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Review
. 2021 Nov 8:12:665044.
doi: 10.3389/fphys.2021.665044. eCollection 2021.

A Systematic Review Examining the Approaches Used to Estimate Interindividual Differences in Trainability and Classify Individual Responses to Exercise Training

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Review

A Systematic Review Examining the Approaches Used to Estimate Interindividual Differences in Trainability and Classify Individual Responses to Exercise Training

Jacob T Bonafiglia et al. Front Physiol. .

Abstract

Background: Many reports describe statistical approaches for estimating interindividual differences in trainability and classifying individuals as "responders" or "non-responders." The extent to which studies in the exercise training literature have adopted these statistical approaches remains unclear. Objectives: This systematic review primarily sought to determine the extent to which studies in the exercise training literature have adopted sound statistical approaches for examining individual responses to exercise training. We also (1) investigated the existence of interindividual differences in trainability, and (2) tested the hypothesis that less conservative thresholds inflate response rates compared with thresholds that consider error and a smallest worthwhile change (SWC)/minimum clinically important difference (MCID). Methods: We searched six databases: AMED, CINAHL, EMBASE, Medline, PubMed, and SportDiscus. Our search spanned the aerobic, resistance, and clinical or rehabilitation training literature. Studies were included if they used human participants, employed standardized and supervised exercise training, and either: (1) stated that their exercise training intervention resulted in heterogenous responses, (2) statistically estimated interindividual differences in trainability, and/or (3) classified individual responses. We calculated effect sizes (ESIR) to examine the presence of interindividual differences in trainability. We also compared response rates (n = 614) across classification approaches that considered neither, one of, or both errors and an SWC or MCID. We then sorted response rates from studies that also reported mean changes and response thresholds (n = 435 response rates) into four quartiles to confirm our ancillary hypothesis that larger mean changes produce larger response rates. Results: Our search revealed 3,404 studies, and 149 were included in our systematic review. Few studies (n = 9) statistically estimated interindividual differences in trainability. The results from these few studies present a mixture of evidence for the presence of interindividual differences in trainability because several ESIR values lay above, below, or crossed zero. Zero-based thresholds and larger mean changes significantly (both p < 0.01) inflated response rates. Conclusion: Our findings provide evidence demonstrating why future studies should statistically estimate interindividual differences in trainability and consider error and an SWC or MCID when classifying individual responses to exercise training. Systematic Review Registration: [website], identifier [registration number].

Keywords: exercise training; individual response; interindividual variability; non-responder analysis; responders; trainability.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the study selection process.
FIGURE 2
FIGURE 2
Timeline and heatmap of the 149 studies included in our systematic review. Numbers refer to a total number of studies in each cell, whereas shading depicts the total number of studies divided by the number of years included in that column. (A) Includes all studies sorted by whether studies used a statistical approach to estimate interindividual differences in trainability, and (B) includes the 116 studies that classified individual responses sorted by the classification categories outlined in Table 2. 2020* includes studies published in 2020 and up to the updated literature search (January 6, 2021). MCID, minimum clinically important difference; SDIR, the standard deviation of individual responses; SWC, smallest worthwhile change. (B) Only contains 113 of the 116 studies that classified individual responses because three studies did not report how individuals were classified (Hubal et al., 2005; Hagstrom and Denham, 2018; Peltonen et al., 2018).
FIGURE 3
FIGURE 3
Forest plot of the studies that statistically estimated interindividual differences in trainability. CTRL, control group; EX, exercise training group; WC, waist circumference; VO2max; maximal oxygen uptake; SBP, systolic blood pressure; HDL-C, high-density lipoprotein cholesterol; TG, triglyceride; VAS, visual analog scale; LBM, lean body mass; BFM, body fat mass; ADAS-cog, Alzheimer’s disease assessment scale-cognitive subscale. aWe combined data from three aerobic training groups (see section “Interindividual Differences in Trainability”); bData from four trials combined by Leifer et al. (2016); cWe combined data from the three training groups (see section “Interindividual Differences in Trainability”), which included an aerobic, resistance, and combined training group.
FIGURE 4
FIGURE 4
Impact of classification approach [A; n = 614 (all outcomes); n = 75 (maximal oxygen uptake, VO2max)] and mean change (B) on response rates. Table 2 outlines the classification categories outlined in (A). *Significant at p < 0.01.

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