Publications by authors named "Enrique G Artero"

60 Publications

Impact of exercise training after bariatric surgery on cardiometabolic risk factors: a systematic review and meta-analysis of controlled trials.

Rev Endocr Metab Disord 2021 Apr 16. Epub 2021 Apr 16.

Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.

The purpose of this systematic review was to provide updated evidence synthesis of the effectiveness of exercise training in patients with obesity undergoing bariatric surgery to improve cardio-metabolic risk. We systematically searched the MEDLINE, EMBASE, Scopus, Cochrane, and Web of Science databases. The studies selected were those in which an exercise-based intervention was performed after bariatric surgery, a control group was present, and at least one of the following outcomes was investigated: VO or VO, resting heart rate (RHR), blood pressure, lipid profile, glucose, and insulin. The study quality was assessed using the PEDro scale and the data were meta-analyzed with a random effects model, comparing control groups to intervention groups using standardized measurements. Twenty articles were included in the systematic review and fourteen (70%) in the meta-analysis. Significant differences were observed between the control and intervention groups (always in favor of exercise) for absolute VO / VO (ES = 0.317; 95% CI = 0.065, 0.569; p = 0.014), VO / peak relative to body weight (ES = 0.673; 95% CI = 0.287, 1.060; p = 0.001), HDL cholesterol (ES = 0.22; 95% CI = 0.009, 0.430; p = 0.041) and RHR (ES = -0.438; 95% CI = -0.753, -0.022; p = 0.007). No effects were observed for either systolic or diastolic blood pressure. Exercise training for patients undergoing bariatric surgery appears to be effective in improving absolute and relative VO / VO, HDL cholesterol and reducing the RHR. More intervention studies using (better) exercise interventions are needed before discarding their effects on other cardiometabolic risk factors. This systematic review and meta-analysis has been registered in Prospero (CRD42020153398).
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http://dx.doi.org/10.1007/s11154-021-09651-3DOI Listing
April 2021

Ideal cardiovascular health in women with systemic lupus erythematosus: Association with arterial stiffness, inflammation, and fitness.

Int J Cardiol 2021 May 20;330:207-213. Epub 2021 Feb 20.

Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain; SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain.

Background: Systemic Lupus Erythematosus (SLE) is closely related to cardiovascular morbidity and mortality. We aimed to examine the association of ideal cardiovascular health (ICH) with arterial stiffness, inflammation, and physical fitness in women with SLE.

Methods: This cross-sectional study included 76 women with SLE (age 43.4±13.8 years old). Ideal levels of 7 health metrics (smoking, body mass index, physical activity, healthy diet, blood pressure, cholesterol, and glucose) were used to define the ICH score (ranging from 0 to 7 ideal metrics) and the ICH status ( defined as presenting ≥4 ideal metrics). Arterial stiffness was measured through pulse wave velocity (PWV) and inflammation through serum high sensitivity C-reactive protein (hs-CRP). Cardiorespiratory fitness (CRF) was measured by 6-min walk test (6MWT), and Siconolfi step test and muscular strength by handgrip strength and 30-s chair stand, and range of motion (ROM) by the back-scratch test.

Results: Higher ICH score was associated with lower PWV (β = -0.122, p = 0.002), lower hs-CRP (β = -0.234, p = 0.056), higher CRF [6MWT (β = 0.263, p = 0.041); Siconolfi step test (β = 0.330, p < 0.001)], higher ROM (β = 0.278, p = 0.013) and higher relative handgrip strength (β = 0.248, p = 0.024). Women with ICH status presented lower PWV (mean difference 0.40 m/s, 95% CI 0.17 to 0.63, p = 0.001), and higher CRF [assessed by 6MWT (mean difference 43.9 m, 95% CI 5.0 to 82.7, p = 0.028)], than women with non-ICH status. Sensitivity analyses using ICH score ranging 0-14 and considering ICH status with ≥5 metrics revealed consistent results.

Conclusion: ICH is associated with lower arterial stiffness, lower inflammation, and higher fitness in women with SLE. Although these results extend current knowledge about the potential role of ICH for primordial prevention of CVD in SLE, they are yet to be confirmed in future prospective research .
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http://dx.doi.org/10.1016/j.ijcard.2021.02.040DOI Listing
May 2021

Heart Rate Variability in Women with Systemic Lupus Erythematosus: Association with Health-Related Parameters and Effects of Aerobic Exercise.

Int J Environ Res Public Health 2020 12 18;17(24). Epub 2020 Dec 18.

Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain.

Abnormal heart rate variability (HRV) has been observed in patients with systemic lupus erythematosus (SLE). In a combined cross-sectional and interventional study approach, we investigated the association of HRV with inflammation and oxidative stress markers, patient-reported outcomes, and the effect of 12 weeks of aerobic exercise in HRV. Fifty-five women with SLE (mean age 43.5 ± 14.0 years) were assigned to either aerobic exercise ( = 26) or usual care ( = 29) in a non-randomized trial. HRV was assessed using a heart rate monitor during 10 min, inflammatory and oxidative stress markers were obtained, psychological stress (Perceived Stress Scale), sleep quality (Pittsburg Sleep Quality Index), fatigue (Multidimensional Fatigue Inventory), depressive symptoms (Beck Depression Inventory), and quality of life (36-item Short-Form Health Survey) were also assessed. Low frequency to high frequency power (LFHF) ratio was associated with physical fatigue ( = 0.019). Sample entropy was inversely associated with high-sensitivity C-reactive protein ( = 0.014) and myeloperoxidase ( = 0.007). There were no significant between-group differences in the changes in HRV derived parameters after the exercise intervention. High-sensitivity C-reactive protein and myeloperoxidase were negatively related to sample entropy and physical fatigue was positively related to LFHF ratio. However, an exercise intervention of 12 weeks of aerobic training did not produce any changes in HRV derived parameters in women with SLE in comparison to a control group.
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http://dx.doi.org/10.3390/ijerph17249501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766283PMC
December 2020

Muscular Strength and Cardiovascular Disease: AN UPDATED STATE-OF-THE-ART NARRATIVE REVIEW.

J Cardiopulm Rehabil Prev 2020 09;40(5):302-309

Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond (Drs Carbone, Kirkman, Garten, and Rodriguez-Miguelez); VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond (Dr Carbone); Department of Education, Faculty of Education Sciences, University of Almería, and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain (Dr Artero); Department of Kinesiology, Iowa State University, Ames (Dr Lee); and John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, Louisiana (Dr Lavie).

