Study selection and characteristics
We identified 2800 records. After de-duplication, 1990 records remained. After screening all the titles and abstracts, we excluded 1858 irrelevant records, leaving 132 records for full-text review. Of the 132 full-texts, 86 publications were excluded. Ultimately, our review included 56 articles involving 4554 participants from six geopolitical regions of the country (Figure 1). Of the included studies, 1 (2%) was done in North-Central, 3 (6.5%) in North-East, 13 (23.9%) in North-West, 4 in South-East (7%), 1(2%) in South-South, 33 (59%) in South-West, and 1(2%) in both South-South and South-West. The included studies were published between 2010 and 2021.
Participants’ characteristics
The mean age of the participants was 44.7±6.97years (41.73± 8.44years and 47.69±5.5years) for the experimental group and control groups, respectively. The male to female for the experimental and control group ratio was 1.1:1 and 1.2:1 respectively. Most of the studies did not report educational backgrounds but amongst studies (five) that did, the average percentage of participants with less than secondary education was 23.5% while 77% for the experiment group that had above secondary education.
Quality Appraisal
Of the 56 studies, we assessed the quality of the 49 RCTs using Pedro. Thirteen (23.2%) studies were found to be optimal, while 43 (76.8%) were of suboptimal quality. All the seven non-randomised experiments assessed using ROBINS-1 had a low risk of bias.
Disorders, interventions and outcomes
A total of 17 disorders were studied. These include non-specific spinal pain 13 (25%), type 2 diabetes mellitus(DM) 9 (16.1%), hypertension 8(13.6%), osteoarthritis 7(12.5%) and HIV infection 5(8.9%), among others. The interventions utilized were exercises 45 (76.3%), manual therapy 5 (8.5%), electrotherapy 5 (8.5%) etc. Types of exercise were stabilization exercises, therapeutic exercise, aerobic exercises, mobilization exercise, resistance exercise, aquatic exercise, walking, McKenzie back exercise, isometric handgrip exercise etc. The three most studied key outcomes were pain intensity 17 (28.8%), blood pressure 11 (18.6%) and blood glucose 5 (8.5%) (Table 3).
Study Designs, Sample size, & Sampling Techniques
Of the 56 studies included in this review, 49 (87.5%), 5 (8.9%) and 2 (3.6%) were randomized control trials, non-randomized control trials and one-group (pre-post) experiments, respectively. Regarding sample size, Onigbinde et al.19 and Lamina et al.20 utilized the least (17) and largest (324) sample sizes, respectively. Probability sampling techniques were employed in 49 (87.5%) of the studies, while non-probability techniques were utilized in 7 (12.5%) studies.
Statistics and Confounding Bias
On assessment for the test of normality of dataset, 5 (10.87%) studies performed a normality test. Three of them21, 22, 23 appropriately used the Shapiro-Wilk test. Abdulahi,24 inappropriately employed Kolmogorov, while John et al.25 did not specify which type of normality test was conducted. Besides the lack of normality test, we found statistical analytical methods used in 41.3% of studies to be inappropriate, for failure to conduct additional analysis of covariates. Of the 56 included studies, 27 (48.2%) suffered confounded-by-indication bias, 21 (37.5%) were without confound, while 8 (14%) had confounded-by-indication bias which was accounted for during statistical analysis. Sources of confounding bias were missing baseline comparison of relevant socio-demographic characteristics (36.8%), missing baseline comparison of key outcome(s) (15.8%), missing baseline comparison of both socio-demographic characteristics and key outcome(s) (26.3%) and failure to account for a statistically significant difference in baseline levels of relevant outcomes in the final post-intervention analysis (21.1%). A few studies (37.5%) employed an intention-treat approach to statistical analysis.
Study Power and Effect Size
Regarding the magnitude of study effect, we found 8 (15.9%) studies with no effect, 8 (15.9%) had a small effect, 18 (31.8%) with medium effect, and 20 (36.4%) had with large effects (Table 3).
