Publications by authors named "Iván Cavero-Redondo"

109 Publications

Diet in the Management of Weight Loss.

Nutrients 2021 Apr 15;13(4). Epub 2021 Apr 15.

Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain.

The prevalence of obesity and related disorders has been growing at an alarming rate in both wealthy and middle-low-income countries [...].
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http://dx.doi.org/10.3390/nu13041306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071278PMC
April 2021

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

What type of physical exercise should be recommended for improving arterial stiffness on adult population? A network meta-analysis.

Eur J Cardiovasc Nurs 2021 Apr 9. Epub 2021 Apr 9.

Universidad de Castilla-La Mancha, Health and Social Research Center, Santa Teresa Jornet s/n, 16171 Cuenca, Spain.

Aims: Physical exercise has been associated with a reduction in arterial stiffness, a subclinical process underlying cardiovascular disease. However, the effect of different types of exercise (aerobic, resistance, combined, interval training, stretching, or mind-body modalities) on arterial stiffness is unclear. This network meta-analysis aimed to examine the effectiveness of different types of exercise on arterial stiffness as measured by pulse wave velocity in adults.

Methods And Results: We searched Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE (via Pubmed), Embase, and Web of Science databases, for randomized clinical trials including at least a comparison group, from their inception to 30 June 2020. A frequentist network meta-analysis was performed to compare the effect of different types of physical exercise on arterial stiffness as measured by pulse wave velocity. Finally, 35 studies, with a total of 1125 participants for exercise intervention and 633 participants for the control group, were included. In the pairwise meta-analyses, the exercises that improved arterial stiffness were: interval training [effect size (ES) 0.37; 95% confidence interval (CI) 0.01-0.73], aerobic exercise (ES 0.30; 95% CI 0.13-0.48) and combined exercise (ES 0.22; 95% CI 0.04-0.40). Furthermore, the network meta-analysis showed that mind-body interventions were the most effective type of exercise to reduce the pulse wave velocity (ES 0.86; 95% CI 0.04-1.69). In addition, combined exercise (ES 0.35; 95% CI 0.08-0.62), aerobic exercise (ES 0.33; 95% CI 0.09-0.57), and interval training (ES 0.33; 95% CI 0.02-0.64) showed significant improvements.

Conclusion: Our findings showed that aerobic exercise, combined exercise, interval training, and mind-body exercises were the most effective exercise modalities for reducing arterial stiffness, assuming an important role in the prevention of cardiovascular diseases.
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http://dx.doi.org/10.1093/eurjcn/zvab022DOI Listing
April 2021

Resting Heart Rate as a Predictor of Cancer Mortality: A Systematic Review and Meta-Analysis.

J Clin Med 2021 Mar 25;10(7). Epub 2021 Mar 25.

Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain.

This work was aimed to synthetize the evidence available about the relationship between resting heart rate (RHR) and the risk of cancer mortality. A computerized search in the Medline, EMBASE, Web of Science, and Cochrane Library databases from their inception to 24 September 2020 was performed. We performed three meta-analyses: (1) cancer mortality comparing the "less than 60 bpm" and "more than 60 bpm" categories; (2) cancer mortality comparing "less than 60 bpm", "60 to 80 bpm", and "more than 80 bpm" categories; and (3) analysis for 10-12 and 20 bpm increase in RHR and risk of cancer mortality. Twenty-two studies were included in the qualitative review, and twelve of them met the inclusion criteria for the meta-analysis. Our results showed a positive association between RHR and the risk of cancer mortality. This association was shown in a meta-analysis comparing studies reporting mean RHR values below and above 60 bpm, when comparing three RHR categories using less than 60 bpm as the reference category and, finally, in dose response analyses estimating the effect of an increase of 10-12 bpm in RHR, both in men and in women. In conclusion, a low RHR is a potential marker of low risk of cancer mortality.
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http://dx.doi.org/10.3390/jcm10071354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037294PMC
March 2021

Prevalence and trends of underweight in European children and adolescents: a systematic review and meta-analysis.

Eur J Nutr 2021 Mar 29. Epub 2021 Mar 29.

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

Purpose: This study aimed at providing prevalence trend estimates of underweight among children and adolescents in Europe from 2000 to 2017.

Methods: MEDLINE, Web of Science, Scopus and CINAHL were searched from their inception up to March 2020. Moreover, searches were conducted on health institutions' websites to identify studies not published in scientific journals. Underweight was defined according to the body mass index (BMI) cut-offs proposed by the International Obesity Task Force (IOTF) and the World Health Organization (WHO) definition criteria. The Mantel-Haenszel method was used to compute the pooled prevalence estimates whenever there was no evidence of heterogeneity; otherwise, the DerSimonian and Laird random-effects method was used. Subgroup analyses by sex, age range (2-13 and 14-18 years old), study year (2000-2006 and 2007-2017), country and European region were conducted.

Results: A total of 49 studies with data from 323,420 children and adolescents aged 2 to 18 years, from 26 countries were included. From 2000 to 2017, according to the IOTF criteria, the prevalence of underweight showed an increasing trend in Eastern, Northern and Southern Europe, where the underweight prevalence ranged from 9.1 to 12.0%, from 4.1 to 6.8%, and from 5.8 to 6.7%, respectively. In Western Europe, the prevalence of underweight tended to decrease, from 14.0 to 11.8%. No significant differences were found by sex or age range.

Conclusion: The prevalence of underweight is considerable (overall, around 8-9%), particularly in Eastern Europe, and follows a slight upward trend during the past decade.

Systematic Review Registration: PROSPERO CRD42017056924.
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http://dx.doi.org/10.1007/s00394-021-02540-0DOI Listing
March 2021

The association of continuous-use medications and sleep parameters in a sample of working adults.

Sleep Breath 2021 Mar 13. Epub 2021 Mar 13.

Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil.

Purpose: Although polypharmacy is linked to health outcomes in the elderly, the use of multiple medications is increasing in middle-aged adults. This study analyzed whether or not the increased number of continuous-use medications (C-UM) is associated with objective and subjective sleep parameters in a working population.

Methods: Cross-sectional study with schoolteachers from public schools in Londrina, Brazil. The participants were classified according to the self-reported number of C-UM. Sleep data were obtained with actigraphy and a concomitant sleep diary for 7 days. The analyses were adjusted for socio-demographic, lifestyle, and morbidity variables.