This review discusses the associations of muscular strength (MusS) with cardiovascular disease (CVD), CVD-related death, and all-cause mortality, as well as CVD risk factors, such as metabolic syndrome, diabetes, obesity, and hypertension. We then briefly review the role of resistance exercise training in modulating CVD risk factors and incident CVD.The role of MusS has been investigated over the years, as it relates to the risk to develop CVD and CVD risk factors. Reduced MusS, also known as dynapenia, has been associated with increased risk for CVD, CVD-related mortality, and all-cause mortality. Moreover, reduced MusS is associated with increased cardiometabolic risk. The majority of the studies investigating the role of MusS with cardiometabolic risk, however, are observational studies, not allowing to ultimately determine association versus causation. Importantly, MusS is also essential for the identification of nutritional status and body composition abnormalities, such as frailty and sarcopenia, which are major risk factors for CVD.
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http://dx.doi.org/10.1097/HCR.0000000000000525DOI Listing
September 2020

Prediction of cardiovascular health by non-exercise estimated cardiorespiratory fitness.

Heart 2020 Dec 2;106(23):1832-1838. Epub 2020 Jul 2.

Cardiovascular and Nutritional Epidemiology, IMDEA-Food, Madrid, Spain.

Objective: To estimate the incidence of major biological cardiovascular disease (CVD) risk factors in adults using non-exercise estimated cardiorespiratory fitness (eCRF).

Methods: 200 039 healthy people (99 957 women), aged ≥18 years (38.5±12.1 years) from the Taiwan MJ Cohort. eCRF was estimated with validated algorithms. Biological CVD risk factors, including hypertension (HTN), hypercholesterolemia, atherogenic dyslipidaemia, type 2 diabetes mellitus (T2DM) and systemic inflammation, were assessed by standardised physical examinations and laboratory tests.

Results: In a basic model, baseline eCRF was inversely associated with the incidence of each CVD risk factor in both men and women (HR per 1 metabolic equivalent (MET) increase in eCRF ranged from 0.53 for T2DM in women to 0.96 for hypercholesterolemia in women). In full adjusted models, the associations were attenuated but remained statistically significant, with the exception of hypercholesterolemia in women. In a subcohort of 116 313 individuals with two repeated exposure measurements, an increase in eCRF was associated in both sexes with a subsequent lower incidence of CVD risk factors (HR per 1-MET increase ranged from 0.58 to 0.91 in models adjusted for age, year of examination and baseline eCRF). Comparisons of predictive performance showed that the addition of eCRF to values of traditional CVD risk factors had relevant improvements in risk discrimination (C-index increased from 0.1% to 3.2%), mainly for HTN and T2DM risk prediction.

Conclusions: eCRF and its changes predict the incidence of biological CVD risk factors, especially HTN and T2DM. Routine assessment of eCRF in clinical settings is technically feasible and might be useful for CVD prevention.
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http://dx.doi.org/10.1136/heartjnl-2020-316871DOI Listing
December 2020

Improvements in Heart Rate Variability in Women with Obesity: Short-term Effects of Sleeve Gastrectomy.

Obes Surg 2020 Oct;30(10):4038-4045

Physical Therapy Department, Universidad de Chile, Independencia 1027, 8380453, Santiago, Chile.

Purpose: Obesity has been associated with reduced vagal function and increased sympathetic activity. Cardiac autonomic dysfunction has emerged as a major risk factor in the development of cardiovascular disease. Cardiac autonomic function (CAF) can be assessed by heart rate variability (HRV), an independent predictor of mortality based on changes in time intervals between adjacent heartbeats (RR). Bariatric surgery is considered the most effective treatment for obesity and its comorbidities, with sleeve gastrectomy (SG) being the most frequent bariatric procedure. There are few studies on HRV changes in women with obesity after SG. The aim of this study was to evaluate the short-term impact of SG on CAF and its relationship with weight loss.

Materials And Methods: An observational cohort study was conducted. Twenty-three female patients were assessed before SG and at 1 and 3 months after surgery. CAF was evaluated by analyzing HRV from 5-min records of RR intervals while the subject was supine. HRV was analyzed in time and frequency domains and with a nonlinear method.

Results: Patients (36.0 ± 11.1 years old, BMI 35.1 ± 3.4 kg/m) presented higher HRV values, on average, in all domains both at 1 and 3 months after SG (p < 0.05). In addition, all anthropometric parameters improved (p < 0.001) although there was no relationship between HRV improvements and anthropometric changes.

Conclusion: SG seems to be effective at reducing excess weight and improving HRV at the short term, and these changes are detectable as early as the first month after surgery. HRV assessment appears as a promising low-cost tool that deserves further research.
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http://dx.doi.org/10.1007/s11695-020-04721-yDOI Listing
October 2020

The relative age effect on physical fitness in preschool children.

J Sports Sci 2020 Jul 20;38(13):1506-1515. Epub 2020 Apr 20.

LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid , Madrid, Spain.

The aim of the present study was to investigate the existence of a relative age effect (RAE) on physical fitness of preschoolers. Anthropometry and physical fitness were assessed in 3147 children (3-5 years old) using the PREFIT battery. Based on the birth year, participants were divided into 3year groups (3-, 4- and 5-years). Within each year group, 4quarter groups were created: quarter 1, preschoolers born from January to March; quarter 2, from April to June; quarter 3, from July to September; quarter 4, from October to December. The MANCOVA analysis revealed a main effect of year group (Wilks' λ = 0.383; F = 369.64; p < 0.001, η = 0.381) and of quarter (Wilks' λ = 0.874; F = 27.67; p < 0.001; η = 0.044) over the whole battery of tests. To the best of our knowledge, this is the first study to report the existence of RAE at the preschool stage. In general, performance improved as the relative age increased (i.e., those born in quarter 1 performed better than those in the other quarters). Individualization strategies should be addressed within the same academic year not only in elementary or secondary years but also in preschoolers.
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http://dx.doi.org/10.1080/02640414.2020.1746559DOI Listing
July 2020

Physical Exercise following bariatric surgery in women with Morbid obesity: Study protocol clinical trial (SPIRIT compliant).

