Table 3.
Quality of evidence GRADE of included studies [29].
| No. of Studies | Study Design | Risk of Bias | Inconsistency | Indirect Evidence * | Inaccuracy | Publication Bias ** | Impact | Quality | Importance *** |
|---|---|---|---|---|---|---|---|---|---|
| Physiological and muscular effects (measured with BMI) (Follow-up 8 weeks–8.5 months) | |||||||||
| 4 [30,32,34,35,36,37] | randomized trials | serious a | serious b | no serious | serious c | no serious | serious c | ⊕⊕⊕⊝ MODERATE | 4/9 |
| Physiological and muscular effects (measured with muscle strength) (Follow-up 8–12 weeks) | |||||||||
| 2 [32,34,35,36] | randomized trials | serious a | no serious d | no serious | no serious d | no serious | no serious d | ⊕⊕⊕⊝ MODERATE | 5/9 |
| Physiological and muscular effects (measured with BF) (Follow-up 8–12 weeks) | |||||||||
| 3 [30,32,34,35,36] | randomized trials | serious a | serious e | no serious | serious e | no serious | serious e | ⊕⊕⊝⊝ LOW | 2/9 |
| Physiological and muscular effects (measured with AMA and MTMA) (Follow-up 8 weeks) | |||||||||
| 1 [34,35,36] | randomized trial | serious a | no serious f | no serious | no serious f | no serious | no serious f | ⊕⊕⊝⊝ LOW | 3/9 |
| Psychological effects (depression and anxiety measured with K-10 and STAI) (Follow-up 5 weeks–8.5 months) | |||||||||
| 2 [31,37] | randomized trials | serious a | serious g | no serious | serious g | no serious | no serious g | ⊕⊕⊝⊝ LOW | 3/9 |
| Cognitive effects (mood measured with POMS) (Follow-up 5 weeks) | |||||||||
| 1 [31] | randomized trial | serious a | no serious h | no serious | no serious h | no serious | no serious h | ⊕⊕⊕⊝ MODERATE | 4/9 |
| Cognitive effects (attitude measured with BAT and EAT-40) (Follow-up 7 weeks) | |||||||||
| 1 [33] | randomized trial | serious a | no serious i | no serious | no serious i | no serious | no serious i | ⊕⊕⊕⊝ MODERATE | 4/9 |
| Behavioral effects (eating measured with EDI, ANSOQ and EDE-Q) (Follow-up 5 weeks–8.5 months) | |||||||||
| 3 [31,33,37] | randomized trials | serious a | no serious j | no serious | no serious j | no serious | no serious j | ⊕⊕⊕⊝ MODERATE | 4/9 |
| Behavioral effects (impulse control measured with CET) (Follow-up 8.5 months) | |||||||||
| 1 [37] | randomized trial | no serious | no serious k | no serious | no serious k | no serious | no serious k | ⊕⊕⊝⊝ LOW | 2/9 |
| Quality of life effects (measured with SF-36, EDQOL and HRQOL-12) (Follow-up 12 weeks–8.5 months) | |||||||||
| 2 [30,37] | randomized trials | serious a | no serious l | no serious | no serious l | no serious | no serious l | ⊕⊕⊕⊝ MODERATE | 4/9 |
AMA: Arm Muscle Area; ANSOQ: Motivation to change 20-item AN Stages of Change Questionnaire; BAT: Body Attitude Test; BF: Body fat; BMI: Body Mass Index; CET: Compulsive Exercise Test; EAT-40: Eating Attitude Test-40; EDE-Q: Eating Disorder Examination Questionnaire; EDI: Eating Disorders Inventory; EDQOL: Eating Disorder Quality of Life; EG: Experimental Group; HRQOL-12: Health-Related Quality of Life (Short Form-12); K-10: Depression and anxiety symptoms Kessler-10 item scale; MTMA: Midthigh muscle area; POMS: Profile of Mood States; SF-36: Medical Outcomes Survey Short-form QoL questionnaire; STAI: State Trait Anxiety Inventory. * Considered no serious because, all patients were well diagnosed, and at least 70% with anorexia nervosa. ** Considered no serious because, the study is published in an indexed international journal, and the article reports significant and not significant results. *** Importance: Range from 1—not important, to 9 it is considered critical. (Importance range: from 7 to 9: critical; from 4 to 6: important; from 1 to 3: limited importance). a. Although the studies had a suitable randomly sequence, blinding of assessors is only fulfilled in one of the studies or it is not fulfilled. b. Most of studies (3 of 4 trials) showed no benefits of the treatment vs control group. c. Only one of the 4 studies report significant changes in BMI. d. Muscle strength show increase in both studies. e. BF does not improve in any of the three studies. f. Both the AMA and MTMA show benefits in the study. g. Only in one study decreases anxiety in experimental group, whereas in the shorter duration (5 weeks). h. Mood shows benefits in experimental group in the study. i. Attitudes show benefits in experimental group in the study. j. Eating attitude improves in two of the three studies. k. Control compulsive exercise shows benefits in experimental group in the study. l. Quality of life improves in experimental group in both studies.