; 6 studies, 224 participants; moderate-certainty evidence) and may result in little to no difference in circulating triglycerides (standardised mean difference (SMD) -0.22, 95% CI -0.62 to 0.17; 9 studies, 262 participants; low-certainty evidence). The evidence for the effect of HIIT on systolic blood pressure is very uncertain (MD -5.22 mmHg, 95% CI -12.27 to 1.84; 7 studies, 215 participants; very low-certainty evidence). High-intensity interval training versus moderate-intensity continuous training HIIT may result in a slight increase in cardiorespiratory fitness (VO2max) compared with MICT (MD 1.39 mL/min/kg, 95% CI 0.44 to 2.34; 37 studies, 1115 participants; low-certainty evidence). HIIT compared with MICT likely results in little to no difference in waist circumference (MD 0.06 cm, 95% CI -1.49 to 1.62; 15 studies, 407 participants; moderate-certainty evidence) and waist-to-hip ratio (MD 0.00, 95% CI -0.01 to 0.02; 5 studies, 155 participants; moderate-certainty evidence). HIIT compared with MICT may result in little to no difference in systolic blood pressure (MD -0.56 mmHg, 95% CI -3.02 to 1.90; 18 studies, 515 participants; low-certainty evidence), and circulating triglycerides (SMD 0.00, 95% CI -0.28 to 0.27; 18 studies, 526 participants; low-certainty evidence). AUTHORS' CONCLUSIONS:Compared with a non-exercise control, HIIT likely increases cardiorespiratory fitness and reduces waist circumference slightly, but we found no clear difference for systolic blood pressure, waist-to-hip ratio, or circulating triglycerides. The certainty of the evidence is low for circulating triglycerides and very low for systolic blood pressure, precluding firm conclusions. Compared with MICT, HIIT may increase cardiorespiratory fitness slightly, but we found no clear difference for systolic blood pressure, waist circumference, waist-to-hip ratio, or circulating triglycerides. The certainty of the evidence is low for cardiorespiratory fitness, systolic blood pressure, and circulating triglycerides, precluding firm conclusions. No studies in either comparison reported all-cause mortality. There were no reports of adverse events, and we are unsure if the studies actively monitored for them. Our analysis included many studies, but all had relatively few participants. The evidence suggests that HIIT may be an effective alternative to MICT for sedentary populations at risk of cardiometabolic disease. There is a need for larger, higher-quality RCTs with longer follow-up to determine the long-term efficacy and effectiveness of HIIT. Future studies should investigate the feasibility and safety of unsupervised HIIT, as all studies included in this review examined supervised HIIT interventions. FUNDING:This Cochrane review was funded (in part) by the National Institute of Health Research (NIHR) and the Foreign, Commonwealth and Development Office (FCDO). REGISTRATION:The protocol for this Cochrane review was published in the Cochrane Library in May 2020 and is available via 10.1002/14651858.CD013617.
Hospital-at-home (HaH) is increasingly adopted to expand hospital capacity, however, data from Asian healthcare remain limited. The study compares cost, utilisation, and clinical outcomes of HaH program compared to traditional hospital care in Singapore. This prospective quasi-experimental study compared patients enrolled in the HaH programme with a comparator group of clinically eligible patients who received ward-based care because they lived outside the programme’s catchment area or when HaH capacity was full. Adults admitted to two hospitals within an academic health system between January 2021 and May 2023 screened for eligibility based on clinical, social and functional criteria. The primary outcome was cost per bed day, with secondary outcomes including total episode cost, clinical outcomes, and patient-reported measures. Inverse probability treatment weighting was applied to balance baseline confounders, and regression analyses were used to evaluate outcomes. Among 302 patients (151 HaH, 151 ward), HaH patients were older (mean [SD] age, 58 [21] vs 51 [21] years) with higher Charlson Comorbidity Index (3 [3] vs 2 [3]). The top three diagnoses were cellulitis (43.0
Introduction Randomised controlled trials (RCTs) investigate the safety and efficacy of interventions. It has become clear however that some RCTs include fabricated data. The INSPECT-SR tool assesses the trustworthiness of RCTs in systematic reviews of healthcare-related interventions. However, where individual participant data (IPD) can be obtained, a more thorough assessment of trustworthiness is possible. Consequently, INSPECT-SR recommends obtaining IPD to resolve uncertainties, though there is no consensus on appropriate methods for forensic analysis of raw data. Our aim is to evaluate IPD checks to establish which are worthwhile, and how they can be implemented in a new tool, INSPECT-IPD (Investigating Problematic Clinical Trials with Individual Participant Data). Methods and analysis Using international expert consensus and empirical evidence, the INSPECT-IPD tool will be developed using five stages: (1) compiling a list of IPD trustworthiness checks, (2) evaluating the usefulness and ease of interpretation of the checks when applying them to a collection of presumed authentic and fabricated IPD datasets, (3) a Delphi survey to