Medicine (Baltimore) 2020 Mar;99(12):e19427

Obstetrics and Gynecology Unit, Torrecárdenas University Hospital, Almería.

Background: Severe and morbid obesity are increasing globally, particularly in women. As BMI increases, the likelihood of anovulation is higher. The primary aim of the EMOVAR clinical trial is to examine, over the short (16 weeks) and medium (12 months) term, the effects of a supervised physical exercise program (focused primarily on aerobic and resistance training) on ovarian function in women with severe/morbid obesity who have undergone bariatric surgery. Secondary objectives are to examine the effects of the intervention on chronic inflammation, insulin resistance, arterial stiffness, physical fitness, and health-related quality of life.

Methods: This is a randomized controlled trial in which ∼40 female bariatric surgery patients, aged between 18 and 45 years old, will be included. Participants assigned to the experimental group will perform a total of 48 sessions of supervised concurrent (strength and aerobic) training (3 sessions/week, 60 min/session) spread over 16 weeks. Patients assigned to the control group will receive lifestyle recommendations. Outcomes will be assessed at baseline, week 16 (i.e., after the exercise intervention) and 12 months after surgery. The primary outcome is ovarian function using the Sex-Hormone Binding Globuline, measured in serum. Secondary outcomes are serum levels of anti-mullerian hormone, TSH, T4, FSH, LH, estradiol, prolactine, and free androgen index, as well as oocyte count, the diameters of both ovaries, endometrial thickness, and uterine arterial pulsatility index (obtained from a transvaginal ultrasound), the duration of menstrual bleeding and menstrual cycle duration (obtained by personal interview) and hirsutism (Ferriman Gallwey Scale). Other secondary outcomes include serum markers of chronic inflammation and insulin resistance (i.e., C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin, glomerular sedimentation rate, glucose, insulin and the HOMA-IR), arterial stiffness, systolic, diastolic and mean blood pressure, body composition, and total weight loss. Physical fitness (including cardiorespiratory fitness, muscular strength, and flexibility), health-related quality of life (SF-36 v2) and sexual function (Female Sexual Function Index) will also be measured.

Discussion: This study will provide, for the first time, relevant information on the effects of exercise training on ovarian function and underlying mechanisms in severe/morbid obese women following bariatric surgery.

Trial Registration Number: ISRCTN registry (ISRCTN27697878).
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http://dx.doi.org/10.1097/MD.0000000000019427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220774PMC
March 2020

Supervised exercise following bariatric surgery in morbid obese adults: CERT-based exercise study protocol of the EFIBAR randomised controlled trial.

BMC Surg 2019 Sep 5;19(1):127. Epub 2019 Sep 5.

Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.

Background: There is increasing evidence of weight regain in patients after bariatric surgery (BS), generally occurring from 12 to 24 months postoperatively. Postoperative exercise has been suggested to ad long-term weight maintenance and to improve physical function in BS patients. However, there are a limited number of intervention studies investigating the possible benefits of exercise in this population. The aim of the current report is to provide a comprehensive CERT (Consensus on Exercise Reporting Template)-based description of the rationale and details of the exercise programme implemented in the EFIBAR Study (Ejercicio FÍsico tras cirugía BARiátrica), a randomised controlled trial investigating the effects of a 16-week supervised concurrent (aerobic and strength) exercise intervention program on weight loss (primary outcome), body composition, cardiometabolic risk, physical fitness, physical activity and quality of life (secondary outcomes) in patients with severe/morbid obesity following bariatric surgery.

Methods: A total of 80 BS patients [60-80% expected women, aged 18 to 60 years, body mass index (BMI) ≥ 40 kg/m or ≥ 35 kg/m with comorbid conditions)] will be enrolled in the EFIBAR Randomized Control Trial (RCT). Participants allocated in the exercise group (n = 40) will undertake a 16-week supervised concurrent (strength and aerobic) exercise programme (three sessions/week, 60 min/session), starting 7 to 14 days after surgery. The rationale of the exercise programme will be described following the CERT criteria detailing the 16 key items. The study has been reviewed and approved by the Ethics Committee of the Torrecárdenas University Hospital (Almería, Spain) (ref. N° 76/2016).

Discussion: The present study details the exercise programme of the EFIBAR RCT, which may serve: 1) exercise professionals who would like to implement an evidence-based exercise programme for BS patients, and 2) as an example of the application of the CERT criteria.

Trial Registration: The trial was prospectively registered at Clinicaltrials.gov NCT03497546 on April 13, 2018.
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http://dx.doi.org/10.1186/s12893-019-0566-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6729089PMC
September 2019

Correction to: Effects of Exercise Training on Weight Loss in Patients Who Have Undergone Bariatric Surgery: a Systematic Review and Meta-Analysis of Controlled Trials.

Obes Surg 2019 Nov;29(11):3778

Department of Education, Faculty of Education Sciences, University of Almería, Ctra. Sacramento s/n, La Cañada de San Urbano, 04120, Almería, Spain.

In the original article the name of author Enrique G. Artero was misspelled.
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http://dx.doi.org/10.1007/s11695-019-04130-wDOI Listing
November 2019

Influence of Body Composition on Arterial Stiffness in Middle-Aged Adults: Healthy UAL Cross-Sectional Study.

Medicina (Kaunas) 2019 Jul 3;55(7). Epub 2019 Jul 3.

Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain.

Several anthropometric and body composition parameters have been linked to arterial stiffness (AS) as a biomarker of cardiovascular disease. However, little is known about which of these closely related factors is more strongly associated with AS. The aim of the present study was to analyze the relationship of different anthropometric and body composition parameters with AS in middle-aged adults. This cross-sectional study included 186 middle-aged participants (85 women, 101 men; age = 42.8 ± 12.6 years) evaluated as part of the Healthy UAL study, a population study conducted at the University of Almería with the main purpose of analyzing the etiology and risk factors associated with cardio-metabolic diseases. Anthropometric measures included neck, waist, and hip circumferences, as well as the waist-to-height ratio (WHtr). Bioimpedance-derived parameters included fat-free mass index (FFMI), fat mass index (FMI), and percent of body fat (%BF). AS was measured by pulse wave velocity (PWV). The relationships of interest were examined through stepwise regression analyses in which age and sex were also introduced as potential confounders. Neck circumference (in the anthropometric model; : 0.889; : age = 0.855, neck = 0.204) and FFMI (in the bio-impedance model; : 0.891; : age = 0.906, FFMI = 0.199) emerged as significant cross-sectional predictors of AS. When all parameters were included together (both anthropometry and bio-impedance), both neck circumference and FFMI appeared again as being significantly associated with AS (: 0.894; : age = 0.882, FFMI = 0.126, neck = 0.093). It was concluded that FFMI and neck circumference are correlated with AS regardless of potential confounders and other anthropometric and bioimpedance-derived parameters in middle-aged adults.
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http://dx.doi.org/10.3390/medicina55070334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681323PMC
July 2019

Muscle strength field-based tests to identify European adolescents at risk of metabolic syndrome: The HELENA study.

