Publications by authors named "Ana Torres-Costoso"

26 Publications

  • Page 1 of 1

EFFECT OF EXERCISE ON FATIGUE IN MULTIPLE SCLEROSIS: A NETWORK META-ANALYSIS COMPARING DIFFERENT TYPES OF EXERCISE.

Arch Phys Med Rehabil 2021 Sep 9. Epub 2021 Sep 9.

Universidad de Castilla La-Mancha. Health and Social Research Center, Cuenca, Spain; Universidad de Castilla La-Mancha. Facultad de Enfermería de Cuenca. Cuenca, Spain; Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Santiago, Chile.

Objective: A network meta-analysis (NMA) of current evidence was conducted to determine if physical exercise has a positive influence on multiple sclerosis (MS) fatigue and type of exercise with the largest effect on fatigue also according to disease severity.

Data Sources: MEDLINE, EMBASE, SPORTDiscus, PEDro, Cochrane Library and Web of Science. The search strategy combined relevant terms related to: a) multiple sclerosis; b) clinical trials; c) exercise; and d) fatigue, from inception to February 2021.

Study Selection: Randomized controlled trials concerning the effectiveness of different types of exercise on total and physical fatigue in people with MS were included.

Data Extraction: The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0) and to evaluate the quality of the evidence, the Grading of Recommendations, Assessment, Development and Evaluation tool was used.

Data Synthesis: A total of 58 studies were examined. Data were pooled using a random effects model. A ranking of seven and eight different exercise interventions for physical and total fatigue scores, respectively, was achieved. The highest effects for pairwise comparisons were for combined exercise and resistance training versus control (ranging between -0.74 and -1.24). In the NMA, combined exercise (-1.51; 95% CI: -2.01, -1.01) and resistance training (-1.15; 95% CI -1.81, -0.49) compared to the control group achieved the highest effects for physical and total fatigue, respectively.

Conclusion: Exercise should be considered an effective fatigue management strategy. Among the different exercise modalities, combined exercise is the most effective exercise modality for improving both, physical and total fatigue. Resistance training is also an effective exercise for total fatigue among people diagnosed with MS.
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http://dx.doi.org/10.1016/j.apmr.2021.08.008DOI Listing
September 2021

Effect of Exercise on Motor Symptoms in Patients With Parkinson's Disease: A Network Meta-analysis.

J Geriatr Phys Ther 2021 Aug 12. Epub 2021 Aug 12.

Social and Health Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain. Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay. Institute of Applied Health Research, University of Birmingham, Birmingham, England. Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Santiago, Chile. Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile.

Background: Although the pharmacological approach may help with motor symptoms in Parkinson's disease (PD), they are clearly not the complete solution. Thus, for the treatment of PD motor symptoms, physical activity has been proposed as an effective intervention.

Methods: A systematic search in MEDLINE, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials databases was conducted to identify randomized controlled trials testing the effectiveness of exercise interventions on motor symptoms of PD. Physical exercise interventions were divided into 9 categories: endurance, resistance, combined, balance, dance, alternative exercises, body weight supported, sensorimotor interventions including endurance exercise, and sensorimotor interventions not including endurance exercise. A pairwise meta-analysis for direct and indirect comparisons between intervention and control/nonintervention groups was carried out.

Results: Fifty-six studies met the inclusion criteria, including 2740 participants, aged between 57.6 and 77.7 years. Results of our analyses showed that sensorimotor training including endurance (effect size [ES]-1.09; 95% confidence interval [CI], -1.68 to -0.50), resistance (ES-0.82; 95% CI, -1.23 to -0.41), and dance (ES-0.64; 95% CI, -1.24 to -0.05) were the most effective physical activity interventions for mitigating PD motor symptoms.

Conclusion: Physical activity interventions are an effective strategy for the management of motor symptoms in patients with PD. Among the different exercise intervention programs, those including more complex and demanding activities (sensorimotor training including endurance, resistance, and dance) seem to be the most effective physical activity interventions.
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http://dx.doi.org/10.1519/JPT.0000000000000322DOI Listing
August 2021

Pilates improves physical performance and decreases risk of falls in older adults: a systematic review and meta-analysis.

Physiotherapy 2021 Sep 7;112:163-177. Epub 2021 Jun 7.

Universidad de Castilla La-Mancha, Health and Social Research Center, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile.

Background: Falls are the leading cause of injury-related deaths in older adults. Physical exercise is a suitable strategy to reduce the risk of falls, but there is little research on the effectiveness of specific exercise modalities.

Objectives: To estimate the effectiveness of Pilates compared to habitual or non-exercise on physical performance and the risk of falls in older adults.

Data Sources: Five databases were searched through April 15, 2021.

Study Selection: Randomized controlled trial in people aged ≥60 years.

Outcomes: balance, strength, flexibility, functionality, and risk of falls.

Data Synthesis: Pooled standardized mean differences were calculated using a random-effects model. Subgroup analyses based on Pilates' modality, the existence of a detailed exercise protocol, supervision by a certified instructor, and overall risk of bias were performed.

Results: Thirty-nine studies were included in the systematic review and meta-analyses. The meta-analyses indicated a moderate effect of Pilates on balance (ES=0.36; 95% CI=0.21 to 0.50), strength (ES=0.63; 95% CI=0.44 to 0.81), flexibility (ES=0.41; 95% CI=0.16 to 0.67), and functionality (ES=0.51; 95% CI=0.32 to 0.72) as well as a large effect on the risk of falls (ES=0.90; 95% CI=0.41 to 1.38) in older adults when compared with control groups. The level of certainty of the findings was low for balance, flexibility, and functionality and moderate for strength and falls.