Results: A total of 17% of the participants were classified as using ≥3C-UM. In fully adjusted analyses, the use of ≥3C-UM was associated with lower actigraphic sleep duration (<6 h) (odds ratio [OR] = 2.51; 95% confidence interval [CI] = 1.01,6.21), higher actigraphic sleep onset latency (SOL) (OR = 2.65; 95%CI = 1.00,7.02), and with a higher number of awakenings during sleep measured by actigraphy (OR = 3.30; 95%CI = 1.32,8.28). The use of ≥3 C-UM was also associated with higher SOL (OR = 3.76; 95%CI = 1.36,10.5) and lower sleep efficiency (OR = 11.6; 95%CI = 2.92,46.1), as measured with the sleep diary. A 1-unit increment in the number of continuous-use medications was associated with higher self-reported SOL and lower subjective sleep efficiency.

Conclusion: The continuous use of ≥3 medications is associated with worse objective and subjective parameters of sleep duration and quality in schoolteachers.
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http://dx.doi.org/10.1007/s11325-021-02343-xDOI Listing
March 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

Fitness and executive function as mediators between physical activity and academic achievement.

J Sports Sci 2021 Feb 21:1-9. Epub 2021 Feb 21.

Nursing, Universidad de Castilla-la Mancha , Cuenca, Spain.

Physical activity is related with academic achievement in children. This cross-sectional study aimed to assess whether cardiorespiratory fitness (CRF) and executive function act as mediators of the association between moderate to vigorous physical activity (MVPA) and academic achievement. This study included 186 schoolchildren (9-11 years) from Cuenca, Spain. Sociodemographic variables, anthropometric variables, academic achievement, executive function (inhibition, cognitive flexibility and working memory), CRF (20-m shuttle run) and physical activity (by accelerometry) were measured. Serial mediation models were estimated using the Hayes´ PROCESS macro. The significant paths in the model mediating this relationship between MVPA and academic achievement were as follows: MVPA → CRF → academic achievement (IE = 0.068, 95% CI: [0.018; 0.127]; IE = 0.079, 95% CI: [0.029; 0.144]; and IE = 0.090, 95% CI: [0.032; 0.165], controlling for inhibition, cognitive flexibility and working memory, respectively), MVPA → CRF → inhibition → academic achievement (0.018, 95% CI: [0.001; 0.047]) and MVPA → cognitive flexibility → academic achievement (0.087, 95% CI: [0.012; 0.169]). The relationship between MVPA and academic achievement may not be direct but mediated by CRF, cognitive flexibility, and inhibition via CRF. Physical activity interventions to improve AA should be focused on improvements in CRF and executive function.
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http://dx.doi.org/10.1080/02640414.2021.1886665DOI Listing
February 2021

Comparative effect of physical exercise versus statins on improving arterial stiffness in patients with high cardiometabolic risk: A network meta-analysis.

PLoS Med 2021 Feb 16;18(2):e1003543. Epub 2021 Feb 16.

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

Background: The comparative analysis of the effect of several doses of statins against different intensities of physical exercise on arterial stiffness (a measure of cardiovascular risk) could shed light for clinicians on which method is most effective in preventing cardiovascular disease (CVD) and be used to inform shared decision-making between doctors and patients. This study was aimed at analyzing the effect, in high cardiometabolic risk patients, of different statins doses and exercise intensities on arterial stiffness (a measure of cardiovascular risk) by integrating all available direct and indirect evidence in network meta-analyses.

Methods And Findings: We systematically searched MEDLINE, Embase, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases from their inception to February 28, 2020; for unpublished trials, we also searched ClinicalTrials.gov. We searched for studies concerning the effect of statins or physical exercise on arterial stiffness, measured by pulse wave velocity (PWV). For methodological quality assessment, Cochrane Collaboration's tool for assessing risk of bias (RoB2) was used. A network geometry graph was used to assess the strength of the evidence. Comparative evaluation of the interventions effect was performed by conducting a standard pairwise meta-analysis and a network meta-analysis (NMA) for direct and indirect comparisons between interventions and control/nonintervention. A total of 22 studies were included in the analyses (18 randomized controlled trials (RCTs) and 4 nonrandomized experimental studies), including 1,307 patients with high cardiometabolic risk from Asia (3 studies), Oceania (2 studies), Europe (10 studies), North America (5 studies), and South America (2 studies). The overall risk of bias assessed with RoB2 was high in all included studies. For standard pairwise meta-analysis and NMA, high-intensity exercise versus control (mean difference (MD) -0.56; 95% CI: -1.01, -0.11; p = 0.015 and -0.62; 95% CI: -1.20, -0.04; p = 0.038, respectively) and moderate statin dose versus control (MD -0.80, 95% CI: -1.59, -0.01; p = 0.048 and -0.73, 95% CI: -1.30, -0.15; p = 0.014, respectively) showed significant MDs. When nonrandomized experimental studies were excluded, the effect on high-intensity exercise versus control and moderate statin dose versus was slightly modified. The main limitation of this study was that the magnitude of the effect of the exercise interventions could be underestimated due to regression toward the mean bias because the baseline cardiometabolic risk profile of patients in the physical exercise intervention trials was healthier than those in the statins ones; consequently, more modest improvements in physical exercise interventions compared to statins interventions can be expected. Additionally, we might consider as limitations the small study sizes, the heterogeneous patient groups, the focus on a proxy endpoint (PWV), and the high risk of bias.

Conclusions: In this NMA, we found that although many patients could benefit from statins for reducing CVD risk, our results support that, considering the beneficial effects of high-intensity exercise on arterial stiffness, it would be worthwhile to refocus our attention on this type of exercise as an effective tool for the prevention of CVD.

Systematic Review Registration: PROSPERO CRD42019123120.
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http://dx.doi.org/10.1371/journal.pmed.1003543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924736PMC
February 2021

Interpregnancy Weight Change and Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Obesity (Silver Spring) 2021 Feb;29(2):454-464

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

Objective: This study aimed to synthesize evidence regarding the association between interpregnancy weight change (IPWC) and gestational diabetes mellitus (GDM) in the subsequent pregnancy.

Methods: MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched from inception to May 10, 2020. This review included studies that reported the association between IPWC and GDM in the subsequent pregnancy without restriction on study design, IPWC classification, or parity. The "no weight change" interpregnancy category was defined by each study, and data were synthesized to analyze the risk of GDM according to weight change.