determine which checks are supported by expert consensus, (4) a series of consensus meetings for selection of checks to be included in the draft tool and finally (5) prospective testing of the draft tool in: a) the production of systematic reviews, and b) the journal editorial process for RCT submissions, leading to refinement based on user feedback. Ethics and dissemination The University of Manchester ethics decision tool determined that ethical approval was not required (18 June 2024). This project includes secondary research and surveys of healthcare researchers on topics relating to their work. All results will be published as preprints and open-access articles, and the final tool will be freely available. ### Competing Interest Statement JW declares funding from NIHR for the INSPECT-SR (NIHR203568) and INSPECT-IPD projects (NIHR303741). He also declares statistics or methodological editor roles for BJOG, Cochrane Gynaecology and Fertility, Reproduction and Fertility, Journal of Hypertension. He performs integrity investigations for various journals and publishers. CH declares funding from NIHR for the INSPECT-IPD project (NIHR303741). NOC is a member of the Cochrane Central Editorial Board. Between 2020 and 2023 NOC was Co-ordinating Editor of the Cochrane Pain, Palliative and Supportive Care group, whose activities were funded by an infrastructure grant from the UK National Institute of Health and Care Research (NIHR). He has received funding from the Federal Ministry of Education and Research, Germany under the ERA-NET Neuron Co-Fund Scheme. MC is Co-ordinating Editor for the Journal of Evidence Based Medicine, JLL Library and Cochrane Methodology Review Group. He is one of the founding co-convenors of the Cochrane Individual Participant Data Meta-analysis (IPD MA) Methods Group and has worked on (and continues to work on) multiple IPD MA and randomised trials. VB is EiC for AJOG MFM, and associate editor for AJOG. LB is Senior Research Integrity Editor, Cochrane, for which she receives remuneration. ES is a Senior Editor of the Cochrane Database of Systematic Reviews. Previously, through March 2023, she was a Co-ordinating Editor of the Cochrane Injuries Group, whose activities were funded by an infrastructure grant from the UK NIHR. She contributed to the Cochrane Editorial Policy on Managing Potentially Problematic Studies. SL is an editor for the Cochrane Gynaecology and Fertility Group, Fertility and Sterility, Human Reproduction Open, and Trials. FN received funding from the French National Research Agency, the French ministry of health and the French ministry of research. He is a work package leader in the OSIRIS project (Open Science to Increase Reproducibility in Science grant agreement No. 101094725). He is also work package leader for the doctoral network MSCA-DN SHARE-CTD (HORIZON-MSCA-2022-DN-01 101120360), funded by the EU. He serves as an academic editor for PLOS One and as an associate editor for Fundamental and Clinical Pharmacology. AA is the trustworthiness editor for AJOG MFM. LP is on the Editorial Board for Journal of Clinical Epidemiology. Paul Bramley is an editor for the journal Anaesthesia. AL is on the editorial board of BMC Medical Ethics. Kylie E Hunter led development of the Individual Participant Data (IPD) Integrity Tool (12). Rui Wang is a Deputy Editor of Human Reproduction Update and Editorial Board Member of BJOG and Cochrane Gynaecology and Fertility Group. He is a co-author of the Individual Participant Data (IPD) Integrity Tool. He is supported by an NHMRC Emerging Leadership Investigator grant (2009767). MvW is Editor-in-Chief of Human Reproduction Update and senior Editor of the Cochrane Database of Systematic Reviews and Co-ordinating Editor of the Cochrane Gynaecology and Fertility Group and Sexually Transmitted Infections Group. BKR, MW, NJLB, EL, IH, EMB, SG, LG, GMK, BK, JAH declare no conflict of interest. ### Funding Statement This study was funded by NIHR Doctoral Research Fellowship (303741) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes See 'Open Sciences Practices' paragraph
RATIONALE:Preterm infants, often gavage-fed due to immaturity, may benefit from interventions that hasten the move to breastfeeding. Olfactory stimulation may increase appetite and speed up the transition to full oral feeding, potentially shortening hospital stay and improving outcomes for both infants and families. OBJECTIVES:To evaluate the benefits and harms of olfactory stimulation for reducing morbidity and promoting development in hospitalized preterm infants. SEARCH METHODS:We searched MEDLINE, Embase, CENTRAL, CINAHL, Epistemonikos, two trial registries, and conference abstracts up to 2 April 2025. We checked the reference lists of included studies and systematic reviews on olfactory or sensory stimulation. ELIGIBILITY CRITERIA:We included randomized controlled trials (RCTs) and quasi-RCTs evaluating olfactory stimulation with different odorants (maternal breast milk, food-associated odors, or non-food-associated odors) in preterm infants (born before 37 weeks' gestation). Eligible controls were no intervention, placebo, or standard care (considered together) or another odorant. We excluded studies combining olfactory stimulation with taste, as another review will focus on combined sensory stimulation. OUTCOMES:Our critical outcomes were