Conclusion And Implications Of Key Findings: Pilates may promote the autonomy of older people in their daily living activities. Systematic Review Registration Number PROSPERO CRD42018116452.
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http://dx.doi.org/10.1016/j.physio.2021.05.008DOI Listing
September 2021

EFFECT OF MANUAL THERAPY INTERVENTIONS ON RANGE OF MOTION AMONG INDIVIDUALS WITH MYOFASCIAL TRIGGER POINTS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Pain Med 2021 Jul 21. Epub 2021 Jul 21.

Universidad de Castilla la-Mancha, Health and Social Research Center, Santa Teresa Jornet, s/n, 16071, Cuenca, Spain.

Objective: Patients with myofascial trigger points (MTPs) frequently manifest restricted range of motion (ROM) during physical evaluation. Multiple manual therapy interventions have been developed for the treatment of MTPs, but their effect on ROM has not been clarified through a systematic review and meta-analysis. Thus, this systematic review aimed to assess the effect of manual therapy interventions on ROM among individuals with MTPs.

Methods: A systematic search was conducted in PubMed, Web of Science, Cochrane, Scopus and Clinical Trials.gov. Articles analysing the effect of manual therapy interventions on ROM were included. The risk of bias was assessed using the Cochrane RoB2 tool. The DerSimonian-Laird method was used to compute the pooled effect size (ES) and its 95% confidence interval (95% CI) for ROM.

Results: A total of 13 randomized controlled trials (RCTs) were included in this systematic review and meta-analysis. The pooled ES for ROM was 0.52 (95% CI: 0.42; 0.63). The pooled ES for ROM evaluated in centimetres was 0.36 (95% CI: 0.14; 0.59) and the pooled ES for ROM evaluated in degrees was 0.57 (95% CI: 0.47; 0.68).

Conclusion: Manual therapy interventions may be an effective approach for improving ROM among individuals with MTPs.
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http://dx.doi.org/10.1093/pm/pnab224DOI Listing
July 2021

Effectiveness of Pilates and Yoga to improve bone density in adult women: A systematic review and meta-analysis.

PLoS One 2021 7;16(5):e0251391. Epub 2021 May 7.

Health and Social Research Center, Universidad de Castilla La-Mancha, Cuenca, Spain.

Background: The ageing population brings about the appearance of age-related health disorders, such as osteoporosis or osteopenia. These disorders are associated with fragility fractures. The impact is greater among postmenopausal women due to an acceleration of bone mineral density (BMD) loss.

Objective: To estimate the effectiveness of Pilates or Yoga on BMD in adult women.

Methods: Five electronics databases were searched up to April 2021. Randomized controlled trials (RCTs), non-RCTs and pre-post studies were included. The main outcome was BMD. Risk of bias was evaluated using the Cochrane risk of bias tool. A random effects model was used to pool data from primary studies. Subgroup analyses based on the type of exercise were conducted.

Results: Eleven studies including 591 participants aged between 45 and 78 years were included. The mean length of the interventions ranged from 12 to 32 weeks, and two studies were performed for a period of at least one year. The pooled effect size for the effect of the intervention (Pilates/Yoga) vs the control group was 0.07 (95% Confidence interval [CI]: -0.05 to 0.19; I2 = 0.0%), and 0.10 (95% CI: 0.01 to 0.18; I2 = 18.4%) for the secondary analysis of the pre-post intervention.

Conclusions: Despite of the non-significant results, the BMD maintenance in the postmenopausal population, when BMD detrimental is expected, could be understood as a positive result added to the beneficial impact of Pilates-Yoga in multiple fracture risk factors, including but not limited to, strength and balance.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251391PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8104420PMC
May 2021

Effectiveness of Pulmonary Rehabilitation in Interstitial Lung Disease, Including Coronavirus Diseases: A Systematic Review and Meta-analysis.

Arch Phys Med Rehabil 2021 Apr 29. Epub 2021 Apr 29.

Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, Facultad de Fisioterapia y Enfermería, Toledo, Spain; Universidad de Castilla-La Mancha, Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Campus de Fábrica de Armas, Toledo, Spain.

Objective: A meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effect of pulmonary rehabilitation on functional capacity and quality of life in interstitial lung diseases, including those caused by coronaviruses.

Data Sources: MEDLINE, EMBASE, SPORTDiscus, Cochrane Library, Web of Science, and MedRxiv from inception to November 2020 were searched to identify documents.

Study Selection: Publications investigating the effect of pulmonary rehabilitation on lung function (forced vital capacity [FVC]), exercise capacity (6-minute walk distance [6MWD]), health related quality of life (HRQOL), and dyspnea were searched.

Data Extraction: The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0).

Data Synthesis: A total of 11 RCTs with 637 interstitial lung disease patients were eligible for analyses. The pooled effect sizes of the association for pulmonary rehabilitation were 0.37 (95% confidence interval [CI], 0.02-0.71) for FVC, 44.55 (95% CI, 32.46-56.64) for 6MWD, 0.52 (95% CI, 0.22-0.82) for HRQOL, and 0.39 (95% CI, -0.08 to 0.87) for dyspnea. After translating these findings considering clinical improvements, pulmonary rehabilitation intervention increased predicted FVC by 5.5%, the 6MWD test improved by 44.55 m, and HRQOL improved by 3.9 points compared with baseline values. Results remained similar in sensitivity analyses.

Conclusions: Although specific evidence for pulmonary rehabilitation of coronavirus disease 2019 patients has emerged, our data support that interstitial lung disease rehabilitation could be considered as an effective therapeutic strategy to improve the functional capacity and quality of life in this group of patients.
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http://dx.doi.org/10.1016/j.apmr.2021.03.035DOI Listing
April 2021

Body Weight Support Gait Training for Patients With Parkinson Disease: A Systematic Review and Meta-analyses.