Results: Thirteen observational studies were included. A higher risk of GDM in the subsequent pregnancy when there was interpregnancy weight gain (odds ratio [OR] = 1.56; 95% CI: 1.30-1.83; I  = 82.30%) was found. However, interpregnancy weight loss was associated with lower risk of GDM in the subsequent pregnancy (OR = 0.83; 95% CI: 0.68-0.98; I  = 58.10%), but the decrease in the risk of GDM in the subsequent pregnancy was greater among women with pregestational BMI higher than 25 kg/m (OR = 0.58; 95% CI: 0.39-0.77; I  = 0.00%).

Conclusions: The risk of GDM in the subsequent pregnancy increases with interpregnancy weight gain, whereas it decreases with interpregnancy weight loss.
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http://dx.doi.org/10.1002/oby.23083DOI Listing
February 2021

The Acute Effect of Exercise on Arterial Stiffness in Healthy Subjects: A Meta-Analysis.

J Clin Med 2021 Jan 14;10(2). Epub 2021 Jan 14.

Health and Social Research Center, Universidad de Castilla-La Mancha, 16171 Cuenca, Spain.

Arterial stiffness has been shown to be a subclinical marker associated with cardiovascular disease. Meanwhile, long-term exercise has been demonstrated to reduce arterial stiffness, providing a decrease in cardiovascular risk. However, the acute effect of exercise on arterial stiffness is unclear. This systematic review and meta-analysis aimed to assess the acute effect of exercise interventions on arterial stiffness in healthy adults. We searched the Cochrane Central Register of Controlled Trials, MEDLINE (via Pubmed), Scopus, and Web of Science databases, from their inception to 30 June 2020. A meta-analysis was performed to evaluate the acute effect of exercise on arterial stiffness using random-effects models to calculate pooled effect size estimates and their corresponding 95% CI. Pulse wave velocity was measured as an arterial stiffness index. The 30 studies included in the meta-analysis showed that pulse wave velocity was not modified immediately after exercise (0 min post) (ES: 0.02; 95% CI: -0.22, 0.26), but subsequently decreased 30 min after exercise (ES: -0.27; 95% CI: -0.43, -0.12). Thereafter, pulse wave velocity increased to its initial value 24 h after exercise (ES: -0.07; 95% CI: -0.21, 0.07). Our results show that, although there is a significant reduction in pulse wave velocity 30 min after exercise, the levels of arterial stiffness return to their basal levels after 24 h. These findings could imply that, in order to achieve improvements in pulse wave velocity, exercise should be performed on a daily basis.
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http://dx.doi.org/10.3390/jcm10020291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831005PMC
January 2021

School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials.

Br J Sports Med 2021 Jan 13. Epub 2021 Jan 13.

Department of Sport Science, Nottingham Trent University, Nottingham, Nottinghamshire, UK.

Objectives: To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness.

Design: Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity.

Participants: Data for 6621 children and adolescents aged 4-18 years from 20 trials were included.

Main Outcome Measures: Peak oxygen consumption (VO mL/kg/min) and minutes of moderate and vigorous physical activity.

Results: Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness.

Conclusions: Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.
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http://dx.doi.org/10.1136/bjsports-2020-102740DOI Listing
January 2021

Effect of retirement on cognitive function: a systematic review and meta-analysis.

Occup Environ Med 2020 Dec 30. Epub 2020 Dec 30.

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

The study aimed to determine the longitudinal association between retirement and cognitive function, including global cognition and memory-related skills. This is a systematic review of longitudinal studies on the association between retirement and cognitive function, using Medline (via PubMed), Scopus, Web of Science and PsycINFO databases from inception to April 2020 and longitudinal studies on the association between retirement and cognitive function. The Newcastle-Ottawa Scale was used to assess risk of bias of included studies. Effect size (ES) and 95% CI were calculated using Cohen's d index. Meta-regressions were calculated on the basis of sample characteristics: percentage of women, years of follow-up and age at baseline. A total of 23 longitudinal studies were included in this systematic review. The pooled ES for the association of retirement with global cognition and memory-related skills was -0.01 (95% CI -0.02 to 0.00; I: 0.0%) and -0.09 (95% CI -0.16 to 0.01; I: 93%), respectively. Meta-regression analyses showed that length of follow-up, percentage of women in the sample and mean age at baseline did not influence the longitudinal association between retirement and adults' memory-related skills. The results of this study indicate that retirement has no negative effects on adults' global cognition and slightly adversely influences memory-related skills. Moreover, this association does not seem to be influenced by some demographic and study characteristics.
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http://dx.doi.org/10.1136/oemed-2020-106892DOI Listing
December 2020

A Cluster Mediation Analysis Confirms the Validity of the "Fat but Fit" Paradigm in Children's Cognitive Function and Academic Achievement.

J Pediatr 2021 04 26;231:231-238.e1. Epub 2020 Dec 26.

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

Objective: To evaluate the fat but fit conceptual model, testing whether this paradigm for body mass index (BMI) and maximum rate of oxygen consumption (VO) exists in schoolchildren and whether executive functions mediate the relationship between fat but fit categories and academic achievement.

Study Design: Cluster cross-sectional analyses of data from 554 children aged 9-11 from Cuenca, Spain. BMI, VO, core executive functions (inhibition, working memory, and cognitive flexibility) and academic achievement (language and mathematics).

Results: Cluster analysis of BMI and VO z-scores resulted in a 4-cluster solution that could be interpreted according to fat unfit, unfat unfit, fat fit, and unfat fit categories. ANCOVA models confirmed an increasing trend by cluster category in terms of VO levels and, conversely, a decreasing trend in terms of adiposity variables. These models also confirmed that children in the fat fit and unfat fit categories scored higher than their peers in the fat unfit and unfat unfit categories. Mediation analyses using fat but fit clusters as multicategory independent variable, executive functions as mediators, and academic achievement as outcome variable showed that the positive association between the BMI-VO clusters and academic achievement was mediated by inhibition levels in fat fit and unfat fit individuals, by working memory levels only in those classified as fat fit, and by cognitive flexibility only in unfat fit individuals.

Conclusions: This study confirms the validity of the 4-cluster conceptual model regarding BMI and VO and reinforces the predictive validity, proving that fitness levels are able to counteract the detrimental effect of obesity on academic achievement.
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http://dx.doi.org/10.1016/j.jpeds.2020.12.062DOI Listing
April 2021

Restorative treatments of dystrophin expression in Duchenne muscular dystrophy: A systematic review.

