Browsing by Author "Ezzatvar, Yasmin"

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    PublicationOpen Access
    Adherence to 24-hour movement guidelines in adolescence and its association with lower risk of hypertension in adulthood
    (Springer, 2025-03-06) García Hermoso, Antonio; López Gil, José Francisco; Yáñez-Sepúlveda, Rodrigo; Olivares-Arancibia, Jorge; Páez-Herrera, Jacqueline; Ezzatvar, Yasmin; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
    Background There is limited research on how adherence to 24 h movement guidelines from adolescence to adulthood afects long-term hypertension outcomes. This study examined the association between sustained adherence to these guidelines and hypertension risk. Methods Analysis was done on data from adolescents 12- to 19-year-olds who took part in Waves I and V of the Add Health Study. Physical activity (PA), screen time, and sleep duration were assessed through self-report questionnaires. Blood pressure (BP) was assessed on the right arm following a 5 min seated rest, utilizing an oscillometric device, and hypertension was defned as systolic/diastolic BP≥140/90 mmHg, physician-diagnosed hypertension, or current antihypertensive medication use. Results This prospective study included a total of 3076 participants (60.3% female), and 802 were diagnosed with hypertension. Meeting sleep duration guidelines at Wave I was associated with reductions in systolic [−0.568 mmHg, 95% biascorrected and accelerated (BCa) confdent interval (CI)−2.128 to−0.011, P=0.044] and diastolic (−0.331 mmHg, 95% BCa CI−1.506 to−0.071, P=0.043) BP at Wave V. Adherence to PA and sleep duration guidelines at both waves further reduced BP, with the greatest decreases observed among participants meeting all three guidelines: systolic (−6.184 mmHg, 95% BCa CI−13.45 to−0.915, P=0.040) and diastolic BP (−3.156 mmHg, 95% BCa CI−6.413 to−0.120, P=0.047). The risk of hypertension was lower among those who met the PA guidelines individually [relative risk (RR) 0.710, 95% CI 0.516–0.976, P=0.035] or adhered to all three recommendations (RR 0.699, 95% CI 0.311–0.899, P=0.030) in both waves. Conclusions Our fndings highlight the cardiovascular benefts of consistently adhering to healthy movement behaviors from adolescence through adulthood.
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    PublicationOpen Access
    Association of physical activity patterns with nocturnal hypoglycemia events in youth with type 1 diabetes
    (Oxford University Press, 2024-07-02) Hormazábal Aguayo, Ignacio; Huerta Uribe, Nidia; Muñoz Pardeza, Jacinto; Ezzatvar, Yasmin; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
    Aims This study sought to elucidate the interactions among physical activity (PA) patterns, mean glucose concentrations, and the incidence of nocturnal hypoglycemia events in children and adolescents with type 1 diabetes, examining the moderating influence of daily dosage on these associations.Methods Eighty-two participants aged 6 to 18 years (43.9% girls) from the Diactive-1 Cohort Study, diagnosed with type 1 diabetes, were included. Data collection involved continuous glucose monitoring, accelerometry to assess real-world PA, as well as documentation of daily insulin doses and carbohydrate counting over the same 7 days.Results A total of 19 participants experienced at least 1 nocturnal hypoglycemia event over a span of 574 measurement days (106 days with and 451 days without nocturnal hypoglycemia). Higher levels of vigorous PA (VPA) were associated with lower same-day mean glucose levels (P = .014). Additionally, higher levels of moderate PA (P = .023), VPA (P = .011), and moderate-to-vigorous PA (P = .010) were associated with a greater number of nocturnal hypoglycemia events. Specifically, a significant association was identified between VPA and nocturnal hypoglycemia events when the daily insulin dose was at or above 1.04 units per kilogram of body weight per day (P = .016).Conclusion Daily VPA is associated with glucose reductions, potentially leading to more hypoglycemic episodes, particularly when there is an excess of daily insulin. This highlights the need for careful insulin management in children and adolescents with type 1 diabetes engaging in VPA.