J Sci Med Sport 2019 Aug 23;22(8):929-934. Epub 2019 Apr 23.

PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain; Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Sweden.

Objectives: To determine whether handgrip strength (HG) and/or standing long jump (SLJ) are capable of detecting risk of metabolic syndrome (MetS) in European adolescents, and to identify age- and sex-specific cut points for these tests.

Design: Cross-sectional study.

Methods: Participants included 969 (aged 12.5-17.5 years old) adolescents from 9 European countries (n = 520 girls). Absolute and relative HG and SLJ tests were used to assess upper and lower muscle strength, respectively. MetS status was determined using the age- and sex-specific cut points proposed by Jolliffe and Janssen´s, Additionally, we computed a continuous cardiometabolic risk index with the average z-score of four cardiometabolic risk factors: Wait circumference, mean arterial pressure, triglycerides/high-density lipoprotein cholesterol, and fasting insulin.

Results: The prevalence of MetS was 3.1% in European adolescents. Relative HG and absolute SLJ were the best tests for detecting the presence of MetS (Area under the receiver operating characteristic (AUC) = 0.799, 95%CI:0.773-0.824; and AUC = 0.695 95%CI:0.665-0.724), respectively) and elevated cardiometabolic risk index (AUC = 0.873, 95%CI:0.838-0.902; and AUC = 0.728 95%CI:0.698-0.756), respectively) and, regardless of cardiorespiratory fitness. We provide age- and sex-specific cut points of upper and lower muscle strength for European adolescents to identify the presence of MetS and elevated cardiometabolic risk index.

Conclusions: The proposed health-related cut points could be used as a starting point to define health-related levels of upper and lower muscle strength in adolescents. Likewise, the diagnostic statistics provided herein can be used to offer feedback to adolescents, parents, and education and health professionals about what it means to meet or fail test standards.
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http://dx.doi.org/10.1016/j.jsams.2019.04.008DOI Listing
August 2019

Prevalence of severe/morbid obesity and other weight status and anthropometric reference standards in Spanish preschool children: The PREFIT project.

Pediatr Res 2020 02 18;87(3):501-510. Epub 2019 Feb 18.

PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain and Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden.

Background: Childhood obesity has become a major health problem in children under the age of 5 years. Providing reference standards would help paediatricians to detect and/or prevent health problems related to both low and high levels of body mass and to central adiposity later in life. Therefore, the aim of this study was to examine the prevalence of different weight status categories and to provide sex- and age-specific anthropometry reference standards for Spanish preschool children.

Methods: A total of 3178 preschool children (4.59±0.87 years old) participated in this study. Prevalence of different degrees of obesity (mild, severe, and morbid) and other weight status categories were determined.

Results: Reference standards were obtained. Prevalence of overweight and obese preschool children in the Spanish population ranged from 21.4 to 34.8%. Specifically, the obesity prevalence was 3.5, 1.2, and 1.3% of these subjects were categorized as mild, severe, and morbid obese. Sex- and age-specific reference standards for anthropometric parameters are provided for every 0.25 years (i.e. every trimester of life).

Conclusion: Our results show a high prevalence of overweight/obese preschoolers. The provided sex- and age-specific anthropometric reference standards could help paediatricians to track and monitor anthropometric changes at this early stage in order to prevent overweight/obesity.
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http://dx.doi.org/10.1038/s41390-019-0325-8DOI Listing
February 2020

Associations between objectively measured and self-reported sleep with academic and cognitive performance in adolescents: DADOS study.

J Sleep Res 2019 08 4;28(4):e12811. Epub 2019 Jan 4.

LIFE Research Group, University Jaume I, Castellón, Spain.

Adequate sleep has been positively related with health and school achievement outcomes during adolescence. The aim of this study was to investigate the associations of objectively measured and self-reported sleep duration and quality with academic and cognitive performance in adolescents. This study was conducted with 257 adolescents (13.9 ± 0.3 years) from the DADOS study (Deporte, ADOlescencia y Salud). Objectively measured and self-reported sleep duration and quality were obtained by a wrist-worn GENEActiv accelerometer and the Spanish version of Pittsburgh Sleep Quality Index questionnaire, respectively. Academic performance was analysed through school records using four indicators: math, language, science and grade point average score. Cognitive performance was measured using the Spanish version of the "SRA Test of Educational Ability". After Benjamini-Hochberg correction for the false discovery rate, objectively measured sleep duration was negatively associated with verbal ability (β = -0.179, p = .004), whilst self-reported sleep quality was positively associated with academic performance (β ranging from 0.209 to 0.273; all p < .001). These associations remained significant after further controlling for physical fitness and physical activity. Conversely, there were no associations between self-reported sleep duration and objective sleep quality with academic and cognitive performance. Our findings fit in line with previous research showing that sleep quality may play an important role on adolescents' academic performance. Further interventional research is needed to clarify the mechanisms by which sleep is related to academic performance in youth.
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http://dx.doi.org/10.1111/jsr.12811DOI Listing
August 2019

Replicability of exercise programs following bariatric surgery.

Atherosclerosis 2018 11 26;278:330-331. Epub 2018 Aug 26.

Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain; SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain.

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http://dx.doi.org/10.1016/j.atherosclerosis.2018.08.026DOI Listing
November 2018

Grip strength cutpoints for youth based on a clinically relevant bone health outcome.

Arch Osteoporos 2018 08 27;13(1):92. Epub 2018 Aug 27.

Department of Health and Human Physiology, University of Iowa, 130 E FH, Iowa City, IA, 52242, USA.

The National Academy of Medicine recommends the handgrip for school-based surveillance of muscle strength for bone health. We established grip strength cutpoints that are linked to bone health in both US and European youth. These cutpoints could serve as a potential set of standards for surveillance and clinical applications.