Arch Phys Med Rehabil 2021 Mar 6. Epub 2021 Mar 6.

Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain; Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay.

Objective: To determine the effectiveness of body weight support (BWS) gait training to improve the clinical severity, gait, and balance in patients with Parkinson disease (PD).

Data Sources: A literature search was conducted until July 2020 in MEDLINE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature.

Study Selection: Randomized controlled trials that aimed at determining the effectiveness of physical activity interventions with BWS during gait training in patients with PD.

Data Extraction: The methodological quality of randomized controlled trials was assessed using the Cochrane risk of bias tool (RoB 2.0). Effect size (ES) and 95% confidence intervals [CIs] were calculated for the Unified Parkinson Disease Rating Scale (UPDRS), the UPDRS section III, the 6-minute walk test (6MWT), gait parameters (ie, velocity, cadence, stride length), and the Berg Balance Scale (BBS).

Data Synthesis: Twelve studies were included in the systematic review. The pooled ES for the effect of BWS on total UPDRS was -0.35 (95% CI, -0.57 to -0.12; I=1.9%, P=.418), whereas for UPDRS III it was -0.35 (95% CI, -0.68 to -0.01; I=66.4 %, P<.001). Furthermore, the pooled ES for 6MWT was 0.56 (95% CI, -0.07 to 1.18; I=77.1%, P=.002), for gait velocity was 0.37 (95% CI, -0.10 to 0.84); I=78.9%, P<.001), for cadence was 0.03 (95% CI, -0.25 to 0.30; I=0.0%, P=.930), for stride length was 1.00 (95% CI, 0.23 to 1.78; I=79.5%, P=.001), and for BBS was 0.65 (95% CI, 0.30, 0.99; I=51.8%, P=.042).

Conclusions: Interventions with BWS could improve the general and motor clinical severity of patients with PD, as well as other parameters such as stride length and balance. However, the effect does not appear to be statistically significant in improving gait parameters such as velocity, cadence, and distance.
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http://dx.doi.org/10.1016/j.apmr.2021.02.016DOI Listing
March 2021

The "Fat but Fit" Paradigm and Bone Health in Young Adults: A Cluster Analysis.

Nutrients 2021 Feb 5;13(2). Epub 2021 Feb 5.

Health and Social Research Center, University of Castilla-La Mancha, 16071 Cuenca, Spain.

The fat but fit paradox has suggested that obese individuals with good fitness levels have lower cardiometabolic risk compared to individuals with normal weight but lower fitness levels. This paradigm has not been explored in the context of bone health. The aim of this study was to test whether categories of fat but fit paradigm assessed by body fat percentage and handgrip strength holds up in young adults and to analyze the relationship between fat but fit categories and bone outcomes. Cluster cross-sectional analyses of data from 499 young adults aged 18 to 30 from Toledo and Cuenca, Spain were conducted. Body fat percentage, handgrip strength, bone mineral content (BMC), bone mineral density (BMD), and dietary nutrients such as, proteins, magnesium, calcium, phosphorus, potassium, and vitamin D were assessed. Cluster analysis of body fat percentage and handgrip z scores resulted in a classification of four clusters that could be interpreted according to Fat Unfit (FU), Unfat Unfit (UU), Fat Fit (FF) and Unfat Fit (UF) categories. ANCOVA models showed that young adults in clusters with higher handgrip strength levels (FF, UF) and with higher key bone nutrients levels (UF) had significantly higher total BMC values than their peers in the UU and FU cluster categories, after controlling for sex, age and height. This study provides two novel conclusions in relation to the fat but fit paradigm: first, it confirms the construct of the four clusters of body fat percentage and handgrip strength, and second, it reinforces the predictive validity of the fat but fit paradigm categories, indicating the positive effect, although it may not just be a causal relationship, of muscular strength and key bone nutrients on counteracting the negative effect of obesity on bone health.
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http://dx.doi.org/10.3390/nu13020518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914522PMC
February 2021

Maternal Education and Academic Achievement in Schoolchildren: The Role of Cardiorespiratory Fitness.

J Pediatr 2021 05 28;232:109-117.e1. Epub 2021 Jan 28.

Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain; Faculty of Education, University of Castilla-La Mancha, Ciudad Real, Spain.

Objectives: To examine the relationship between maternal education, cardiorespiratory fitness, and academic achievement in schoolchildren, specifically whether the association between maternal education and academic achievement is mediated by cardiorespiratory fitness.

Study Design: This is a secondary analysis of a cross-sectional study including 478 Spanish schoolchildren aged 8-11 years. ANOVA was used to test differences in cardiorespiratory fitness by maternal education level. ANCOVA was used to test the differences in academic achievement by the educational level of mothers and the cardiorespiratory fitness of children, controlling for each other. A mediation analysis was used to test if the relationship between maternal education and academic achievement was explained by cardiorespiratory fitness.

Results: A higher level of maternal education was associated with a higher cardiorespiratory fitness level and academic achievement in children; moreover, the cardiorespiratory fitness level in children was associated with better academic achievement (P < .05). Finally, cardiorespiratory fitness acted as a partial mediator of the relationship between maternal education and academic achievement in boys (z = 1.81; P = .03) but not in girls (z = 0.86; P = .19), explaining 6.54% of this relationship for the total sample and 6.67% for boys.

Conclusions: This study suggests that the benefits of maternal education on academic achievement are partially explained by the mediating role of cardiorespiratory fitness.
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http://dx.doi.org/10.1016/j.jpeds.2021.01.047DOI Listing
May 2021

Low- and moderate-intensity aerobic exercise acutely reduce blood pressure in adults with high-normal/grade I hypertension.