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    PublicationOpen Access
    Can an active lifestyle reduce the risk of obesity in adulthood among adolescents with Attention-Deficit/Hyperactivity Disorder symptoms? An ambispective cohort study
    (Elsevier, 2024) García Hermoso, Antonio; Ezzatvar, Yasmin; Izquierdo Redín, Mikel; López Gil, José Francisco; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
    Various studies have associated Attention-Deficit/Hyperactivity Disorder (ADHD) with obesity, but the role of physical activity in this connection is uncertain. This study examined whether adopting an active lifestyle can mitigate the link between adolescent ADHD and the risk of adult obesity. Longitudinal data from the Add Health Study (Waves I, III, and V) were used. Participants self-reported ADHD symptoms (hyperactivity/impulsivity, inattention, combined) during Wave III and self-assessed their recent moderate-to-vigorous physical activity. An "active lifestyle" required meeting activity criteria in both adolescence (Wave I) and adulthood (Wave III-V). Of 2609 participants, 1.42 % exhibited combined ADHD symptoms. A non-linear relationship was observed between inattentive/hyperactive scores and body mass index (BMI) and waist circumference (WC). Individuals with ≥ 6 hyperactivity/impulsivity symptoms had higher BMI (1.29 kg/m²) and WC (1.27 cm) at adulthood. Logistic regressions indicate that, compared to individuals without ADHD maintaining an active lifestyle, both inactive participants with and without ADHD show an elevated risk of obesity (odds ratio [OR]=1.56 to 2.63) and abdominal obesity in adulthood (OR = 1.51 to 2.50). Mediation analysis models further confirm these findings, suggesting that physical activity may explain this association. Though exact mechanisms warrant further exploration, adopting an active lifestyle offers promise for reducing obesity risk among individuals with ADHD symptoms.
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    PublicationOpen Access
    A cluster randomized controlled trial of the Archena Infancia Saludable project on 24-h movement behaviors and adherence to the mediterranean diet among schoolchildren: a pilot study protocol
    (MDPI, 2023) López Gil, José Francisco; García Hermoso, Antonio; Smith, Lee; Gallego, Alejandra; Victoria-Montesinos, Desirée; Ezzatvar, Yasmin; Hershey, María Soledad; Gutiérrez Espinoza, Héctor; Mesas, Arthur; Jiménez-López, Estela; Sánchez-Miguel, Pedro Antonio; López-Benavente, Alba; Moreno Galarraga, Laura; Chen, Sitong; Brazo-Sayavera, Javier; Fernández-Montero, Alejandro; Alcaraz, Pedro E.; Panisello Royo, Josefa María; Tárraga López, Pedro J.; Kales, Stefanos N.; Ciencias de la Salud; Osasun Zientziak
    Objective: The aim of this paper is to describe the protocol of pilot cluster randomized controlled trial (RCT) that will evaluate the effects of a lifestyle-based intervention. The Archena Infancia Saludable project will have several objectives. The primary objective of this project is to determine the 6-month effects of a lifestyle-based intervention on adherence to 24-h movement behaviors and Mediterranean diet (MedDiet) in schoolchildren. The secondary objective of this project is to test the intervention effects of this lifestyle-based intervention on a relevant set of health-related outcomes (i.e., anthropometric measurements, blood pressure, perceived physical fitness, sleep habits, and academic performance). The tertiary objective is to investigate this intervention’s “halo” effect on parents’/guardians’ 24-h movement behaviors and adherence to the MedDiet. Methods: The Archena Infancia Saludable trial will be a cluster RCT submitted to the Clinical Trials Registry. The protocol will be developed according to SPIRIT guidelines for RCTs and CONSORT statement extension for cluster RCTs. A total of 153 eligible parents/guardians with schoolchildren aged 6–13 years will be randomized into an intervention group or a control group. This project focuses on two fundamental pillars: 24-h movement behaviors and MedDiet. It will mainly focus on the relationship between parents/guardians and their children. Behavior change strategies for dietary and 24-h movement behaviors in schoolchildren will be based on healthy lifestyle education for parents/guardians through infographics, video recipes, brief video clips, and videos. Conclusions: Most of the current knowledge on 24-h movement behaviors and adherence to the MedDiet is based on cross-sectional or longitudinal cohort studies, warranting a need to design and conduct RCTs to obtain more robust evidence on the effect of a healthy lifestyle program to increase 24-h movement behaviors and to improve adherence to the MedDiet in schoolchildren.