Purpose: The U.S. National Academy of Medicine and experts in Europe recommend the use of grip strength as a valuable and accessible musculoskeletal fitness measure due to its association with bone health. This is the first study to facilitate this recommendation by developing bone health-related grip strength cutpoints for youth based on empirical associations with the well accepted marker of bone development, i.e., height-adjusted total body less head bone mineral content (TBLH_BMC).

Methods: A purposive sample of healthy youth from Midwest USA (n = 433 youth; 14.1 ± 2.3 years; 1998-2004) and a random sample of healthy adolescents from Zaragoza, Spain (n = 355 youth; 14.9 ± 1.2 years; 2006-2007) were used to develop and test cut-points. Participants' grip strength was measured using a hand-held dynamometer while height-adjusted TBLH_BMC was determined using dual-energy x-ray absorptiometry. Grip strength scores were linked to TBLH_BMC using receiver operator characteristic curves, and grip strength cutpoints were tested based on the area under the curve (AUC), sensitivity (Se), specificity (Sp), and predictive odds ratios. All analyses were conducted in 2016.

Results: The AUC approximated or exceeded 0.80 for grip strength cutpoints, and the associated Se and Sp indices ranged from 53.6 to 92.5%. Sensitivity and Sp remained similar in the validation sample and those not meeting the grip strength cutpoints were five to eight times more likely to have insufficient TBLH_BMC, depending on their sex and cutpoint being considered.

Conclusions: Grip strength is strongly related to TBLH_BMC, and the proposed cutpoints demonstrated acceptable classification accuracy for screening healthy youth and tracking healthy bone development in community settings. The utility of the cutpoints should be further examined in more diverse populations of youth.
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http://dx.doi.org/10.1007/s11657-018-0502-0DOI Listing
August 2018

The Effect of Physical Activity Interventions on Glycosylated Haemoglobin (HbA) in Non-diabetic Populations: A Systematic Review and Meta-analysis.

Sports Med 2018 May;48(5):1151-1164

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

Background: Physical activity is widely perceived to be beneficial for preventing type 2 diabetes mellitus and for controlling glycaemic levels in patients with type 2 diabetes, but evidence supporting a positive effect in the control of glycaemic levels in healthy people is rather weak. The aim of this review was to estimate the effect of physical activity on glycaemic control measured by glycosylated haemoglobin (HbA) levels in non-diabetic populations, and to determine which type of physical activity has a greater influence on glycaemic control.

Methods: We systematically searched the MEDLINE, EMBASE, Cochrane Library and Web of Science databases, from inception to May 2017, for experimental studies addressing the effect of physical activity on glycaemic control measured by HbA levels in non-diabetic populations. The DerSimonian and Laird method was used to compute pooled estimates of effect size (ES) and respective 95% confidence intervals (CIs). The effect of physical activity on HbA levels was estimated in two ways: (1) physical activity intervention versus control; and (2) physical activity pre-post intervention. Additionally, subgroup analyses were performed based on age of participants and different aspects of the intervention.

Results: Fifteen published studies were included in the meta-analysis. In analyses comparing physical activity intervention and control, we found a decrease of HbA levels in favour of the intervention group (ES = 0.32; 95% CI 0.01-0.62) with substantial heterogeneity (I = 63.2%; p = 0.008). In the pre-post analysis, there was a decrease in HbA levels post physical activity intervention (ES = 0.17; 95% CI 0.01-0.33) with low heterogeneity (I = 25.8%; p = 0.164). Additionally, for physical activity intervention versus control, a decrease in HbA levels was observed in resistance exercise and in intervention length below 12 weeks. Furthermore, for pre-post effect analyses, a decrease in HbA levels was observed in the supervised physical activity programme, other type of exercises, intervention length below 12 weeks and exercise intervention week duration above 150 min subgroups.

Conclusions: This systematic review and meta-analysis provides an overview of the evidence supporting physical activity as a suitable intervention for glycaemic control as measured by HbA levels in non-diabetic populations.

Trial Registration: PROSPERO CRD42016050991.
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http://dx.doi.org/10.1007/s40279-018-0861-0DOI Listing
May 2018

Association of Resistance Exercise, Independent of and Combined With Aerobic Exercise, With the Incidence of Metabolic Syndrome.

Mayo Clin Proc 2017 08 13;92(8):1214-1222. Epub 2017 Jun 13.

Department of Exercise Science, University of South Carolina, Columbia, SC; Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.

Objective: To determine the association of resistance exercise, independent of and combined with aerobic exercise, with the risk of development of metabolic syndrome (MetS).

Patients And Methods: The study cohort included adults (mean ± SD age, 46±9.5 years) who received comprehensive medical examinations at the Cooper Clinic in Dallas, Texas, between January 1, 1987, and December, 31, 2006. Exercise was assessed by self-reported frequency and minutes per week of resistance and aerobic exercise and meeting the US Physical Activity Guidelines (resistance exercise ≥2 d/wk; aerobic exercise ≥500 metabolic equivalent min/wk) at baseline. The incidence of MetS was based on the National Cholesterol Education Program Adult Treatment Panel III criteria. We used Cox regression to generate hazard ratios (HRs) and 95% CIs.

Results: Among 7418 participants, 1147 (15%) had development of MetS during a median follow-up of 4 years (maximum, 19 years; minimum, 0.1 year). Meeting the resistance exercise guidelines was associated with a 17% lower risk of MetS (HR, 0.83; 95% CI, 0.73-0.96; P=.009) after adjusting for potential confounders and aerobic exercise. Further, less than 1 hour of weekly resistance exercise was associated with 29% lower risk of development of MetS (HR, 0.71; 95% CI, 0.56-0.89; P=.003) compared with no resistance exercise. However, larger amounts of resistance exercise did not provide further benefits. Individuals meeting both recommended resistance and aerobic exercise guidelines had a 25% lower risk of development of MetS (HR, 0.75; 95% CI, 0.63-0.89; P<.001) compared with meeting neither guideline.

Conclusion: Participating in resistance exercise, even less than 1 hour per week, was associated with a lower risk of development of MetS, independent of aerobic exercise. Health professionals should recommend that patients perform resistance exercise along with aerobic exercise to reduce MetS.
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http://dx.doi.org/10.1016/j.mayocp.2017.02.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546793PMC
August 2017

Pain and Physical Function Following Bariatric Surgery.