J Clin Hypertens (Greenwich) 2020 09 9;22(9):1732-1736. Epub 2020 Aug 9.

Institute of Biomedicine - iBiMED, School of Health Sciences, University of Aveiro, Aveiro, Portugal.

The aim of the study is to compare the acute effects of low- and moderate-intensity aerobic exercise on post-exercise blood pressure in active adults with high-normal/grade I hypertension. Thirteen physically active adults (67.0 ± 8.7 years) randomly completed two aerobic exercise sessions of 30 minutes at low (30% heart rate reserve [HRres]) and moderate (60% HRres) intensity. Blood pressure was assessed pre-session and every hour until 3 hours after. Systolic blood pressure decreased after both exercise intensities without significant differences between sessions at 1 hour after the session (30%: -10.0 ± 12.6% vs 60%: -11.4 ± 12.7 mm Hg, P > .05). Three hours after the 60% session, the systolic blood pressure remained significantly lower than baseline (139.9 ± 12.9 to 129.3 ± 11.9 mm Hg, P < .05), but without significant differences between sessions. No relevant changes were observed in diastolic and mean blood pressure. In conclusion, a single session of aerobic exercise acutely reduces systolic blood pressure in active adults with high-normal/grade I hypertension.
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http://dx.doi.org/10.1111/jch.14000DOI Listing
September 2020

The effect of hallux valgus open and percutaneous surgery on AOFAS scale: a systematic review and meta-analysis.

Qual Life Res 2021 Apr 2;30(4):957-966. Epub 2021 Jan 2.

Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain.

Purpose: To estimate the comparative effect of open and percutaneous hallux valgus (HV) surgery on patients' quality of life (QoL) using the American Orthopedic Foot and Ankle Society (AOFAS) scale including total score and individual domains (pain, function, and alignment).

Methods: MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2020 for studies on the effect of HV surgery on patients' QoL using the AOFAS score. A standardized mean difference score was calculated on the total AOFAS score and on each AOFAS domain (pain, function, and alignment) using Cohen's d index.

Results: Considering the 53 published studies included, the pooled effect size (ES) estimates for the AOFAS total score were 3.69 (95% CI 3.37-4.01; I = 95.5%) for open surgery and 3.40 (95% CI 2.99-3.80, I = 88.2%) for percutaneous surgery. The total pooled ES estimate was 3.61 (95% CI 3.35-3.87, I = 94.5%). Considering the pain domain, the pooled ES estimates were 2.21 (95% CI 1.98-2.43, I = 64%) for open surgery and 2.52 (95% CI 1.83-3.20, I = 92.6%) for percutaneous surgery. For the function domain, the pooled ES estimates were 1.37 (95% CI 0.93-1.81, I = 91%) for open surgery and 2.28 (95% CI 1.10-3.47, I = 96.8%) for percutaneous surgery. Finally, the pooled ES estimates for the alignment domain were 3.99 (95% CI 3.51-4.47, I = 85.7%) for open surgery and 2.66 (95% CI 2.23-3.09, I = 78.5%) for percutaneous surgery.

Conclusion: Our data support that HV surgery increases the total AOFAS score as well as the AOFAS scores by domain (pain, function, and alignment). Furthermore, our data show that HV surgery increases patients' QoL, after both open and percutaneous surgery, without differences between them.
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http://dx.doi.org/10.1007/s11136-020-02715-yDOI Listing
April 2021

Association Between Muscular Strength and Bone Health from Children to Young Adults: A Systematic Review and Meta-analysis.

Sports Med 2020 Jun;50(6):1163-1190

Health and Social Research Center (CESS), Universidad de Castilla-La Mancha, Ed/ Melchor Cano, C/Santa Teresa Jornet s/n, 16071, Cuenca, Spain.

Background: Osteoporosis is a major worldwide health concern. The acquisition of bone mass during growth decreases the risk of osteoporosis later in life. Muscular strength is an important and modifiable factor to improve bone development in this period.

Objective: The aim of this review was to summarize the relationship between muscular strength and bone health.

Methods: Cross-sectional data from studies addressing this association from childhood to young adulthood were systematically searched. The DerSimonian and Laird method was used to compute pooled estimates of effect size and respective 95% CI. The meta-analyses were conducted separately for upper limbs or lower limbs muscular strength and for bone regions. Additionally, a regression model was used to estimate the influence of determinants such as age, lean mass, fat mass, height, weight and cardiorespiratory fitness in this association.

Results: Thirty-nine published studies were included in the systematic review. The pooled effect size for the association of upper limbs muscular strength with upper limbs, spine and total body BMD ranged from 0.70 to 1.07 and with upper limbs, spine and total body BMC ranged from 1.84 to 1.30. The pooled effect size for the association of lower limbs muscular strength with lower limbs, spine and total body BMD ranged from 0.54 to 0.88 and with lower limbs, spine and total body BMC ranged between 0.81 and 0.71. All reported pooled effect size estimates were statistically significant.

Conclusion: This systematic review and meta-analysis supports that muscular strength should be considered as a useful skeletal health marker during development and a target outcome for interventions aimed at improving bone health.
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http://dx.doi.org/10.1007/s40279-020-01267-yDOI Listing
June 2020

Pilates Method Improves Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis.

J Clin Med 2019 Oct 23;8(11). Epub 2019 Oct 23.

Health and Social Care Center, Universidad de Castilla La-Mancha, 16002 Cuenca, Spain.