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    PublicationOpen Access
    Comprehensive management of children and adolescents with type 1 diabetes mellitus through personalized physical exercise and education using an mHealth system: the Diactive-1 study protocol
    (Frontiers Media, 2024) Hormazábal Aguayo, Ignacio; Muñoz Pardeza, Jacinto; López Gil, José Francisco; Huerta Uribe, Nidia; Chueca-Guindulain, María J.; Berrade-Zubiri, Sara; Burillo Sánchez, Elisabeth; Izquierdo Redín, Mikel; Ezzatvar, Yasmin; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
    Introduction: The use of new technologies presents an opportunity to promote physical activity, especially among young people with type 1 diabetes (T1DM), who tend to be less active compared to their healthy counterparts. The aim of this study is to investigate the impact of a personalized resistance exercise program, facilitated by the Diactive-1 App, on insulin requirements among children and adolescents diagnosed with T1DM. Methods and analysis: A minimum of 52 children and adolescents aged 8-18 years, who were diagnosed with T1DM at least 6 months ago, will be randomly assigned to either a group engaging in an individualized resistance exercise program at least 3 times per week over a 24-week period or a waiting-list control group. The primary outcome will be the daily insulin dose requirement. The secondary outcomes will include glycemic control, cardiometabolic profile, body composition, vascular function, physical fitness, 24-hour movement behaviors, diet, and psychological parameters. The usability of the app will also be assessed. Ethics and dissemination: Ethical approval to conduct this study has been granted by the University Hospital of Navarra Research Board (PI_2020/140). Parents or legal guardians of minors participating in the study will provide written consent, while children and adolescents will sign an assent form to indicate their voluntary agreement. The trial's main findings will be shared through conference presentations, peer-reviewed publications, and communication directly with participating families. This study aims to offer valuable insights into the holistic management of children and adolescents with T1DM by utilizing personalized exercise interventions through an mHealth system.
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    PublicationOpen Access
    Development and validation of a scale measuring perceived barriers to physical activity in Spanish for children and adolescents with type 1 diabetes: the Physical Activity Barriers Scale for pediatric type 1 diabetes (PABS-1) questionnaire
    (Elsevier, 2025-06-01) García Hermoso, Antonio; Huerta Uribe, Nidia; Hormazábal Aguayo, Ignacio; Muñoz Pardeza, Jacinto; Chueca-Guindulain, María J.; Burillo Sánchez, Elisabeth; Ezzatvar, Yasmin; López Gil, José Francisco; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
    Aims: To develop and validate the psychometric properties, reliability, and criterion validity of the Physical Activity Barriers Scale for pediatric type 1 diabetes (PABS-1) in Spanish-speaking children and adolescents with type 1 diabetes. Method: A cross-sectional study was conducted with a sample of 93 Spanish-speaking children and adolescents with type 1 diabetes. The PABS-1 questionnaire was developed by experts and refined with patient feedback. Its validity was assessed by comparing results with accelerometer data, linking scores to objective physical activity measures. Results: The PABS-1 showed good internal consistency, with a Cronbach’s alpha (α) coefficient of 0.89, indicating strong reliability. Confirmatory factor analysis supported a four-factor structure, with physical, diabetes-related, psychological, and environmental barriers showing good fit indices (comparative fit index [CFA] = 0.94, root mean square error of [RMSEA] = 0.06, standardized root mean square residual [SRMR] = 0.05). Although the associations were small, the total PABS-1 score was significantly negatively correlated with cardiorespiratory fitness (Spearman’s rho [ρ]= -0.15, p = 0.035) and moderate-to-vigorous physical activity (ρ = − 0.12, p = 0.039). Among the four factors, motivational barriers exhibited the strongest associations with physical activity and fitness, showing significant negative correlations. Conclusions: The PABS-1 is a valid and reliable tool for assessing perceived barriers to physical activity in Spanish-speaking children and adolescents with type 1 diabetes.