JAMA 2016 Aug;316(7):770-1

Area of Physical Education and Sport, University of Almería, Almería, Spain.

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http://dx.doi.org/10.1001/jama.2016.8590DOI Listing
August 2016

When Will Physical Activity be Routinely Measured in the Clinical Setting? The Case for Bariatric Surgery.

Am J Hypertens 2016 09;29(9):e1

Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.

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http://dx.doi.org/10.1093/ajh/hpw058DOI Listing
September 2016

Changes in Gastric Volume and Their Implications for Weight Loss after Laparoscopic Sleeve Gastrectomy.

Obes Surg 2017 02;27(2):303-309

Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.

Background: Laparoscopic sleeve gastrectomy (LSG) is a relatively new surgical technique for the treatment of morbid obesity. It is unclear whether the volume of the gastric remnant can expand after surgery as a result of intraluminal pressure maintained over time. If this were the case, the increased volume could affect weight loss and the improvement in comorbidities. This study aims to assess the evolution of residual gastric volume (RGV) during the first year after LSG and its relationship with weight loss.

Material And Methods: We conducted a prospective study of 112 patients who underwent LSG from February 2009 to December 2013. In order to measure the RGV after surgery, all patients were evaluated radiologically by an esophagogastroduodenal (EGD) transit at 1 and 12 postoperative months.

Results: All patients showed a significant reduction in BMI compared with the preoperative measurement (33.48 ± 5.78 vs. 50.54 ± 6.69 kg/m; p < 0.001). Increased RGV was observed when comparing the results obtained by EGD transit at 1 (68.39 ± 25.89 cm) and 12 postoperative months (122.58 ± 38.76 cm; p < 0.001). There was no association between increase in gastric volume and weight loss at 1-year follow-up (r = 0.01; p = 0.910).

Conclusions: The volume of the gastric remnant increased significantly during the first year after LSG. However, this increase was not associated with weight loss. Further prospective research with longer follow-up periods is needed to confirm or contrast the present results.
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http://dx.doi.org/10.1007/s11695-016-2274-1DOI Listing
February 2017

Cardiorespiratory Fitness and Risk of Sudden Cardiac Death in Men and Women in the United States: A Prospective Evaluation From the Aerobics Center Longitudinal Study.

Mayo Clin Proc 2016 07;91(7):849-57

Department of Exercise Science, University of South Carolina, Columbia; Department of Epidemiology and Biostatistics, University of South Carolina, Columbia.

Objectives: To examine the relation between cardiorespiratory fitness (CRF) and sudden cardiac death (SCD) in a large US adult population and to study the effects of hypertension, obesity, and health status on the relation of CRF with SCD.

Patients And Methods: A total of 55,456 individuals (mean age, 44.2 years; 13,507 women) from the Aerobics Center Longitudinal Study, a prospective observational investigation (from January 2, 1974, through December 31, 2002), were included. Cardiorespiratory fitness was assessed by a maximal treadmill test, and baseline assessment included an extensive set of measurements.

Results: There were 109 SCDs. An inverse risk of SCD was found across incremental CRF levels after adjusting for potential confounders. Participants with moderate and high CRF levels had 44% (hazard ratio, 0.56; 95% CI, 0.35-0.90) and 48% (hazard ratio, 0.52; 95% CI, 0.30-0.92) significantly lower risk of SCD, respectively, than did those with low CRF levels (P<.001). The risk of SCD decreased by 14% (hazard ratio, 0.86; 95% CI, 0.77-0.96) per 1-metabolic equivalent increase in the fully adjusted model. Hypertensive, overweight, or unhealthy individuals with moderate to high CRF levels had lower risks of SCD (ranging from 58% to 72% of lower risk) than did those with the same medical conditions and low CRF levels.

Conclusion: The risk of SCD in US men and women could be partially reduced by ensuring moderate to high levels of CRF independently of other risk factors and especially in those who are hypertensive, overweight, or unhealthy.
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http://dx.doi.org/10.1016/j.mayocp.2016.04.025DOI Listing
July 2016

Association of physical fitness and fatness with cognitive function in women with fibromyalgia.

J Sports Sci 2016 Sep 19;34(18):1731-9. Epub 2016 Jan 19.

a Department of Physical Education and Sport, Faculty of Sport Sciences , University of Granada , Granada , Spain.

This study assessed the association of fitness and fatness with cognitive function in women with fibromyalgia, and the independent influence of their single components on cognitive tasks. A total of 468 women with fibromyalgia were included. Speed of information processing and working memory (Paced Auditory Serial Addition Task), as well as immediate and delayed recall, verbal learning and delayed recognition (Rey Auditory Verbal Learning Test) were assessed. Aerobic fitness, muscle strength, flexibility and motor agility were assessed with the Senior Fitness Test battery. Body mass index, percent body fat, fat-mass index and waist circumference were measured. Aerobic fitness was associated with attention and working memory (all, p < 0.05). All fitness components were generally associated with delayed recall, verbal learning and delayed recognition (all, p < 0.05). Aerobic fitness showed the most powerful association with attention, working memory, delayed recall and verbal learning, while motor agility was the most powerful indicator of delayed recognition. None of the fatness parameters were associated with any of the outcomes (all, p > 0.05). Our results suggest that fitness, but not fatness, is associated with cognitive function in women with fibromyalgia. Aerobic fitness appears to be the most powerful fitness component regarding the cognitive tasks evaluated.
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http://dx.doi.org/10.1080/02640414.2015.1136069DOI Listing
September 2016

ANTHROPOMETRIC CHARACTERISTICS AND PHYSICAL FITNESS LEVEL IN RELATION TO BODY WEIGHT STATUS IN CHILEAN PRESCHOOL CHILDREN.

Nutr Hosp 2015 Jul 1;32(1):346-53. Epub 2015 Jul 1.

Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile..