Cardiorespiratory fitness has been postulated as an independent predictor of several chronic diseases. We aimed to estimate the effect of Pilates on improving cardiorespiratory fitness and to explore whether this effect could be modified by a participant's health condition or by baseline VO max levels. We searched databases from inception to September 2019. Data were pooled using a random effects model. The Cochrane risk of bias (RoB 2.0) tool and the Quality Assessment Tool for Quantitative Studies were performed. The primary outcome was cardiorespiratory fitness measured by VO max. The search identified 527 potential studies of which 10 studies were included in the systematic review and 9 in the meta-analysis. The meta-analysis showed that Pilates increased VO max, with an effect size (ES) = 0.57 (95% CI: 0.15-1; I = 63.5%, = 0.018) for the Pilates group vs. the control and ES = 0.51 (95% CI: 0.26-0.76; I = 67%, = 0.002) for Pilates pre-post effect. The estimates of the pooled ES were similar in both sensitivity and subgroup analyses; however, random-effects meta-regressions based on baseline VO max were significant. Pilates improves cardiorespiratory fitness regardless of the population's health status. Therefore, it may be an efficacious alternative for both the healthy population and patients suffering from specific disorders to achieve evidenced-based results from cardiorespiratory and neuromotor exercises.
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http://dx.doi.org/10.3390/jcm8111761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912807PMC
October 2019

Body Mass Index, Lean Mass, and Body Fat Percentage as Mediators of the Relationship between Milk Consumption and Bone Health in Young Adults.

Nutrients 2019 Oct 17;11(10). Epub 2019 Oct 17.

Centro de Estudios Socio-Sanitarios, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain.

Identifying environmental factors that influence bone health is crucial for developing effective intervention strategies that maximize peak bone mass. The aim of this study was to estimate the relationship between milk consumption and bone mineral density (BMD) in young adults, and to examine whether this relationship is mediated by body mass index (BMI) and total lean and fat mass. A cross-sectional study involving college students ( = 239) from a Spanish public university was performed. Data on milk consumption and anthropometric and body composition variables were collected. The Pearson correlation coefficients among total body BMD, body composition variables, and milk consumption ranged from -0.111 to -1.171, most of them statistically significant ( < 0.05). The ANCOVA (analysis of covariance) models showed that those with higher regular milk consumption had less total body BMD than those with lower regular milk consumption ( < 0.05), even after controlling for different sets of confounders. In the mediation analysis, BMI and lean and fat mass turned out to act as full mediators of the relationship between regular milk consumption and total body BMD (z = -1.7148, -1.3208, and -1.8549, respectively; ≤ 0.05). In conclusion, milk consumption, per se, does not seem to have a direct effect on bone development, because its association seems to be fully mediated by body composition variables in young adults.
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http://dx.doi.org/10.3390/nu11102500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835529PMC
October 2019

Effectiveness of pharmacological treatments in Duchenne muscular dystrophy: a protocol for a systematic review and meta-analysis.

BMJ Open 2019 09 6;9(9):e029341. Epub 2019 Sep 6.

Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.

Introduction: In recent years, important advances have been made in the treatment of Duchenne muscular dystrophy (DMD). This protocol proposes a methodology for carrying out a systematic review and meta-analysis that aims to: (1) improve the evidence of the benefits of different pharmacological treatments in boys with DMD, and (2) compare the benefit of treatments specifically aimed at delaying the progression of disease in the functional outcomes.

Methods And Analysis: This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and by the Cochrane Collaboration Handbook. A thorough selection of the literature will be done through the MEDLINE, EMBASE and Web of Science databases. The search will be conducted in English and Spanish. The Risk of Bias 2.0 tool from the Cochrane Collaboration will be used to assess the risk of bias. A narrative synthesis of the data will be performed. Meta-analysis will be conducted for effect of treatment on the 6 min walking distance (6MWD), North Star Ambulatory Assessment and Timed Functional Tests. Subgroup analyses will be performed by age or baseline values of the 6MWD, and overall bias.

Ethics And Dissemination: The approval of an ethical committee is not required. All the included trials will comply with the current ethical standards and the Declaration of Helsinki. The results of this proposed systematic review and meta-analysis will provide a general overview and evidence concerning the effectiveness of pharmacological treatments in Duchenne muscular dystrophy. Findings will be disseminated to academic audiences through peer-reviewed publications, as well as to clinical audiences, patients' associations and policy makers, and may influence guideline developers in order to improve outcomes for these patients.

Prospero Registration Number: CRD42018102207.
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http://dx.doi.org/10.1136/bmjopen-2019-029341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731948PMC
September 2019

Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review.

J Physiother 2018 10 13;64(4):222-228. Epub 2018 Sep 13.

Social and Health Care Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile.

Question: In intubated adult patients receiving mechanical ventilation, does multimodality respiratory physiotherapy prevent ventilator-associated pneumonia, shorten length of intensive care unit (ICU) stay, and reduce mortality?

Design: A systematic review with meta-analysis of randomised controlled trials.

Participants: Intubated adult patients undergoing mechanical ventilation who were admitted to an intensive care unit.

Intervention: More than two respiratory physiotherapy techniques such as positioning or postural drainage, manual hyperinflation, vibration, rib springing, and suctioning.

Outcomes Measures: Incidence of ventilator-associated pneumonia (VAP), duration of ICU stay, and mortality.

Results: Five trials were included in the meta-analysis. Random-effects models were used to calculate pooled weighted mean difference (WMD) for length of ICU stay and pooled risk ratio (RR) for incidence of VAP, and fixed-effects model was used to calculate pooled RR for mortality. The effect on the incidence of VAP was unclear (RR 0.73 in favour of multimodality respiratory physiotherapy, 95% CI 0.38 to 1.07). The effect on length of stay was also unclear (WMD -0.33days shorter with multimodality respiratory physiotherapy, 95% CI -2.31 to 1.66). However, multimodality respiratory physiotherapy significantly reduced mortality (RR 0.75, 95% CI 0.58 to 0.92).