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    PublicationOpen Access
    Effects of acupuncture versus placebo on clinical status and potential specific effects in fibromyalgia: an umbrella review of 11 meta-analyses
    (SAGE, 2024-08-20) Araya-Quintanilla, Felipe; Ramírez Vélez, Robinson; Méndez Rebolledo, Guillermo; Cuyul-Vásquez, Iván; Arce Álvarez, Alexis; Ezzatvar, Yasmin; Gutiérrez Espinoza, Héctor; Ciencias de la Salud; Osasun Zientziak
    Background: the use of acupuncture is related to patients' expectations, and the therapeutic interaction effect remains a topic of debate in the literature. Accordingly, it is still unclear whether acupuncture can generate positive clinical effects in patients with fibromyalgia (FM). Objective: to determine the effectiveness of acupuncture versus placebo for clinical outcomes and determine the overall effect not attributed to specific effects in patients with FM. Design: umbrella review of systematic reviews (SRs) and meta-analyses. Data sources and methods: an electronic search was performed in MEDLINE (via PubMed), Web of Science, CENTRAL, EMBASE, LILACS, CINAHL, PEDro, and SPORTDiscus databases from inception until December 2023. We selected studies with a clinical diagnosis of FM and that analyzed the effectiveness of acupuncture compared with a placebo. Pain intensity, functional status, fatigue, sleep quality, and depression symptoms were assessed. Effect sizes were calculated as the mean difference (MD) or standard mean difference (SMD). The quality of intervention reporting was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: Eleven SRs with 8399 participants were included. Compared with placebo, acupuncture was associated with reductions in pain intensity (MD = -1.13 cm, 95% CI -2.09 to -0.17, p < 0.001), physical function (SMD = -0.63, 95% CI -1.67 to 0.41, p = 0.06), sleep quality (SMD = -0.25, 95% CI -1.39 to 0.88, p = 0.06), and fatigue (SMD = 0.20, 95% CI = 0.17 to 0.22, p < 0.001). The proportion not attributable to specific effects (PCE) of acupuncture was 58% for pain intensity (PCE = 0.58, 95% CI 0.45 to 0.71), 57% for physical function (PCE = 0.57, 95% CI -0.07 to 1.20), and 69% for fatigue (PCE = 0.69, 95% CI 0.18 to 1.21). Conclusion: acupuncture showed a statistically significant difference in decreased pain intensity and fatigue in women with FM. However, the certainty of evidence was low to very low; its effects are not clinically important, and more than 50% of the overall treatment effects were not attributed to the specific effects of acupuncture.
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    PublicationOpen Access
    Effects of exercise training on glycaemic control in youths with type 1 diabetes: a systematic review and meta-analysis of randomised controlled trials
    (Taylor & Francis, 2022) García Hermoso, Antonio; Ezzatvar, Yasmin; Huerta Uribe, Nidia; Alonso Martínez, Alicia; Chueca-Guindulain, María J.; Berrade-Zubiri, Sara; Izquierdo Redín, Mikel; Ramírez Vélez, Robinson; Ciencias de la Salud; Osasun Zientziak
    The aim of the study is to evaluate whether exercise interventions are associated with improved glycaemic control in children and adolescents with type 1 diabetes mellitus (T1DM), and to examine its relationship with the characteristics of the intervention (i.e. type, intensity, length, and duration of the sessions). Eligible criteria were randomised controlled trials of youth aged 6– 18 years with T1DM, participating in an exercise-based intervention where glycaemic control is measured (i.e. glycated haemoglobin [HbA1c]). Pooled effect sizes (Hedges’g) were calculated using random-effects inverse-variance analyses. Fourteen studies enrolling 509 patients were analysed. Effect size was expressed as Hedges’ g to correct for possible small sample bias. Overall, HbA1c levels in the exercise group (g = –0.38 95% confidence interval [CI], –0.66 to –0.11; mean difference [MD] = –0.62%) were reduced compared with the control group. Concurrent training (g = –0.63 95%CI, –1.05 to –0.21), high-intensity exercise (g = –0.43 95%CI, –0.83 to –0.03), interventions ≥24 weeks (g = –0.92 95%CI, –1.44 to –0.40), and sessions ≥60 minutes (g = –0.71 95%CI, –1.05 to –0.08) showed larger changes (MD = –0.66% to 1.30%). In conclusion, our study suggests that programmes longer than 24 weeks with at least 60 min/session of high-intensity concurrent exercise may serve as a supportive therapy to metabolic control in youth with T1DM.