The purpose of this study was to describe anthropometric and physical fitness characteristics of low-income Chilean preschool children and to examine whether weight status influences children's performance on fitness tests. A total of 434 preschool children (246 boys; 5.48 ± 0.31 years) participated in our study. Anthropometry (weight, height, body mass index -BMI- and waist circumference) and fitness tests (handgrip strength test, standing long jump and 20 m sprint) were assessed by trained nutritionists and physical education teachers, respectively. Significant differences in anthropometry and fitness tests between boys and girls were found. The prevalence of overweight was higher in girls; in contrast to that of obesity. Compared to normal-weight children, overweight/obese boys and girls were heavier and had greater waist circumference (P < 0.001), were taller (P ≤ 0.002), and showed higher performance in handgrip strength (P ≤ 0.027) but not in standing long jump nor 20 m sprint (P ≥ 0.052). Screening physical fitness levels in overweight/obese preschool children could be an important tool in order to design an efficacy physical activity programme.
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http://dx.doi.org/10.3305/nh.2015.32.1.9092DOI Listing
July 2015

Cardiorespiratory fitness and ideal cardiovascular health in European adolescents.

Heart 2015 May 8;101(10):766-73. Epub 2014 Dec 8.

Department of Physical Education and Sports, Faculty of Sport Sciences, PROmoting FITness and Health through physical activity research group (PROFIT), University of Granada, Granada, Andalucia, Spain Department of Biosciences and Nutrition at NOVUM, Unit for Preventive Nutrition, Karolinska Institutet, Huddinge, Sweden.

Objective: We studied in European adolescents (i) the association between cardiorespiratory fitness and ideal cardiovascular health as defined by the American Heart Association and (ii) whether there is a cardiorespiratory fitness threshold associated with a more favourable cardiovascular health profile.

Methods: Participants included 510 (n=259 girls) adolescents from 9 European countries. The 20 m shuttle run test was used to estimate cardiorespiratory fitness. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviours (smoking, body mass index, physical activity and diet) and three factors (total cholesterol, blood pressure and glucose).

Results: Higher levels of cardiorespiratory fitness were associated with a higher number of ideal cardiovascular health components in both boys and girls (both p for trend ≤0.001). Levels of cardiorespiratory fitness were significantly higher in adolescents meeting at least four ideal components (13% higher in boys, p<0.001; 6% higher in girls, p=0.008). Receiver operating characteristic curve analyses showed a significant discriminating accuracy of cardiorespiratory fitness in identifying the presence of at least four ideal cardiovascular health components (43.8 mL/kg/min in boys and 34.6 mL/kg/min in girls, both p<0.001).

Conclusions: The results suggest a hypothetical cardiorespiratory fitness level associated with a healthier cardiovascular profile in adolescents. The fitness standards could be used in schools as part of surveillance and/or screening systems to identify youth with poor health behaviours who might benefit from intervention programmes.
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http://dx.doi.org/10.1136/heartjnl-2014-306750DOI Listing
May 2015

Systematic review and proposal of a field-based physical fitness-test battery in preschool children: the PREFIT battery.

Sports Med 2015 Apr;45(4):533-55

PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Carretera de Alfacar s/n, 18071, Granada, Spain,

Background: Physical fitness is a powerful health marker in childhood and adolescence, and it is reasonable to think that it might be just as important in younger children, i.e. preschoolers. At the moment, researchers, clinicians and sport practitioners do not have enough information about which fitness tests are more reliable, valid and informative from the health point of view to be implemented in preschool children.

Objective: Our aim was to systematically review the studies conducted in preschool children using field-based fitness tests, and examine their (1) reliability, (2) validity, and (3) relationship with health outcomes. Our ultimate goal was to propose a field-based physical fitness-test battery to be used in preschool children.

Data Sources: PubMed and Web of Science.

Study Eligibility Criteria: Studies conducted in healthy preschool children that included field-based fitness tests.

Study Appraisal And Synthesis Methods: When using PubMed, we included Medical Subject Heading (MeSH) terms to enhance the power of the search. A set of fitness-related terms were combined with 'child, preschool' [MeSH]. The same strategy and terms were used for Web of Science (except for the MeSH option). Since no previous reviews with a similar aim were identified, we searched for all articles published up to 1 April 2014 (no starting date). A total of 2,109 articles were identified, of which 22 articles were finally selected for this review.

Results: Most studies focused on reliability of the fitness tests (n = 21, 96%), while very few focused on validity (0 criterion-related validity and 4 (18%) convergent validity) or relationship with health outcomes (0 longitudinal and 1 (5%) cross-sectional study). Motor fitness, particularly balance, was the most studied fitness component, while cardiorespiratory fitness was the least studied. After analyzing the information retrieved in the current systematic review about fitness testing in preschool children, we propose the PREFIT battery, field-based FITness testing in PREschool children. The PREFIT battery is composed of the following tests: the 20 m shuttle-run test for assessing cardiorespiratory fitness, the handgrip-strength and the standing long-jump tests for assessing musculoskeletal fitness, and the 4 × 10 m shuttle run and the one-leg-stance tests for assessing motor fitness, i.e. speed/agility and balance, respectively. The rationale for the selection of each of the tests included in the PREFIT battery is provided in this review, as well as directions for future research.

Limitations: Levels of evidence based on quality assessment of selected studies could not be constructed due to the limited number of studies identified for each test.

Conclusions: The present systematic review has identified a need for further research on the validity of fitness tests in preschool children, as well as on their relationship with health. Due to this limited information, the PREFIT battery hereby proposed is based on the output of the current systematic review in preschool children, together with existing evidence in older children and adolescents. While we wait for more evidence to be accumulated in preschool children, the PREFIT battery hereby proposed is a useful tool for assessing physical fitness in children aged 3-5 years.
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http://dx.doi.org/10.1007/s40279-014-0281-8DOI Listing
April 2015

Disability predictors in chronic low back pain after aquatic exercise.

Am J Phys Med Rehabil 2014 Jul;93(7):615-23

From the Department of Physical Education and Sport, University of Granada, Granada, Spain (PÁB-B, MD-F, AR-F); Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia (EGA); Department of Education, University of Almería, Almería, Spain (EGA); Department of Physiotherapy, Universidade Federal da Paraíba, Paraiíba, Brasil (MCG-C); and Department of Physiotherapy, University of Granada, Granada, Spain (MA-M).