Ann Clin Transl Neurol 2020 09 10;7(9):1738-1752. Epub 2020 Aug 10.

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

To evaluate the effect of pharmacological treatments that increase the synthesis of dystrophin in Duchenne muscular dystrophy (DMD). Systematic searches were carried out in MEDLINE, EMBASE, and Web of Science, and in gray literature from inception to December 2019. Clinical trials addressing the effect of restorative treatments of dystrophin expression in children and adolescents with DMD on functional outcomes {(6-minute walking distance [6MWD], other timed functional tests [TFTs], The North Star Ambulatory Assessment)}, dystrophin expression, cardiorespiratory function, and biochemical tests were included. The DerSimonian-Laird method was used to calculate the pooled estimates for functional outcomes. Eleven studies were included in the systematic review and five in the meta-analysis. Eteplirsen showed a significant effect on 6MWD, Δ6MWD = 67.3 m (95% CI: 27.32, 107.28), and Δ6MWD = 151.0 m (95% CI: 36.15, 265.85) at 48 weeks and 3 years, respectively. In the systematic review, analyzing individually the clinical trials using Ataluren and Drisapersen showed a nonsignificant effect on 6MWD. However, the meta-analysis showed a significant effect on 6MWD for Ataluren and Drisapersen, Δ6MWD = 18.3 m (95% CI: 1.0, 35.5) and Δ6MWD = 21.5 m (95% CI: 4.7, 38.3), respectively. There were no significant differences according to baseline age for Drisapersen. Similarly, the meta-analysis showed effect in TFT with Ataluren. All drugs induced a partial synthesis of dystrophin, and exon skipping was obtained with Eteplirsen and Drisapersen. Eteplirsen also improved forced vital capacity (Δ%pFVC = 1.8%) and maximal inspiratory pressure (Δ%pMIP = 4.4%). Eteplirsen and Ataluren could modestly reduce disease progression. However, more trials are needed to confirm its efficacy, as well as quality of life and cost-utility studies.
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http://dx.doi.org/10.1002/acn3.51149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480922PMC
September 2020

Association between arterial stiffness and the clustering of metabolic syndrome risk factors: a systematic review and meta-analysis.

J Hypertens 2021 Jun;39(6):1051-1059

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

Objectives: Metabolic syndrome (MetS) is a cluster of different cardiometabolic risk factors (CMRFs), and its different combinations with other CMRFs, such as arterial stiffness have been hypothesized to explain, at least partially, increased risk of cardiovascular disease. Thus, in this systematic review and meta-analysis, we aimed to synthesize the evidence regarding the association between the clustering of MetS-related CMRFs and arterial stiffness measured using pulse wave velocity (PWV).

Methods: Original studies analysing the association between arterial stiffness, measured using PWV, and MetS were systematically searched. Pooled effect size estimates and their respective 95% confidence intervals (CI) were calculated using the DerSimonian and Laird method for two separate analyses: the diagnosis of MetS and PWV values and the number of CMRFs and PWV values.

Results: Moderate effect size estimates were observed between MetS and PWV (0.68, 95% CI: 0.54-0.82) with a slightly higher effect size for the low-risk compared with the high-risk population group (0.75, 95% CI: 0.58-0.92; and 0.51, 95% CI: 0.32-0.82, respectively). A trend between the number of MetS-related CMRFs and PWV was found with the pooled effect size nearly doubling as the number of MetS-related CMRFs increased, 0.11 (95% CI: 0.04-0.17) for one MetS-related CMRF, 0.26 (95% CI: 0.13-0.4) for two, and 0.4 (95% CI: 0.2-0.6) for three or more.

Conclusion: These results demonstrated a clinically relevant association between MetS and PWV and an increasing trend in PWV values, such as a MetS-related CMRF increase. Although these results should be considered cautiously because of the considerable heterogeneity, our findings reinforce the rationale of MetS as an aggregation of risk factors with common causes, which could provide additional useful information to guide clinical management.
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http://dx.doi.org/10.1097/HJH.0000000000002754DOI Listing
June 2021

Effect of eHealth to increase physical activity in healthy adults over 55 years: A systematic review and meta-analysis.

Scand J Med Sci Sports 2021 Apr 16;31(4):776-789. Epub 2020 Dec 16.

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

To estimate the effect of eHealth interventions on increasing physical activity (PA) in healthy adults over 55 years, a systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE, Cochrane, Web of Science, SPORTDiscus, and Scopus databases were searched, from inception to February 2020, for experimental studies reporting the effect of eHealth interventions on steps/day, daily moderate-to-vigorous physical activity (MVPA min/day), PA min/week, and MVPA min/week among adults over 55 years. The DerSimonian and Laird method was used to compute a pooled effect size (ES) estimate and the respective 95% confidence interval (95% CI). Eighteen studies were included in this meta-analysis with adults whose age ranged from 58 to 74.2 years. The interventions lasted between four and 52 weeks. The ES estimates of eHealth interventions on increasing PA were 0.59 (95% CI: 0.15-1.02) for steps/day, 0.49 (95% CI: 0.17-0.80) for daily MVPA, 0.13 (95% CI: 0.01-0.24) for total weekly PA and 0.31 (95% CI: 0.13-0.48) for weekly MVPA. Considering clinical improvements, the mean change difference estimates were an increase of 1616.28 steps/day (95% CI: 386.25-2846.31), 7.41 minutes of daily MVPA (95% CI: 3.24-11.57), 40.54 minutes of total weekly PA (95% CI: -8.71 to 89.79) and 56.35 minutes of weekly MVPA (95% CI: 17.43-95.27). In conclusion, eHealth interventions are effective in increasing PA levels among adults over 55 years, resulting in increased steps/day, MVPA min/day, PA min/week and MVPA min/week.
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http://dx.doi.org/10.1111/sms.13903DOI Listing
April 2021

Gestational weight gain and offspring's cognitive skills: a systematic review and meta-analysis.

BMC Pediatr 2020 11 26;20(1):533. Epub 2020 Nov 26.

Universidad de Castilla-La Mancha, Centro de Estudios Sociosanitarios, Cuenca, Spain.

Background: Gestational weight gain has been associated with some adverse perinatal outcomes, but few studies have examined the association between gestational weight gain and offspring's cognition and their conclusions are inconsistent. Our systematic review and meta-analysis aimed to synthesize the evidence regarding the association between gestational weight gain and offspring's cognitive skills.