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    PublicationOpen Access
    Handgrip strength, cardiometabolic risk and body composition in youth with type 1 diabetes: the Diactive-1 Cohort Study
    (BMJ Publishing, 2024-12-04) Huerta Uribe, Nidia; Hormazábal Aguayo, Ignacio; Muñoz Pardeza, Jacinto; Chueca-Guindulain, María J.; Berrade-Zubiri, Sara; Andrés Sesma, Carlos; Burillo Sánchez, Elisabeth; Ezzatvar, Yasmin; Yáñez-Sepúlveda, Rodrigo; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
    Objective: this study aimed to explore the association between handgrip strength, cardiometabolic risk (CMR) and body composition in youth with type 1 diabetes. Methods: for this prospective cohort study, muscular fitness was assessed via handgrip test and relativised by weight, and body composition, evaluated through dual-energy X-ray absorptiometry in type 1 diabetes patients aged 6-18 years. CMR score included z-scores for total body fat, blood pressure, glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride-glucose index. Results: eighty-three patients were analysed at baseline and 1-year follow-up (44.6% females, mean age 12.77 years). Individuals with high handgrip strength tended to have lower CMR and body fat compared with those with low handgrip strength. Over a year, individuals with high handgrip strength showed reduced HbA1c, CMR and subcutaneous fat. Consistently meeting high handgrip strength criteria resulted in reductions in HbA1c levels, CMR score and subcutaneous adipose tissue compared with those who never complied or lost compliance during follow-up. Additionally, subjects classified with high handgrip strength both at baseline and follow-up had a lower likelihood of being classified with high CMR (OR=0.241, 95% CI 0.121 to 0.947, p=0.044). Conclusions: high handgrip strength was associated with significant cardiometabolic and body composition benefits in youth with type 1 diabetes. This tool could be considered of potential clinical value for incorporating assessments like handgrip tests to monitor and address cardiometabolic health.
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    PublicationOpen Access
    Impact of an mHealth and tailored physical activity intervention on the management and outcomes of children and adolescents with type 1 diabetes mellitus: a comprehensive approach to incidence, usability, and hypoglycemia risk
    (2025) Hormazábal Aguayo, Ignacio; García Hermoso, Antonio; Ezzatvar, Yasmin; Ciencias de la Salud; Osasun Zientziak
    Esta tesis doctoral se basa en un proyecto de investigación llevado a cabo por la unidad de "Actividad Física en la Infancia y Juventud" del Centro de Investigación Biomédica Navarrabiomed, en colaboración con el grupo E-FIT (Ejercicio Físico, Salud y Calidad de Vida). Incluye datos tanto de un estudio de cohorte longitudinal, denominado Estudio de Cohorte Diactive-1, como de un ensayo controlado aleatorizado (ECA) titulado Diactive-1: Manejo Integral de Niños y Adolescentes con Diabetes Mellitus Tipo 1 (DMT1) a través del Ejercicio Físico Personalizado y Control Glucémico Utilizando un Sistema eHealth. Este proyecto ha sido financiado por el Instituto de Salud Carlos III (PI_2020/140) y se ha llevado a cabo en la Unidad de Endocrinología Pediátrica del Hospital Universitario de Navarra (HUN) (España). La investigación tiene como objetivo comprender el efecto de un programa de ejercicio físico personalizado y multidimensional, que incluye control dietético y terapia con insulina, sobre el control glucémico y la adherencia al tratamiento en niños y adolescentes con DMT1, a través del uso de una aplicación móvil. Esta Tesis Doctoral consta de tres estudios publicados en revistas científicas internacionales. El primer estudio (Capítulo 1) tuvo como objetivo determinar la incidencia global de DMT1 en niños y adolescentes menores de 20 años desde el año 2000 hasta 2022, incluyendo un subanálisis de los períodos pre-pandemia y pandemia de COVID-19. El segundo estudio (Capítulo 2) se centró en analizar la relación entre los parámetros de actividad física, los niveles promedio de glucosa y los eventos de hipoglucemia nocturna durante 7 días, buscando estimar un umbral de dosis de insulina para prevenir eventos de hipoglucemia nocturna en niños y adolescentes con DMT1. El tercer estudio (Capítulo 3) presenta un protocolo de estudio para un RCT cuyo objetivo principal es comparar los efectos de una intervención de 24 semanas con la aplicación Diactive-1 frente al cuidado estándar en los requerimientos de dosis de insulina en niños y adolescentes con T1DM. Los objetivos secundarios incluyen evaluar el impacto de la intervención con la aplicación Diactive-1 en el control glucémico, el perfil cardiometabólico, la composición corporal, la función vascular, la condición física, los comportamientos de movimiento de 24 horas, los hábitos alimentarios y el bienestar psicológico en comparación con un grupo de control que recibe el cuidado estándar, durante el período de intervención de 24 semanas. El cuarto estudio (Capítulo 4) se centró en evaluar la usabilidad de la app Diactive-1, diseñada para apoyar el entrenamiento de fuerza muscular en niños y adolescentes con DMT1, en línea con las directrices de la Sociedad Internacional de Diabetes Pediátrica y Adolescente y la Asociación Americana de Diabetes.