Conclusion: Multimodality respiratory physiotherapy appeared to reduce mortality in ICU patients. It was unclear whether this occurred via a reduction in the incidence of VAP and/or length of stay because the available data provided very imprecise estimates of the effect of multimodality respiratory physiotherapy on these outcomes. These very imprecise estimates include the possibility of very worthwhile effects on VAP incidence and length of ICU stay; therefore, these outcomes should be the focus of further investigation in rigorous trials.

Registration: PROSPERO CRD42018094202. [Pozuelo-Carrascosa DP, Torres-Costoso A, Alvarez-Bueno C, Cavero-Redondo I, López Muñoz P, Martínez-Vizcaíno V (2018) Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review. Journal of Physiotherapy 64: 222-228].
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http://dx.doi.org/10.1016/j.jphys.2018.08.005DOI Listing
October 2018

Agreement Between Dual-Energy X-Ray Absorptiometry and Quantitative Ultrasound to Evaluate Bone Health in Adolescents: The PRO-BONE Study.

Pediatr Exerc Sci 2018 11 26;30(4):466-473. Epub 2018 May 26.

2 University of Exeter.

Purpose: The present study aims to investigate the association between dual-energy X-ray absorptiometry (DXA) and quantitative ultrasound (QUS) parameters and the intermethods agreement in active males.

Methods: In this cross-sectional study, bone health (by DXA and calcaneal QUS), physical activity (by accelerometers), and anthropometrics measurements were assessed in 117 active adolescents (12-14 y old). Bivariate correlation coefficients were calculated to assess the relationships between DXA standard regions of interest and QUS parameters. Intraclass correlation coefficients and Bland-Altman plots were used to assess the level of agreement between bone mineral content regions derived from DXA and stiffness index. The measurements were z score transformed for comparison.

Results: Most QUS parameters were positive and significantly correlated with DXA outcomes (stiffness index: r = .43-.52; broadband ultrasound attenuation: r = .50-.58; speed of sound: r = .25-.27) with the hip showing the highest correlations. Moreover, the present study found fair to good intraclass correlation coefficients of agreement (.60-.68) between DXA and QUS to assess bone health. The Bland-Altman analysis showed a limited percentage of outliers (3.2%-8.6%).

Conclusion: QUS device could represent an acceptable alternative method to assess bone health in active adolescent males.
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http://dx.doi.org/10.1123/pes.2017-0217DOI Listing
November 2018

Agreement Between Standard Body Composition Methods to Estimate Percentage of Body Fat in Young Male Athletes.

Pediatr Exerc Sci 2018 08 15;30(3):402-410. Epub 2018 Mar 15.

3 University of Zaragoza.

Purpose: To examine the intermethods agreement of dual-energy X-ray absorptiometry (DXA) and foot-to-foot bioelectrical impedance analysis (BIA) to assess the percentage of body fat (%BF) in young male athletes using air-displacement plethysmography (ADP) as the reference method.

Methods: Standard measurement protocols were carried out in 104 athletes (40 swimmers, 37 footballers, and 27 cyclists, aged 12-14 y).

Results: Age-adjusted %BF ADP and %BF BIA were significantly higher in swimmers than footballers. ADP correlates better with DXA than with BIA (r = .84 vs r = .60, P < .001). %BF was lower when measured by DXA and BIA than ADP (P < .001), and the bias was higher when comparing ADP versus BIA than ADP versus DXA. The intraclass correlation coefficients between DXA and ADP showed a good to excellent agreement (r = .67-.79), though it was poor when BIA was compared with ADP (r = .26-.49). The ranges of agreement were wider when comparing BIA with ADP than DXA with ADP.

Conclusion: DXA and BIA seem to underestimate %BF in young male athletes compared with ADP. Furthermore, the bias significantly increases with %BF in the BIA measurements. At the individual level, BIA and DXA do not seem to predict %BF precisely compared with ADP in young athletic populations.
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http://dx.doi.org/10.1123/pes.2017-0171DOI Listing
August 2018

The risk of eating disorders and bone health in young adults: the mediating role of body composition and fitness.

Eat Weight Disord 2019 Dec 13;24(6):1145-1154. Epub 2017 Nov 13.

Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.

Purpose: To analyze the independent relationship between the risk of eating disorders and bone health and to examine whether this relationship is mediated by body composition and cardiorespiratory fitness (CRF).

Methods: In this cross-sectional study, bone-related variables, lean mass, fat mass (by DXA), risk of eating disorders (SCOFF questionnaire), height, weight, waist circumference and CRF were measured in 487 university students aged 18-30 years from the University of Castilla-La Mancha, Spain. ANCOVA models were estimated to test mean differences in bone mass categorized by body composition, CRF or risk of eating disorders. Subsequently, linear regression models were fitted according to Baron and Kenny's procedures for mediation analysis.

Results: The marginal estimated mean ± SE values of total body bone mineral density for the categories "no risk of eating disorders" and "risk of eating disorders" were 1.239 ± 0.126 < 1.305 ± 0.089, P = 0.021. However, this relationship disappeared after adjustment for any of the parameters of body composition or CRF. Therefore, all body composition parameters (except for lean mass) and CRF turned out to be full mediators in the association between the risk of eating disorders and bone health in young adults.

Conclusions: Body composition and CRF mediate the association between the risk of eating disorders and bone health. These findings highlight the importance of maintaining a healthy weight and good CRF for the prevention of the development of eating disorders and for the maintenance of good bone health in young adults.

Level Of Evidence: Level V, cross-sectional descriptive study.
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http://dx.doi.org/10.1007/s40519-017-0458-xDOI Listing
December 2019

Accuracy of Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis.