Methods: In this systematic review and meta-analysis (PROSPERO number, CRD42017073266), we systematically searched MEDLINE, EMBASE, Web of Science and the Cochrane Library for studies examining association between gestational weight gain and offspring's cognitive skills, without restriction in study design or language. Two reviewers extracted in an independent way the data. The Quality of Reporting of Observational Longitudinal Research scale was used to assess the quality of included studies. Effect size (ES) for adjusted models and their corresponding 95% confidence intervals were calculated for (i) intelligence quotient, (ii) language related skills and (iii) mathematic related skills comparing offspring's cognitive skills when gestational weight gain was within recommendations (as reference) with those from mothers whose gestational weight gain was above or below the recommendations.

Results: Thirteen studies were included. There was a positive trend that associated gestational weight gain above recommendations with better offspring's intelligence quotient, although not statistically significant (ES 0.02, 95% CI -0.00, 0.05; I = 0.00%).

Conclusions: There is a not significant positive association between gestational weight gain above recommendations and intelligence quotient and some studies reported associations between gestational weight gain and offspring's cognitive skills. Our analyses confirm a wide variability in the results of studies published so far and highlights the need for conducting studies including specific samples of pregnant women by pre-pregnancy body mass index and trimester of pregnancy.
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http://dx.doi.org/10.1186/s12887-020-02429-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690030PMC
November 2020

Effect of physical activity on cognitive domains in dementia and mild cognitive impairment: overview of systematic reviews and meta-analyses.

Aging Ment Health 2020 Nov 4:1-9. Epub 2020 Nov 4.

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

Objective: To assess the effect of physical activity on cognitive domains in persons with dementia or mild cognitive impairment.

Design: An overview of systematic reviews and meta-analyses of randomized controlled trials were performed.

Methods: A literature search was performed in PubMed, Scopus, and Cochrane Database of Systematic Reviews databases up to February 2020. Data about the change in cognitive domains after physical activity intervention was extracted and plotted.

Results: We included 11 meta-analyses in this overview. The most frequent type of physical activity for the intervention group was the aerobic exercise with a duration between 6 and 78 weeks. Global cognition was the most common form of assessing the cognitive function, follow of executive function, delayed recall, attention, and verbal fluency. We found a positive effect of physical activity on global cognition, executive function, and delayed recall, but no effect on verbal fluency, attention, and immediate recall.

Conclusion: Physical activity shows a positive effect on cognition in people with dementia and mild cognitive impairment, especially when it was assessed as global cognition. Positive effects on executive function and memory were also shown. This result confirms the relevance of physical activity in the treatment of persons with cognitive impairment.
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http://dx.doi.org/10.1080/13607863.2020.1839862DOI Listing
November 2020

Predictors of in-hospital COVID-19 mortality: A comprehensive systematic review and meta-analysis exploring differences by age, sex and health conditions.

PLoS One 2020 3;15(11):e0241742. Epub 2020 Nov 3.

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

Objective: Risk factors for in-hospital mortality in confirmed COVID-19 patients have been summarized in numerous meta-analyses, but it is still unclear whether they vary according to the age, sex and health conditions of the studied populations. This study explored these variables as potential mortality predictors.

Methods: A systematic review was conducted by searching the MEDLINE, Scopus, and Web of Science databases of studies available through July 27, 2020. The pooled risk was estimated with the odds ratio (p-OR) or effect size (p-ES) obtained through random-effects meta-analyses. Subgroup analyses and meta-regression were applied to explore differences by age, sex and health conditions. The MOOSE guidelines were strictly followed.

Results: The meta-analysis included 60 studies, with a total of 51,225 patients (12,458 [24.3%] deaths) from hospitals in 13 countries. A higher in-hospital mortality risk was found for dyspnoea (p-OR = 2.5), smoking (p-OR = 1.6) and several comorbidities (p-OR range: 1.8 to 4.7) and laboratory parameters (p-ES range: 0.3 to -2.6). Age was the main source of heterogeneity, followed by sex and health condition. The following predictors were more markedly associated with mortality in studies with patients with a mean age ≤60 years: dyspnoea (p-OR = 4.3), smoking (p-OR = 2.8), kidney disease (p-OR = 3.8), hypertension (p-OR = 3.7), malignancy (p-OR = 3.7), diabetes (p-OR = 3.2), pulmonary disease (p-OR = 3.1), decreased platelet count (p-ES = -1.7), decreased haemoglobin concentration (p-ES = -0.6), increased creatinine (p-ES = 2.4), increased interleukin-6 (p-ES = 2.4) and increased cardiac troponin I (p-ES = 0.7). On the other hand, in addition to comorbidities, the most important mortality predictors in studies with older patients were albumin (p-ES = -3.1), total bilirubin (p-ES = 0.7), AST (p-ES = 1.8), ALT (p-ES = 0.4), urea nitrogen (p-ES), C-reactive protein (p-ES = 2.7), LDH (p-ES = 2.4) and ferritin (p-ES = 1.7). Obesity was associated with increased mortality only in studies with fewer chronic or critical patients (p-OR = 1.8).

Conclusion: The prognostic effect of clinical conditions on COVID-19 mortality vary substantially according to the mean age of patients.

Prospero Registration Number: CRD42020176595.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241742PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608886PMC
November 2020

Monitoring gestational weight gain and prepregnancy BMI using the 2009 IOM guidelines in the global population: a systematic review and meta-analysis.

BMC Pregnancy Childbirth 2020 Oct 27;20(1):649. Epub 2020 Oct 27.

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

Background: Previous studies have reported a high prevalence of excessive gestational weight gain (GWG) in women with prepregnancy BMI classified as overweight and obese. However, the joint evidence regarding GWG and prepregnancy BMI in the worldwide population has not been synthesized. Thus, this systematic review and meta-analysis aimed to estimate global and regional mean GWG and the prevalence of GWG above, within and below 2009 Institute of Medicine (IOM) guidelines. Second, we aimed to estimate global and regional prepregnancy BMI and the prevalence of BMI categories according to World Health Organization (WHO) classification.

Methods: We searched Medline, Embase, the Cochrane Library and Web of Science to identify observational studies until 9 May 2018. We included studies published from 2009 that used 2009 IOM guidelines, reporting data from women in general population with singleton pregnancies. The 2009 IOM categories for GWG and the WHO categories for prepregnancy BMI were used. DerSimonian and Laird random effects methods were used to estimate the pooled and their respective 95% confidence intervals (95% CIs) of the mean and by category rates of GWG and prepregnancy BMI, calculated by global and regions.