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    PublicationOpen Access
    Incidence of type 1 diabetes mellitus in children and adolescents under 20 years of age across 55 countries from 2000 to 2022: a systematic review with meta-analysis
    (Wiley, 2023) Hormazábal Aguayo, Ignacio; Ezzatvar, Yasmin; Huerta Uribe, Nidia; Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
    Aims: the aim of this study was to determine the global incidence of type 1 diabetes mellitus (T1DM) in children and adolescents under 20 years of age from 2000 to 2022. Materials and methods: two reviewers searched three electronic databases (PubMed, Web of Science, and CINAHL) for studies published between January 2000 and November 2022. Pooled estimates of T1DM incidence with a 95% confidence interval (CI) per 100,000 person-years were calculated by country/region, sex, age, and COVID-19 pandemic period (pre-COVID-19 and pandemic). Results: the study included 126 studies from 55 countries and 18 regions. The incidence rate (IR) of T1DM from 2000 to 2022 was 14.07 (95%CI, 12.15-16.29) per 100,000 person-years. Finland and high-income North America had the highest IR, with 56.81 (95%CI, 55.91-57.73) and 28.77 (95%CI, 26.59-31.13) per 100,000 person-years, respectively. The IR was 13.37 (95%CI, 10.60-16.88) per 100,000 person-years in boys and 13.87 (95%CI, 11.51-16.70) per 100,000 person-years in girls. There were statistically significant differences among different age ranges: 0-4 versus 5-9 and 10-14 years old (p < 0.001); 5-9 versus 15-19 (p < 0.001) and 10- 14 versus 15-19 years old (p = 0.003). Finally, during the pandemic period (2020-2022), the IR was 24.84 (95%CI, 17.16-35.96) per 100,000 person-years, which was higher but not significant compared with the prepandemic period (2017-2019) of 13.56 (95%CI, 7.49-24.56) per 100,000 person-years (p = 0.090). Conclusions: the IR of T1DM in children and adolescents under 20 years of age is substantial, especially during the pandemic period, although it varies across regions. More reliable data from additional countries are needed to determine the worldwide incidence of T1DM.
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    PublicationOpen Access
    Is device-measured vigorous physical activity associated with health-related outcomes in children and adolescents? A systematic review and meta-analysis
    (Elsevier, 2021) García Hermoso, Antonio; Ezzatvar, Yasmin; Ramírez Vélez, Robinson; Olloquequi, Jordi; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
    Objective: this study sought to analyze the prospective association between vigorous-intensity physical activity (VPA) and health-related outcomes in children and adolescents. Methods: studies reporting associations between device-measured VPA and health-related factors in children and adolescents aged 3-18 years were identified through database searches (MEDLINE, EMBASE, and SPORTDiscus). Correlation coefficients were pooled if outcomes were reported by at least 3 studies, using DerSimonian-Laird random effects models. Results: data from 23 studies including 13,674 participants were pooled using random effects models. Significant associations were found between VPA at baseline and overall adiposity (r = -0.09, 95% confidence interval (95%CI): -0.15 to -0.03; p = 0.002; I-2 = 89.8%), cardiometabolic risk score (r = -0.13, 95%CI: -0.24 to -0.02, p = 0.020; I-2 = 69.6%), cardiorespiratory fitness (r = 0.25, 95%CI: 0.15-0.35; p < 0.001; I-2 = 57.2%), and total body bone mineral density (r = 0.16, 95%CI: 0.06 to 0.25; p = 0.001; I-2 = 0%). Conclusion: VPA seems to be negatively related to adiposity and cardiometabolic risk score and positively related to cardiorespiratory fitness and total body bone mineral density among children and adolescents at follow-up. Therefore, our findings support the need to strengthen physical activity recommendations regarding VPA due to its health benefits in children and adolescents.