Table 3: Effect size, and statistical power of the included studies
S/N
|
Author
|
Intervention for outcome(tool) in condition
|
P-values
|
Effect size
|
Power %
|
Remark
|
|
Abass et al.21
|
Lumbar stabilization for PI in chronic LBP
|
0.236
|
0.082
|
48%
|
X
|
|
Adeniyi et al.26
|
Exercise for pain in Type 2 DM
|
< 0.05
|
IN
|
|
-
|
|
Adeniyi et al,10
|
Exercise improving for SBP in Type 2 DM
|
0.030
|
IN
|
|
-
|
|
Akinola et al.27
|
Exercise improving GMF in spastic CP
|
0.001
|
0.236
|
9%
|
X
|
|
Abdulahi,24
|
CIMT improving MF in stroke
|
> 0.05
|
0.348
|
46%
|
X
|
|
Adepoju et al.28
|
Exercise improving balance in CP
|
0.339
|
0.57
|
58%
|
X
|
|
Ajiboye et al.29
|
Exercise improving walking capacity in CHF (biventricular)
|
p<0.05
|
1.28
|
100%
|
√
|
|
Akodu & Akindutire,30
|
Exercise for sleep disturbance in LBP (NS)
|
0.030
|
0.6
|
100%
|
√
|
|
Aliyu et al.22
|
Exercise for pain in LBP (NS)
|
0.600
|
0.0078
|
85%
|
√
|
|
Aweto et al.31
|
Exercise for depression score in PL HIV
|
0.925
|
0.36
|
100%
|
√
|
|
Bello et al.23
|
Manual therapy for FVC in lumbar radiculopathy
|
0.000
|
0.26
|
46%
|
X
|
|
Bello & Adeniyi,32
|
Exercise for pain intensity (VASB) in LBP
|
0.020
|
1.93
|
100%
|
√
|
|
Bolarinde et al.33
|
Exercise for PI in LBP
|
<0.001
|
0.023
|
60%
|
X
|
|
Ezema et al.34
|
Exercise for FBS in Type 2 DM
|
0.001
|
0.59
|
100%
|
√
|
|
Ezema et al.35
|
Exercise for SBP in PL HIV
|
0.000
|
2.74
|
100%
|
√
|
|
Fadupin & Akinola36
|
Exercise for FBS in Type 2 DM
|
p<0.05
|
0.16
|
100%
|
√
|
|
Fayehun et al.37
|
Walking prescription for HBA1c in Type 2 DM
|
0.0150
|
0.035
|
5%
|
X
|
|
Aweto et al.38
|
Incentive spirometry for FVC in Type 2 DM
|
0.9250
|
0.071
|
6%
|
X
|
|
Idowu & Adeniyi39
|
Graded activity with monitoring for PI in LBP and Type 2 DM
|
<0.001
|
1.94
|
99%
|
√
|
|
Ige et al.40
|
Pulmonary rehab for FEV1 in COPD
|
<0.050
|
2.518
|
100%
|
√
|
|
Jegede et al.41
|
Exercise for WR in obese individuals
|
<0.001
|
1.17
|
99%
|
√
|
|
John et al.25
|
Exercise for SBP in PL HIV
|
0.001
|
0.12
|
100%
|
√
|
|
Johnson et al.42
|
McKenzie for PI in LBP
|
0.020
|
1.18
|
79%
|
X
|
|
Lamina et al.43
|
Exercise for SBP in hypertension
|
0.001
|
1.04
|
100%
|
√
|
|
Lamina & Okoye,44
|
Exercise for lipid profile in hypertension
|
0.001
|
0.007
|
57%
|
X
|
|
Lamina & Okoye,45
|
Moderate intensity training for SBP in hypertension
|
0.001
|
1.22
|
100%
|
√
|
|
Maduagwu et al.46
|
Exercise on CD4 in HIV seropositive
|
0.917
|
0.023
|
6%
|
X
|
|
Maruf et al.47
|
Exercise for BP in hypertension
|
0.075
|
0.39
|
74%
|
X
|
|
Mbada et al.48
|
McKenzie for DBEE in LBP
|
0.001
|
0.27
|
100%
|
√
|
|
Odebiyi et al.49
|
Exercise and massage for QoL of cancer patient
|
0.001 *
|
0.39
|
100%
|
√
|
|
Odole & Ojo,50
|
Telephone based therapy for PI on OA
|
0.001
|
0.16
|
100%
|
√
|
|
Ogbutor et al.51
|
Exercise for SBP in pre hypertensives
|
1.653
|
1.5
|
100%
|
√
|
|
Ogwumike et al.52
|
2 Exercises for Adiposity in peri and post menopausals
|
0.050