Results: Sixty-three published studies from 29 countries with a total sample size of 1,416,915 women were included. The global prevalence of GWG above and below the 2009 IOM guidelines, was 27.8% (95% CI; 26.5, 29.1) and 39.4% (95% CI; 37.1, 41.7), respectively. Furthermore, meta-regression analyses showed that the mean GWG and the prevalence of GWG above guidelines have increased. The global prevalence of overweight and obesity, was 23.0% (95% CI; 22.3, 23.7) and 16.3% (95% CI; 15.4, 17.4), respectively. The highest mean GWG and prepregnancy BMI were in North America and the lowest were in Asia.

Conclusions: Considering the high prevalence of GWG above the 2009 IOM guidelines and women with overweight/obesity and their continuously increasing trend in most regions, clinicians should recommend lifestyle interventions to improve women's weight during reproductive age. Due to regional variability, these interventions should be adapted to each cultural context.

Trial Registration: Prospectively registered with PROSPERO ( CRD42018093562 ).
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http://dx.doi.org/10.1186/s12884-020-03335-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590483PMC
October 2020

The accuracy of toe brachial index and ankle brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis.

Atherosclerosis 2020 12 1;315:81-92. Epub 2020 Oct 1.

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

Background And Aims: We aimed to compare the diagnostic accuracy of ankle brachial index (ABI) and toe brachial index (TBI) for peripheral arterial disease (PAD) in a wide spectrum of PAD populations and reference standard tests, and to examine variables influencing heterogeneity in the estimates.

Methods: Systematic searches in EMBASE, MEDLINE, Web of Science and the Cochrane Library databases were performed, from inception to January 2020. Hierarchical summary receiver operating characteristic curves (HSROC) were used to summarize the pooled test performance.

Results: Thirty five (patient-level: 1318 patients, limb-level: 5637 limbs) and nine studies (patient-level: 294 patients, limb-level: 826 limbs) were included in ABI and TBI meta-analyses, respectively. The QUADAS-2 tool identified many studies with high risk of bias, especially in the "patient selection" domain. Pooled estimates for ABI in detecting 50% or greater stenosis were sensitivity = 61% (95% CI: 55-69), specificity = 92% (95% CI: 89-95) and dOR = 16.5 (95% CI: 11.5-23.6). Similarly, TBI yielded sensitivity = 81% (95% CI: 70-94), specificity = 77% (95% CI: 66-90) and dOR = 13.1 (95% CI: 7.0-24.8). In a direct comparison of seven studies jointly analyzing ABI and TBI, TBI showed better overall diagnostic accuracy (16.4 vs 11.0 in dOR) at the expense of sensitivity (82% vs 52%), while specificity (77% vs 94%) performed worse in TBI than ABI. Heterogeneity was large in sensitivity for ABI, with variables as different reference standard tests, smoking habit and PAD prevalence accounting for such variability. Similarly, gender, different index test cut-offs and sample size influenced the heterogeneity in TBI specificity.

Conclusions: Though ABI and TBI showed similar diagnostic performance to diagnose PAD, TBI showed far better sensitivity than ABI, especially in "challenging populations", as those exhibiting calcification.
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http://dx.doi.org/10.1016/j.atherosclerosis.2020.09.026DOI Listing
December 2020

Effect of Physical Exercise Programs on Myofascial Trigger Points-Related Dysfunctions: A Systematic Review and Meta-analysis.

Pain Med 2020 11;21(11):2986-2996

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

Objective: Myofascial pain syndrome is one of the primary causes of health care visits. In recent years, physical exercise programs have been developed for the treatment of myofascial trigger points, but their effect on different outcomes has not been clarified. Thus, this study aimed to assess the effect of physical exercise programs on myofascial trigger points.

Methods: A systematic search was conducted in Pubmed, Web of Science, and Scopus. Articles analyzing the effect of physical exercise programs on pain intensity, pressure pain threshold, range of motion, and disability were included. Risk of bias was assessed using the Cochrane RoB2 tool. The DerSimonian-Laird method was used to compute the pooled effect sizes (ES) and their 95% confidence interval (95% CI) for pain intensity, pressure pain threshold, range of motion, and disability.

Results: A total of 24 randomized controlled trials were included in this systematic review and meta-analysis. The pooled ES were -0.47 (95% CI = -0.61 to -0.33) for pain intensity, 0.63 (95% CI = 0.31 to 0.95) for pressure pain threshold, 0.43 (95% CI = 0.24 to 0.62) for range of motion, and -0.18 (95% CI = -0.45 to 0.10) for disability.

Conclusions: Physical exercise programs may be an effective approach in the treatment of pain intensity, pressure pain threshold, and range of motion among patients with myofascial trigger points.
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http://dx.doi.org/10.1093/pm/pnaa253DOI Listing
November 2020

Are Advanced Glycation End Products in Skin Associated with Vascular Dysfunction Markers? A Meta-Analysis.

Int J Environ Res Public Health 2020 09 22;17(18). Epub 2020 Sep 22.

Health and Social Research Center, Universidad de Castilla-La Mancha, 16171 Cuenca, Spain.

Evidence exists regarding the association between advanced glycation end products and different cardiovascular disease subclinical processes, such as arterial stiffness and atherosclerosis. With this systematic review and meta-analysis, we aimed to provide a synthesis of the evidence regarding the association of arterial stiffness measured by pulse wave velocity and atherosclerosis measured by carotid intima media thickness with skin autofluorescence. A systematic search was performed using: MEDLINE (PubMed), SCOPUS, and Web of Science, until 30 March 2020. Cross-sectional studies or baseline data from prospective longitudinal studies were considered. The DerSimonian and Laird method was used to calculate the pooled estimates of correlation coefficients and the corresponding 95% confidence intervals (CI) for the association of pulse wave velocity and carotid intima media thickness with skin autofluorescence. Twenty-five studies were included in the systematic review and meta-analysis, including 6306 subjects. The pooled correlation coefficient was 0.25 (95% CI: 0.18, 0.31) for pulse wave velocity and skin autofluorescence, and 0.31 (95% CI: 0.25, 0.38) for carotid intima media thickness and skin autofluorescence. This systematic review and meta-analysis provide a synthesis of the evidence showing a positive weak association of pulse wave velocity and carotid intima media thickness with skin autofluorescence.
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http://dx.doi.org/10.3390/ijerph17186936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559442PMC
September 2020

Association between type of rotator cuff tear and functional outcomes in patients with massive and irreparable rotator cuff tear: A pre-post intervention study.

