AIM to compare the effectiveness and harms of higher exercise dose, including higher exercise load and/or higher volume, with lower exercise dose (lower load and/or lower volume) in people with rotator cuff tendinopathy DESIGN: Systematic review (PROSPERO: CRD42017077478) DATA SOURCES: CENTRAL, MEDLINE, EMBASE, CINAHL from inception to March 2019. ELIGIBILITY CRITERIA Randomised controlled trials comparing higher versus lower dose exercise. DATA EXTRACTION AND RISK OF BIAS Two authors independently determined eligibility, extracted data and assessed risk of bias using the Cochrane tool. Outcomes were function and pain (overall, activity, night), and proportion of participants with adverse events. The primary endpoint was >six weeks to three months (other endpoints included up to six weeks & beyond three months) and GRADE was used to assess evidence certainty. RESULTS Three trials (N=283), none at low risk of bias for all domains, were included. Low certainty evidence (1 trial, N=102) indicated improved function (20 points [95% CI 12 to 28 points] on 0-100 point scale) with higher load and volume exercise at three months, but little or no clinically important between-group difference in activity or night pain (overall pain not reported). Very low certainty evidence (1 trial, N=120) indicated higher load exercise conferred no function benefits over lower load exercise at six weeks. Very low certainty evidence (1 trial, N=61) indicated benefit of uncertain clinical importance in function with higher versus lower volume exercise at three months and clinically important benefit at >3 months (pain outcomes not reported). Risk of adverse events was uncertain. CONCLUSIONS There are few studies that investigate higher dose exercise for rotator cuff tendinopathy.Low to very low certainty and conflicting evidence found about the value of higher versus lower dose exercise for people with rotator cuff tendinopathy.

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高剂量与低剂量运动对肩袖肌腱病的疗效：随机对照试验的系统评价

旨在比较较高运动剂量（包括较高运动负荷和/或较大运动量）与较低运动剂量（较低负荷和/或较低运动量）对肩袖肌腱病患者的有效性和危害设计：系统评价（PROSPERO：CRD42017077478）数据来源：CENTRAL、MEDLINE、EMBASE、CINAHL，从成立到 2019 年 3 月。 资格标准 比较高剂量和低剂量运动的随机对照试验。数据提取和偏倚风险 两位作者使用 Cochrane 工具独立确定资格、提取数据并评估偏倚风险。结果是功能和疼痛（总体、活动、夜间），以及发生不良事件的参与者比例。主要终点是 > 6 周至 3 个月（其他终点包括长达 6 周和 超过三个月）和 GRADE 用于评估证据的确定性。结果 纳入了三项试验（N=283），所有领域的偏倚风险均不低。低确定性证据（1 项试验，N=102）表明，在三个月时，更高的负荷和容量锻炼可改善功能（0-100 分制，20 分 [95% CI 12 至 28 分]），但在- 活动或夜间疼痛的组差异（未报告总体疼痛）。非常低的确定性证据（1 项试验，N=120）表明，在六周时，高负荷运动与低负荷运动相比没有带来功能益处。非常低的确定性证据（1 项试验，N=61）表明，在三个月时进行较大量与较小量运动相比，在功能上具有不确定的临床重要性的益处，并且在 >3 个月时具有临床重要的益处（未报告疼痛结果）。不良事件的风险不确定。结论 很少有研究调查肩袖肌腱病的高剂量运动。低到非常低的确定性和相互矛盾的证据发现高剂量运动与低剂量运动对肩袖肌腱病患者的价值。