|
0.959
|
23%
|
X
|
|
Ojoawo et al.53
|
Exercise for PI in LBP
|
1.000
|
0.052
|
5%
|
X
|
|
Ojoawo et al.54
|
US and massage for PI in LBP
|
0.001
|
0.57
|
99%
|
√
|
|
Ojoawo et al.55
|
TOP for PI in cervical radiculopathy
|
<0.05
|
0.53
|
85%
|
√
|
|
Ojoawo & Olabode,56
|
TOP a1nd traction for NDI in cervical radiculopathy
|
0.889
|
0.125
|
42%
|
X
|
|
Okonkwo et al.57
|
TENS for PI in injection sciatic pain
|
0.001
|
0.16
|
13%
|
X
|
|
Olagbegi et al.58
|
Exercise for SQMS in OA
|
> 0.05
|
0.07
|
100%
|
√
|
|
Olagbegi et al.59
|
Exercise for ADL in OA
|
< 0.001
|
0.737
|
100%
|
√
|
|
Onuwe et al.60
|
Double modality for PP in MSK injuries
|
< 0.05
|
0.293
|
24%
|
X
|
|
Lamina & Okoye,61
|
Exercise for SBP in hypertension
|
0.001
|
0.67
|
100%
|
√
|
|
Maduagwu et al.62
|
Exercise for CD4 cells on in HIV
|
0.002
|
0.82
|
90%
|
√
|
|
Usman et al.63
|
Combination therapy for PI in OA
|
0.001
|
0.34
|
100%
|
√
|
|
Mbada et al.64
|
Exercise for FAB in LBP
|
0.154
|
0.076
|
9%
|
X
|
|
Lamina & Okoye20
|
Interval training program for SBP in hypertension
|
0.001
|
0.27
|
100%
|
√
|
|
Aweto et al.65
|
Incentive spirometer for FEV in asthma
|
0.001
|
0.441
|
73%
|
X
|
|
Kaka et al.66
|
Exercise for VAS in NS-neck pain
|
0.001
|
1.267
|
100%
|
√
|
|
Maharaj & Nuhu,67
|
Exercise for FBS in type 2 DM
|
0.002
|
0.122
|
21%
|
X
|
|
Maruf et al.68
|
Exercise for SBP in hypertensive patients
|
0.001
|
0.751
|
98%
|
√
|
|
Ezema et al.69
|
Exercise for FBS in type 2 DM
|
< 0.01
|
-1.281
|
98%
|
√
|
|
Ojoawo et al.70
|
VOP for RMDQ in chronic LBP
|
0.692
|
0.549
|
68%
|
X
|
|
Ojoawo et al.71
|
Exercise for VAS in knee OA
|
< 0.01
|
0.386
|
87%
|
√
|
|
Onigbinde et al.19
|
Exercise for dynamic B in stroke
|
0.040
|
0.938
|
95%
|
√
|
|
Onigbinde et al.72
|
IQS for RMx in OA
|
0.001
|
0.644
|
89%
|
√
|
|
Onigbinde et al.73
|
SWD for VAS in OA
|
0.03
|
0.747
|
42%
|
X
|
X: finding is probably not a reflection of true effect; √: finding is probably a reflection of true effect; IN: information not available. DM: diabetes mellitus; CP: cerebral palsy; CIMT: Constraint-induced movement therapy; CHF: congestive heart failure;WR: weight reduction; LBP (NS): Low back pain (non-specific); SBP: Systolic blood pressure; Type 2 DM: Type 2 diabetes mellitus; (G) MF: (Gross) motor function; CHF: Chronic heart failure; (PL) HIV: (People living with) Human Immuno-deficiency virus; FVC; Forced vital capacity; VAS (B): Visual analogue scale (back); PI: Pain intensity; FBS: Fasting blood sugar; HBA1c: Glycosylated hemoglobin; DBEE: dynamic back extensors endurance; COPD: Chronic obstructive pulmonary disease; QoL: Quality of life; OA: Osteoarthritis; DRPEE: Dynamic Back Endurance Exercise; US: Ultrasound; SQS: static quadriceps muscle strength; TOP: Transverse Oscillatory pressure; ADL: Activity of daily living; FAB: Fear-Avoidance Beliefs IQS- isometric quadriceps strengthening SWD- short wave diathermy RM- Repetitive maximum RMDQ- Roland-Morris Disability Questionnaire; FPG