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    PublicationOpen Access
    Loneliness and social isolation as risk factors for type 2 diabetes onset: a systematic review and meta-analysis
    (Elsevier, 2025-05-01) Ezzatvar, Yasmin; Caballero, Óscar; Duclos-Bastías, Daniel; Yáñez-Sepúlveda, Rodrigo; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
    Aims: This study sought to analyze the association of social isolation and loneliness with the risk of type 2 diabetes onset. Methods: Two authors systematically searched PubMed, EMBASE, and Web of Science databases for studies published until February 2025, assessing the risk of incidence of type 2 diabetes in individuals who are socially isolated or lonely. To quantify the risk of incident diabetes, hazard ratios (HR) for loneliness and social isolation were pooled using a random-effects inverse-variance model with empirical Bayes estimation. Results: Nine prospective cohort studies were included, comprising 1,112,887 individuals (60.5 % female, mean age = 57.1 years), with 50,961 new cases of type 2 diabetes over a mean follow-up of 10.7 years. Loneliness was associated with a 32% increased risk of type 2 diabetes (HR = 1.32 [95 % confidence interval [CI]:1.11–1.57]). Social isolation was linked to a 20% higher risk (HR = 1.20 [95 %CI:1.01–1.43]). The included studies showed fair-to-good methodological quality (mean score: 10.11/14) based on the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Conclusions: Social isolation and loneliness are significant risk factors for type 2 diabetes. Addressing social connectedness could be a valuable strategy for diabetes prevention, emphasizing the need to incorporate psychosocial factors into public health initiatives.
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    PublicationOpen Access
    Long-term impact of adherence to muscle-strengthening guidelines on inflammation markers: a 17-year follow-up study with obesity parameters as mediators
    (BMJ Publishing, 2024-12-07) García Hermoso, Antonio; Ezzatvar, Yasmin; Yáñez-Sepúlveda, Rodrigo; Olivares-Arancibia, Jorge; Páez-Herrera, Jacqueline; López Gil, José Francisco; Ciencias de la Salud; Osasun Zientziak
    Objective: To evaluate the relationship between adherence to muscle-strengthening guidelines in young adulthood and inflammation markers over a 17-year follow-up period. Additionally, it aims to examine whether body mass index (BMI) and waist circumference (WC) act as mediators in this relationship. Methods: The study analysed data from young adults aged 18–26 years who participated in waves III (2001–2002), IV (2008–2009) and V (2016–2018) of the Add Health Study. Adherence to muscle-strengthening guidelines was self-reported, and participants were classified as adherent if they engaged in strength training ≥2 days per week across all waves. Venous blood samples were collected at participants’ homes to measure highsensitivity C reactive protein (hs-CRP) levels and various cytokine concentrations, including interleukin (IL)−6, IL1beta, IL-8, IL-10 and tumour necrosis factor-alpha (TNFα). A global inflammation score was also calculated using z-scores of these markers. Results: A total of 2320 individuals participated (60.8% females). Participants adhering to muscle-strengthening guidelines exhibited significant reductions in hs-CRP, IL-6 and the inflammation z-score, with mean difference (MD) of −1.556mg/L (95% CI BCa −2.312 to −0.799), −0.324 pg/mL (95% BCa CI −0.586 to −0.062), and −0.400 (95% BCa CI −0.785 to −0.035), respectively. Mediation analysis revealed that BMI and WC levels at wave V significantly mediated the relationship between strength training and inflammation z-score, with significant indirect effects of −0.142 (95% CI −0.231 to −0.055) for BMI and −0.210 (95% CI −0.308 to −0.124) for WC. Conclusion: Adherence to muscle-strengthening guidelines alone may not be sufficient to achieve a notable decrease in inflammation without concurrent reductions in these obesity parameters.
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    PublicationOpen Access
    Maintaining an active lifestyle from adolescence to adulthood might alleviate the adverse association of preterm birth with cardiometabolic health
    (Elsevier, 2024) Ezzatvar, Yasmin; López Gil, José Francisco; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa.