apnea, intermittent hypoxemia, duration of hospital stay, time to full oral feeding, and exclusive breastfeeding. Our important outcomes included blindness and sensorineural deafness requiring amplification. RISK OF BIAS:We used the Cochrane risk of bias tool (RoB 2) to assess risk of bias in the included studies. SYNTHESIS METHODS:We conducted meta-analyses using fixed-effect models to calculate risk ratios (RRs) for dichotomous data and mean differences (MDs) for continuous data, each with its 95% confidence interval (CI). We assessed the certainty of evidence using GRADE. INCLUDED STUDIES:We included 14 trials enrolling 1087 neonates. The types of olfactory stimulation under investigation were maternal breast milk (9 studies); food-associated odors such as cinnamon, vanilla, or anise (5 studies); and non-food-associated odors such as rose or parents' scent (3 studies). Three studies evaluated two different odorants. Gestational age and bodyweight varied widely. The comparators were placebo, no intervention, and standard care. Eleven studies aimed to assess the effect of olfactory stimulation on infant feeding outcomes such as time to full oral feeding, weight gain, length of hospital stay, or a combination of these outcomes. Three studies aimed to assess the effect of olfactory stimulation on apnea prevention, oxygen saturation, or both. We identified five ongoing trials. SYNTHESIS OF RESULTS:No studies reported apnea as a dichotomous outcome, intermittent hypoxemia, exclusive breastfeeding, or major neurodevelopmental disability for any of the comparisons. We downgraded the certainty of evidence for limitations in study design, imprecision, and indirectness. Olfactory stimulation with maternal breast milk versus no intervention, placebo, or standard care The evidence is very uncertain about the effect of olfactory stimulation with maternal breast milk on the mean number of daily apnea episodes (MD -0.50, 95% CI -1.27 to 0.27; 1 study, 26 participants; very low-certainty evidence) and duration of hospital stay in days (MD -0.18, 95% CI -0.64 to 0.27; I² = 0%; 4 studies, 270 participants; very low-certainty evidence). Olfactory stimulation with maternal breast milk may result in a slight reduction in time to full oral feeding in days (MD -1.68, 95% CI -3.25 to -0.11; I² = 30%; 3 studies, 204 participants; low-certainty evidence). Olfactory stimulation with food-associated odors versus no intervention, placebo, or standard care Olfactory stimulation with food-associated odors may result in a slight reduction in the mean number of daily apnea episodes (MD -1.99, 95% CI -2.69 to -1.29; I² = 58%; 2 studies, 62 participants; low-certainty evidence). The evidence is very uncertain about the effect of olfactory stimulation with food-associated odors on duration of hospital stay in days (MD -2.65, 95% CI -6.18 to 0.89; I² = 20%; 3 studies, 185 participants; very low-certainty evidence) and time to full oral feeding in days (MD -2.06, 95% CI -5.16 to 1.04; I² = 36%; 3 studies, 185 participants; very low-certainty evidence). Olfactory stimulation with non-food-associated odors versus no intervention, placebo, or standard care Olfactory stimulation with non-food-associated odors may result in a slight reduction in duration of hospital stay in days (MD -3.23, 95% CI -5.50 to -0.97; I² = 0%; 2 studies, 94 participants; low-certainty evidence). The evidence is very uncertain about the effect of olfactory stimulation with non-food-associated odor on the mean number of daily apnea episodes (MD -2.13, 95% CI -2.28 to -1.98; 1 study, 60 participants; very low-certainty evidence) and time to full oral feeding (mean 21 (standard deviation 3.1) days in the intervention group and mean 21 (standard deviation 15.6) days in the control group; 1 study, 27 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS:Olfactory stimulation with maternal breast milk compared to no intervention, placebo, or standard care may result in a slight reduction in time to full oral feeding, but the evidence is very uncertain about its effect on frequency of apnea episodes and duration of hospital stay. Olfactory stimulation with food-associated odors compared to no intervention, placebo, or standard care may result in a slight reduction in frequency of apnea episodes, but the evidence is very uncertain about its effect on duration of hospital stay and time to full oral feeding. Olfactory stimulation with non-food-associated odors compared to no intervention, placebo, or standard care may result in a slight reduction in duration of hospital stay, but the evidence is very uncertain about its effect on frequency of apnea episodes and time to full oral feeding. Future studies should be more rigorous in their design, report using TIDieR (Template for Intervention Description and Replication) checklists, have larger sample sizes, and measure outcomes such as apnea (number of infants with ≥ 1 episode), intermittent hypoxemia (number of infants with ≥ 1 episode), exclusive breastfeeding, and major neurodevelopmental disabilities. FUNDING:Dedicated funding for this review can be found in the 'Sources of support' section. REGISTRATION:Protocol: https://doi.org/10.1002/14651858.CD016074.
OBJECTIVES:This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of cognitive-behavioural therapy for the management of subacute and chronic NP in adults.