Arch Phys Med Rehabil 2018 04 22;99(4):758-765.e10. Epub 2017 Sep 22.

Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.

Objective: To evaluate the accuracy of inlet and outlet ultrasonography measurements for the diagnosis of carpal tunnel syndrome (CTS).

Data Sources: MEDLINE, EMBASE, the Cochrane Library, and the Web of Science databases were systematically searched from inception to February 2017.

Study Selection: Observational studies comparing the diagnostic accuracy of inlet and outlet ultrasonography measurements were selected.

Data Extraction: Random-effects models for the diagnostic odds ratio (dOR) values computed by Moses' constant for a linear model and 95% confidence intervals (CIs) were used to calculate the accuracy of the test. Hierarchical summary receiver operating characteristic curves were used to summarize overall test performance.

Data Synthesis: Twenty-eight published studies were included in the meta-analysis. The pooled dOR values for the diagnosis of CTS were 31.11 (95% CI, 20.42-47.40) for inlet-level and 16.94 (95% CI, 7.58-37.86) for outlet-level measurements. The 95% confidence region for the point that summarizes overall test performance of the included studies occurred where the cutoffs ranged from 9.0 to 12.6mm for inlet-level measurements and from 9.5 to 10.0mm for outlet-level measurements.

Conclusions: Both ultrasonography measurements for the diagnosis of CTS showed sufficient accuracy for their use in clinical settings, although the overall accuracy was slightly higher for inlet-level than for outlet-level measurements. The addition of outlet and inlet measurements does not increase the accuracy for the diagnosis. Therefore, the inlet-level ultrasonography measurement appears to be an appropriate method for the diagnosis of CTS.
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http://dx.doi.org/10.1016/j.apmr.2017.08.489DOI Listing
April 2018

Lean mass explains the association between muscular fitness and bone outcomes in 13-year-old boys.

Acta Paediatr 2017 Oct 30;106(10):1658-1665. Epub 2017 Jul 30.

Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, UK.

Aim: This study investigated the associations between fitness indices and bone outcomes in young males.

Methods: Data were collected between autumn and winter 2014-2015 on 121 males with a mean age of 13.1 ± 0.1 years: 41 swimmers, 37 footballers, 29 cyclists and 14 nonathletes. Participants were recruited from athletic clubs and schools across South West England. Lean mass, areal bone mineral density and hip structural estimates were measured using dual-energy X-ray absorptiometry. The relationships between bone outcomes and the vertical jump, standing long jump and the 20-m shuttle run test were analysed using three regression models: model 1 was adjusted by age and stature, model 2 added vigorous physical activity and model 3 then added lean mass.

Results: The boys' performance in the vertical jump and standing long jump was positively associated with the majority of bone outcomes in models 1 and 2, but most of these disappeared in model 3. The 20-m shuttle run test was positively associated with most bone outcomes in all three models. Lean mass played a key role in the association between muscular fitness and bone outcomes.

Conclusion: Vigorous physical activity did not explain the associations between fitness and bone outcomes, but lean mass did.
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http://dx.doi.org/10.1111/apa.13972DOI Listing
October 2017

Association between physical activity, sedentary behavior, and fitness with health related quality of life in healthy children and adolescents: A protocol for a systematic review and meta-analysis.

Medicine (Baltimore) 2017 Mar;96(12):e6407

Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, USACH, Santiago, Chile School of Nursing and Physiotherapy, Universidad de Castilla-La Mancha, Toledo School of Education, Universidad de Castilla-La Mancha, Ciudad Real, Castilla-La Mancha, Spain.

Background: Health related quality of life (HRQoL) is a subjective, multidimensional and changing over time construct. When HRQoL is decreased, a child is less likely to be able to develop normally and mature into a healthy adult. Physical inactivity is a priority public health problem. Evidence suggests how even moderate levels of physical activity or high fitness levels are associated with benefits for the health in children and adolescents. The aims of this systematic review are to examine the evidence about the relationship between physical activity, sedentary behavior, and fitness with HRQoL, and estimate the effects of interventions that have tested the effectiveness of the increase of the physical activity, the improvement of the physical fitness or the avoidance of sedentary behaviors in HRQoL in healthy subjects aged under 18 years old.

Methods: This systematic review and meta-analysis protocol was conducted following the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. To identify relevant studies, the following electronic databases will be searched: MEDLINE, EMBASE, Cochrane Database, Web of Science, and PEDro. Reference lists of relevant studies will be examined for links to potential related articles. The methodological quality of the observational included studies will be scored using a quality assessment checklist. For the intervention studies, the risk of bias will be estimated using The Cochrane Collaboration tool for assessing risk of bias. Reviewers will determine whether a meta-analysis is possible when data have been extracted. If it is, subgroup analyses will be carried out by age and socioeconomic status, and by the different dimensions of the HRQoL. If is not possible, a descriptive analysis will be conducted.

Conclusion: To our knowledge, this systematic review and meta-analysis will be the first that synthesizes the existing results about the relationship between physical activity, sedentary behavior, physical fitness, and HRQoL, and the effect of physical activity interventions on HRQoL, in healthy subjects under 18 years old. This study will clarify this relationship and will provide evidence for decision-making. Limitations may include the quality of the selected studies and their characteristics. Only studies published in English and Spanish will be included.

Systematic Review Registration: PROSPERO CRD42015025823.
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http://dx.doi.org/10.1097/MD.0000000000006407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371476PMC
March 2017

Insulin and bone health in young adults: The mediator role of lean mass.

PLoS One 2017 21;12(3):e0173874. Epub 2017 Mar 21.

Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain.

Background: The positive relationship between lean mass (LM) and bone health is well known, but a positive association between insulin and LM has also been described. Insulin has some anabolic properties on bone through the stimulation of osteoblast differentiation, yet the role of LM as a confounder or mediator in this relationship remains uncertain.