J Shoulder Elbow Surg 2020 Sep 10. Epub 2020 Sep 10.

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

Background: The aim of this study was to analyze: (1) the differences in the pre-post change in functional outcomes after a physical therapy program by the type of massive and irreparable rotator cuff tear (MIRCT) controlling for potential confounders, and (2) the influence of lifestyle behaviors and demographic and tear tendon characteristics on function in patients over 60 years of age with conservatively treated MIRCT.

Materials And Methods: In this pre-post intervention study, 92 patients were prospectively recruited at the Clinical Hospital San Borja Arriaran, with atraumatic MIRCT, between 60 and 75 years of age (mean: 67.9 ± 4.5 years), and the mean of length of symptoms was 16.5 months (±5.7 months). Patients received a physical therapy program consisting of manual therapy and a specific exercise program of 2 sessions per week for 12 weeks. The imaging findings were performed by 2 medical radiologists who classified the rotator cuff tear according to the criteria proposed by Collins. Shoulder function, upper limb function, and pain intensity were assessed with the Constant-Murley; Disabilities of the Arm, Shoulder, and Hand; and visual analog scale (VAS), respectively. Analysis of covariance models were estimated to assess differences in MIRCT categories between functional outcomes. Multiple regression model analysis was used for the association between the change in functional outcomes and lifestyle behaviors, and demographic and tear tendon characteristics.

Results: The results showed no pre-post change in functional outcomes by type of MIRCT in all models (P > .05). There is an association between length of symptoms (P = .000), and the baseline values of the 3 functional measures (P = .000) are associated with changes in Constant-Murley; Disabilities of the Arm, Shoulder, and Hand; and VAS. In addition, changes in VAS are associated with body mass index (BMI) (P = .000), and changes in Constant-Murley are associated with gender (P = .023), BMI (P = .000), and tobacco consumption (P = .000).

Conclusion: There is no difference in functional outcomes by type of MIRCT after a physical therapy program controlling for potential confounders. In addition, there is an association of length of symptoms with all functional outcomes, an association of BMI with VAS and Constant-Murley questionnaire, and an association between tobacco consumption and Constant-Murley questionnaire. Our results could influence the orthopedic surgeon's decisions; thus, not predicting the functional outcome through imaging findings could lead clinicians to reconsider the need for surgery in the treatment algorithm in patients over 60 years with MIRCT. In addition, demographic characteristics and lifestyle behaviors might be considered within the patient's evaluation and follow-up to decide on surgical interventions and evaluate the clinical course of the disease. Further studies measuring additional variables and longer follow-up are needed to confirm these results.
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http://dx.doi.org/10.1016/j.jse.2020.08.034DOI Listing
September 2020

Effectiveness of Mobile Health Interventions Promoting Physical Activity and Lifestyle Interventions to Reduce Cardiovascular Risk Among Individuals With Metabolic Syndrome: Systematic Review and Meta-Analysis.

J Med Internet Res 2020 08 31;22(8):e17790. Epub 2020 Aug 31.

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

Background: Physical activity and lifestyle interventions, such as a healthy diet, have been proven to be effective approaches to manage metabolic syndrome. However, these interventions require great commitment from patients and clinicians owing to their economic costs, time consumption, and lack of immediate results.

Objective: The aim of this systematic review and meta-analysis was to analyze the effect of mobile-based health interventions for reducing cardiometabolic risk through the promotion of physical activity and healthy lifestyle behaviors.

Methods: PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and SPORTdiscus databases were searched for experimental studies evaluating cardiometabolic risk indicators among individuals with metabolic syndrome who were included in technology-assisted physical activity and lifestyle interventions. Effect sizes, pooled mean changes, and their respective 95% CIs were calculated using the DerSimonian and Laird method. Outcomes included the following clinical and biochemical parameters: body composition (waist circumference [WC] and BMI), blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]), glucose tolerance (fasting plasma glucose [FPG] and glycated hemoglobin A1c [HbA]), and lipid profile (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL-C], and triglycerides).

Results: A total of nine studies were included in the meta-analysis. Owing to the scarcity of studies, only pooled mean pre-post changes in the intervention groups were estimated. Significant mean changes were observed for BMI (-1.70 kg/m2, 95% CI -3.20 to -0.20; effect size: -0.46; P=.03), WC (-5.77 cm, 95% CI -9.76 to -1.77; effect size: -0.54; P=.005), SBP (-7.33 mmHg, 95% CI -13.25 to -1.42; effect size: -0.43; P=.02), DBP (-3.90 mmHg, 95% CI -7.70 to -0.11; effect size: -0.44; P=.04), FPG (-3.65 mg/dL, 95% CI -4.79 to -2.51; effect size: -0.39; P<.001), and HDL-C (4.19 mg/dL, 95% CI 2.43-5.95; effect size: 0.23; P<.001).

Conclusions: Overall, mobile-based health interventions aimed at promoting physical activity and healthy lifestyle changes had a strong positive effect on cardiometabolic risk indicators among individuals with metabolic syndrome. Nevertheless, further research is required to compare this approach with usual care in order to support the incorporation of these technologies in health systems.

Trial Registration: PROSPERO CRD42019125461; https://tinyurl.com/y3t4wog4.
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http://dx.doi.org/10.2196/17790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490678PMC
August 2020

Exercise versus fixed-dose combination therapy for cardiovascular risk factors control and atherosclerotic disease prevention: a network meta-analysis protocol.

BMJ Open 2020 07 8;10(7):e036734. Epub 2020 Jul 8.

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

Introduction: Despite the consistent evidence of the benefits of physical activity on preventing atherosclerotic cardiovascular diseases (ASCVD) and some cardiovascular risk factors, such as hypertension and dyslipidaemia, the prescription of drugs remains the most widely used approach to prevent ASCVD in clinical settings. The purpose of this study protocol is to provide a meta-synthesis methodology for comparing the effect of fixed-dose combination therapy and physical exercise on controlling cardiovascular risk factors and preventing ASCVD.