The physical and psychological factors associated with reduction of disability after aquatic exercise are not well understood. Sixty participants (30 men and 30 women; age, 50.60 [9.69] yrs; body mass index, 27.21 [5.20] kg/m²) with chronic low back pain were prospectively recruited. The 8-wk aquatic therapy program was carried out in an indoor pool sized 25 × 6 m, with 140-cm water depth and 30°C (1°C) of water temperature, where patients exercised for 2-5 days a week. Each aquatic exercise session lasted 55-60 mins (10 mins of warm-up, 20-25 mins of aerobic exercise, 15-20 mins of resistance exercise, and 10 mins of cooldown). Demographic information, disability (Oswestry Disability Index), back pain (visual analog scale), quality-of-life (Short Form 36), abdominal muscular endurance (curl-up), handgrip strength, trunk flexion and hamstring length (sit and reach), resting heart rate, and body mass index were outcomes variables. Significant correlations between change in disability and visual analog scale (at rest, flexion, and extension), curl-up and handgrip (r ranged between -0.353 and 0.582, all Ps < 0.01) were found. Changes in pain and abdominal muscular endurance were significant predictors of change in disability after therapy.
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http://dx.doi.org/10.1097/PHM.0000000000000123DOI Listing
July 2014

Longitudinal algorithms to estimate cardiorespiratory fitness: associations with nonfatal cardiovascular disease and disease-specific mortality.

J Am Coll Cardiol 2014 Jun 2;63(21):2289-96. Epub 2014 Apr 2.

Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.

Objectives: This study sought to determine the capacity of cardiorespiratory fitness (CRF) algorithms without exercise testing to predict the risk for nonfatal cardiovascular disease (CVD) events and disease-specific mortality.

Background: Cardiorespiratory fitness (CRF) is not routinely measured, as it requires trained personnel and specialized equipment.

Methods: Participants were 43,356 adults (21% women) from the Aerobics Center Longitudinal Study, followed up between 1974 and 2003. Estimated CRF was determined on the basis of sex, age, body mass index, waist circumference, resting heart rate, physical activity level, and smoking status. Actual CRF was measured by a maximal treadmill test. Risk reduction per 1-metabolic equivalent increase, discriminative ability (c statistic), and net reclassification improvement were determined.

Results: During a median follow-up of 14.5 years, 1,934 deaths occurred, 627 due to CVD. In a subsample of 18,095 participants, 1,049 cases of nonfatal CVD events were ascertained. After adjustment for potential confounders, both measured and estimated CRF were inversely associated with risks for all-cause mortality, CVD-related mortality and nonfatal CVD events in men, and all-cause mortality and nonfatal CVD events in women. The risk reduction per 1-metabolic equivalent increase ranged from approximately 10% to 20%. Measured CRF had a slightly better discriminative ability (c statistic) than did estimated CRF, and the net reclassification improvement values in measured CRF versus estimated CRF were 12.3% in men (p < 0.05) and 19.8% in women (p < 0.001).

Conclusions: These CRF algorithms utilized information routinely collected to obtain an estimate of CRF, which provides a valid indication of health status. In addition to identifying people at risk, this method can provide more appropriate exercise recommendations that reflect initial CRF levels.
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http://dx.doi.org/10.1016/j.jacc.2014.03.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045928PMC
June 2014

Dietary indices, cardiovascular risk factors and mortality in middle-aged adults: findings from the Aerobics Center Longitudinal Study.

Ann Epidemiol 2014 Apr 24;24(4):297-303.e2. Epub 2014 Jan 24.

Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.

Purpose: We examined the association between three predefined dietary indices and both cardiovascular disease (CVD) risk factors and long-term mortality in adult Aerobics Center Longitudinal Study's participants.

Methods: Between 1987 and 1999, 12,449 (77% male) participants aged 20-84 years completed a clinical examination, which included dietary assessment by 3-day diet records. Three dietary indices were calculated: the Ideal Diet Index, the Diet Quality Index, and the Mediterranean Diet Score. CVD risk factors measurements included body mass index, total cholesterol, fasting glucose, blood pressure, and cardiorespiratory fitness. We calculated hazard ratios from Cox regression analyses, adjusting for potential confounders including physical fitness.

Results: Higher Ideal Diet Index, Diet Quality Index, and Mediterranean Diet Score scores were consistently associated with lower body mass index, cholesterol and glucose levels, and diastolic blood pressure, and higher cardiorespiratory fitness (all P < .05). However, after adjusting for age, sex, energy intake, and baseline examination year, the indices were not significantly related to all-cause, CVD, or cancer mortality. No association was observed in fully adjusted models, which controlled for fitness.

Conclusions: Although these dietary indices based on 3-day diet records are strongly associated cross-sectionally to CVD risk profile of middle-aged men and women, they do not add to ability to predict long-term mortality in follow-up.
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http://dx.doi.org/10.1016/j.annepidem.2014.01.007DOI Listing
April 2014

Aquatic therapy improves pain, disability, quality of life, body composition and fitness in sedentary adults with chronic low back pain. A controlled clinical trial.

Clin Rehabil 2014 Apr 31;28(4):350-60. Epub 2013 Oct 31.

1University of Granada, Granada, Spain.

Objective: To determine the effects of a two-month intensive aquatic therapy programme on back pain, disability, quality of life, body composition and health-related fitness in sedentary adults with chronic low back pain.

Design: Controlled clinical trial.

Setting: Community.

Subjects: Forty-nine sedentary patients with chronic low back pain.

Interventions: Patients were allocated into active group (n = 24, two months, five times/week) or waiting list, control group (n = 25) according to space on the programme.

Main Measures: Outcomes variables were pain (visual analogue scale), disability (Oswestry Disability Index), quality of life (Quality Short-Form Health Survey 36), body composition (weight, body mass index, body fat percentage and skeletal muscle mass) and health-related fitness (sit-and-reach, handgrip strength, curl-up, Rockport 1-mile test).

Results: The active group significantly improved low back pain (-3.83 ± 0.35 mm on the visual analogue scale ), disability (-12.7 ± 1.3 points for the Oswestry Disability Index) and the standardized physical component (10.3 ± 1.4 points for the Quality Short-Form Health Survey 36) of quality-of-life domains (P < 0.001), with no significant changes on the standardized mental component (P = 0.114). In relation to body composition and fitness, the active group showed significant improvements (all P-values < 0.01). The control group presented no significant change in any parameter.

Conclusions: A two-month intensive aquatic therapy programme of high-frequency (five times/week) decreases levels of back pain and disability, increases quality of life, and improves body composition and health-related fitness in sedentary adults with chronic low back pain.
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http://dx.doi.org/10.1177/0269215513504943DOI Listing
April 2014