Objective: To examine whether the association between insulin levels and bone health is mediated by LM.

Methods: A cross-sectional study was conducted at the Castilla La Mancha University (Spain) involving 466 young adults (113 young men; 19.5±2.3 years). LM and total-body bone mineral content (BMC) were measured by dual energy x-ray absorptiometry, and insulin was measured in fasting serum samples.

Results: Young adults with high total LM had higher values of total-body BMC than their peers after controlling for age and sex, this relationship persisted after adjusting for insulin levels (p<0.001). In mediation analyses, insulin levels were positively associated with total-body BMC (b = 0.05; p<0.001) and total LM acted as an intermediate variable, attenuating the association between insulin levels and total-body BMC (b = -31.98; p>0.05) as indicated by Sobel test values for indirect effect (z = 4.43; p<0.001).

Conclusions: LM plays an important role in the relationship between insulin levels and bone health, in such a way that while increases in LM have a positive influence on bone health, they are also negatively associated with insulin levels.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0173874PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5360249PMC
August 2017

Obesity as a Mediator between Cardiorespiratory Fitness and Blood Pressure in Preschoolers.

J Pediatr 2017 Mar 29;182:114-119.e2. Epub 2016 Nov 29.

Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain; Faculty of Health Sciences, Autonomous University of Chile, Talca, Chile. Electronic address:

Objectives: To analyze the relationships between body mass index (BMI), cardiorespiratory fitness (CRF), and blood pressure (BP), and to examine whether obesity acts as a mediator between fitness and BP in children.

Study Design: A cross-sectional analysis using a population-based sample of 1604 school children aged 4-7 years attending 21 schools from the provinces of Ciudad Real and Cuenca, Spain, was undertaken. Data on anthropometric variables, BP measurements, and CRF were collected. The relationships between body composition (BMI, percent body fat, and waist circumference), CRF, and mean arterial pressure was estimated using Pearson correlation coefficients. ANCOVA tested the differences in BP measurements by categories of BMI and CRF, controlling for different sets of confounders. The PROCESS macro developed by Preacher and Hayes was used for mediation analysis.

Results: BP values were significantly higher in school children with excess weight and poorer CRF. In addition, BMI acts as a full mediator in the association between CRF and mean arterial pressure in boys at 62.28% (z = -5.433; P ≤ .001) and a partial mediator in girls at 35.24% (z = -5.246; P ≤ .001).

Conclusions: BMI mediates the relationship between CRF and mean arterial pressure. These findings highlight the importance of maintaining a healthy weight for the prevention of high BP levels in childhood.

Trial Registration: ClinicalTrials.gov: NCT01971840.
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http://dx.doi.org/10.1016/j.jpeds.2016.11.005DOI Listing
March 2017

Physical activity and bone health in schoolchildren: the mediating role of fitness and body fat.

PLoS One 2015 27;10(4):e0123797. Epub 2015 Apr 27.

Social and Health Care Research Center, University of Castilla La-Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile.

Background: The relationship between physical activity (PA) and bone health is well known, although the role of percent body fat (%BF) and fitness as confounders or mediators in this relationship remains uncertain.

Objective: To examine whether the association between PA and bone mineral content (BMC) is mediated by %BF and cardiorespiratory fitness (CRF).

Methods: In this cross sectional study, BMC, total %BF (by DXA), vigorous PA (VPA), CRF, age and height were measured in 132 schoolchildren (62 boys, aged 8-11 years). ANCOVA was used to test differences in BMC by %BF, CRF and VPA, controlling for different sets of confounders. Simple mediation analyses and serial multiple mediation analyses were fitted to examine whether the relationship between PA and BMC is mediated by %BF and fitness.

Results: Children with high %BF had higher total body BMC than their peers after controlling for all sets of confounders. Children with good CRF or VPA had significantly less total body BMC after controlling for age and sex but in children with good CRF this inverse relation disappeared after adjusting by %BF. %BF and CRF both act as a full mediator in the association between VPA and BMC, after inclusion of the potential confounders in the models.

Conclusion: Fitness and %BF seem to have a mediator role on the relationship between physical activity and bone mass.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0123797PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411135PMC
January 2016

Lean mass as a total mediator of the influence of muscular fitness on bone health in schoolchildren: a mediation analysis.

J Sports Sci 2015 11;33(8):817-30. Epub 2014 Nov 11.

a School of Nursing and Physiotherapy , University of Castilla La Mancha , Toledo , Spain.

This report aims to analyse the independent association of lean mass and muscle fitness with bone mineral content (BMC) and bone mineral density (BMD), and to examine whether the relationship between muscle fitness and bone health is mediated by lean mass. Body composition (by dual energy X-ray absorptiometry (DXA)), muscle fitness, physical activity, age and height were measured in 132 schoolchildren (62 boys, aged 8-11 years). Analysis of covariance tested differences in bone-related variables by lean mass and muscle fitness, controlling for different sets of confounders. Linear regression models fitted for mediation analyses examined whether the association between muscle fitness and bone mass was mediated by lean mass. Children with good performance in handgrip and standing long jump had better and worse bone health, respectively. These differences disappeared after controlling for lean mass. Children with high lean mass had higher values in all bone-related variables. In addition, the relationship between muscle fitness and bone mass was fully mediated by lean mass. In conclusion, the relationship between upper-limbs muscle fitness and bone health seems to be dependent on lean mass but not on muscle fitness. Schoolchildren with high lean mass have more BMC and BMD in all regions. Lean mass mediates the association between muscle fitness and bone mass.
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http://dx.doi.org/10.1080/02640414.2014.964750DOI Listing
December 2015
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