Methods And Analysis: This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the recommendations of the Cochrane Collaboration Handbook. We plan to conduct a computerised search in Medline, Web of Science, Embase, Cochrane Database of Systematic Reviews and SPORTDiscus from inception to May 2020 for studies testing the effectiveness of physical exercise or fixed-dose combination drug therapy in preventing ASCVD, all-cause and cardiovascular mortality and controlling some cardiovascular risk factors (hypertension and dyslipidaemia). Since performing network meta-analyses (NMA) is a statistical approach that allows direct and indirect comparisons of interventions, where sufficient studies are included, we plan to perform the following NMA comparing the effect of fixed-dose combination therapy and physical exercise interventions on (1) improving lipid profile, (2) reducing blood pressure, (3) preventing cardiovascular events and all-cause and cardiovascular mortality and (4) improving compliance with the therapeutic strategy and reducing adverse events.

Ethics And Dissemination: Ethical approval will not be needed because data included in the NMA will be extracted from published trials that meet accepted ethical standards. The results will be published in academic peer-reviewed journals, and the evidence gathered by this project could be included in the preventive cardiovascular disease guidelines.

Prospero Registration Number: CRD42019122794.
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http://dx.doi.org/10.1136/bmjopen-2019-036734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348467PMC
July 2020

Effect of Behavioral Weight Management Interventions Using Lifestyle mHealth Self-Monitoring on Weight Loss: A Systematic Review and Meta-Analysis.

Nutrients 2020 Jul 3;12(7). Epub 2020 Jul 3.

Universidad de Castilla-La Mancha, Health and Social Research Center, 16071 Cuenca, Spain.

Alongside an increase in obesity, society is experiencing the development of substantial technological advances. Interventions that are easily scalable, such as lifestyle (including diet and physical activity) mobile health (mHealth) self-monitoring, may be highly valuable in the prevention and treatment of excess weight. Thus, the aims of this systematic review and meta-analysis were to estimate the following: (i) the effect of behavioral weight management interventions using lifestyle mHealth self-monitoring on weight loss and (ii) the adherence to behavioral weight management interventions using lifestyle mHealth self-monitoring. MEDLINE via PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and the Web of Science databases were systematically searched. The DerSimonian and Laird method was used to estimate the effect of and adherence to behavioral weight management interventions using lifestyle mHealth self-monitoring on weight loss. Twenty studies were included in the systematic review and meta-analysis, yielding a moderate decrease in weight and higher adherence to intervention of behavioral weight management interventions using lifestyle mHealth self-monitoring, which was greater than other interventions. Subgroup analyses showed that smartphones were the most effective mHealth approach to achieve weight management and the effect of behavioral weight management interventions using lifestyle mHealth self-monitoring was more pronounced when compared to usual care and in the short-term (less than six months). Furthermore, behavioral weight management interventions using lifestyle mHealth self-monitoring showed a higher adherence than: (i) recording on paper at any time and (ii) any other intervention at six and twelve months.
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http://dx.doi.org/10.3390/nu12071977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400167PMC
July 2020

Accuracy of Pulse Wave Velocity Predicting Cardiovascular and All-Cause Mortality. A Systematic Review and Meta-Analysis.

J Clin Med 2020 Jul 2;9(7). Epub 2020 Jul 2.

Universidad de Castilla-La Mancha, Health and Social Research Center, 16071 Cuenca, Spain.

Increased arterial stiffness has been associated with an increased risk of developing cardiovascular diseases and all-cause mortality. Pulse wave velocity (PWV) is an innovative and affordable measurement of arterial stiffness which may be an accessible tool to estimate mortality risk; however, no meta-analysis has estimated its predictive performance for cardiovascular and all-cause mortality. Moreover, reference values for PWV have only been established by consensus for healthy populations. The aim of this review was to estimate PWV and especially carotid femoral PWV performance predicting cardiovascular and all-cause mortality as well as comparing the resulting cfPWV thresholds with already established values in order to increase its validity. Original studies measuring PWV thresholds and its association with cardiovascular and all-cause mortality were systematically searched. The DerSimonian and Laird method was used to compute pooled estimates of diagnostic odds ratio (dOR), and overall test performances were summarized in hierarchical summary receiver operating characteristic curves (HSROC). Six studies were included in the meta-analysis. The pooled dOR values for the predictive performance of cfPWV were 11.23 (95 % CI, 7.29-1.29) for cardiovascular mortality and 6.52 (95% CI, 4.03-10.55) for all-cause mortality. The area under the HSROC curve for cfPWV was 0.75 (95% CI, 0.69-0.81) for cardiovascular mortality and 0.78 (95% CI, 0.74-0.83) for all-cause mortality, where the closest cut-off point to the summary point was 10.7 and 11.5, respectively. This systematic review and meta-analysis demonstrates that cfPWV is a useful and accurate cardiovascular mortality predictor and that its previously estimated reference values for estimating risk may be used in high-risk populations.
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http://dx.doi.org/10.3390/jcm9072080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408852PMC
July 2020

Effectiveness of hallux valgus surgery on patient quality of life: a systematic review and meta-analysis.

Acta Orthop 2020 08 14;91(4):450-456. Epub 2020 May 14.

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

Background and purpose - The quality of life (QoL) of patients with hallux valgus (HV) usually improves postoperatively. Evidence regarding the effect of HV surgery on different domains of patient QoL remains inconclusive. This systematic review and meta-analysis estimates the effect of HV surgery on patient QoL through distinguishing effects on physical domains (comprising physical function and body pain domains) using the EuroQol-5D, short form (SF) health survey-12, and SF-36 QoL scales and a visual analogue scale (VAS) score and mental and social domains using QoL scales.Patients and methods - MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2019 for studies on the effect of HV surgery on patient QoL. A standardized mean difference score was calculated for each specific QoL domain (mental, social, pain, physical, and VAS) using Cohen's d index. The pooled effect size (ES) was estimated using a random-effects model based on the DerSimonian and Laird method.Results - From 12 published studies selected, the estimated pooled ES for QoL was 1.01 (95% confidence interval [CI] 0.52-1.51; I = 87%) for body pain and 0.43 (CI 0.31-0.55, I = 35%) for physical function. Regarding the composite mental and social domains of QoL, the pooled ES estimates were 0.24 (CI 0.00-0.47, I = 80%) and 0.42 (CI 0.21-0.63, I = 6.4%), respectively. The pooled difference in means for the VAS score was -4.1 (CI -4.5 to -3.6, I = 90%).Interpretation - Our data showed that HV surgery decreased patients' perceptions regarding pain. Furthermore, the data confirmed that HV surgery increased patients' QoL, particularly concerning physical and social domains.
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http://dx.doi.org/10.1080/17453674.2020.1764193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023907PMC
August 2020