    Aims: We aimed to determine whether physical activity attenuates preterm birth's adverse effects on adult cardiometabolic health. Methods: This retrospective study utilized data from the Add Health Study, a prospective cohort conducted in the United States. During Wave V (mean age: 37 years; 60.7% women; mean body mass index: 29 kg/m2; mean waist circumference: 95 cm), we evaluated cardiometabolic risk factors and preterm birth status (i.e., born <37 weeks). Self-reported physical activity data was collected through questionnaires during Waves I (ages 12–19) and Wave V. An "active lifestyle" was defined by adherence to recommendations during both waves, spanning from adolescence to adulthood. Results: The sample, comprising 3320 individuals, with 9.5% being preterm, included 7.6% who remained physically active throughout both adolescence and adulthood. Preterm-born individuals who were inactive had higher rates of obesity (incidence rate ratio [IRR] = 1.39, 95% confidence interval (CI) 1.05–1.84), abdominal obesity (IRR = 1.46, 95% CI 1.11–1.92), hyperlipidemia (IRR 3.50, 95% CI 1.94–4.29), type 2 diabetes (IRR = 2.37, 95% CI 1.12–5.01), and metabolic syndrome (IRR = 2.61, 95% CI 1.17–5.80) compared to active term-born individuals. Maintaining an active lifestyle appeared to decrease the risk of obesity and hyperlipidemia in adults born preterm (p > 0.05). Conclusions: While preterm birth is associated with an elevated risk of adult cardiometabolic risk, maintaining an active lifestyle appeared to slightly mitigate the risk of obesity and hyperlipidemia in adults born preterm.
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    Physical activity is related to lower levels of neurofilament light and plasma tau protein: a 22-year follow-up study from adolescence to adulthood
    (Elsevier, 2025-06-01) Ezzatvar, Yasmin; López Gil, José Francisco; Yáñez-Sepúlveda, Rodrigo; Olivares-Arancibia, Jorge; Páez-Herrera, Jacqueline; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
    Purpose: To investigate the association between physical activity (PA) and neurodegeneration biomarkers from adolescence to adulthood by examining tau protein and neurofilament light chain (NfL) levels in blood samples. Methods: The study analyzed data from adolescents aged 12–19 years who participated in Waves I (1994–1996) and V (2016–2018) of the Add Health study over a span of 22 years. It assessed PA through self-reported questionnaires. Neurodegeneration measures at Wave V used venous blood collected via phlebotomy. Samples were analyzed using single-molecule array (Simoa) technology on a Quanterix HD-1 analyzer, using digital enzyme-linked immunosorbent assay to quantify NfL and tau proteins from serum and plasma samples. Results: In the present study, 3,182 individuals participated, with females comprising 61% of the sample. Participants adhering to the PA guidelines in both waves reported lower levels of NfL (−0.583 pg/mL, 95% bias-corrected and accelerated (BCa) confidence interval (CI): −1.235 to −0.068) and tau protein levels (−0.244 pg/mL, 95% BCa CI: −0.405 to −0.078). Adjusted analyses confirmed significant lower levels of tau protein (−0.210 pg/mL, 95% BCa CI: −0.350 to −0.072) for Wave I adherents and even lower levels in NfL (−0.421 pg/mL, 95% BCa CI: −0.929 to −0.007) and tau protein levels (−0.229 pg/mL, 95% BCa CI: −0.412 to −0.053) for active participants in both waves. Discussion: Our findings suggest that consistent engagement in PA may reduce certain neurodegenerative biomarkers, potentially influencing neurological health outcomes.
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    Physical fitness and activity levels as predictors of subjective well-being in youths with type 1 diabetes mellitus: a 2-year longitudinal analysis of the diactive-1 cohort study
    (Wiley, 2025-03-05) Muñoz Pardeza, Jacinto; López Gil, José Francisco; Huerta Uribe, Nidia; Hormazábal Aguayo, Ignacio; Yáñez-Sepúlveda, Rodrigo; Ezzatvar, Yasmin; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
    Subjective well-being (SWB), including cognitive and affective components, may be influenced by the management of type 1diabetes mellitus (T1DM). Physical fitness and adherence to physical activity (PA) are associated with better glycaemic stabilityand diabetes management. However, the relationship with SWB is not yet understood. The aim of the study was to determinethe relationship between physical fitness, PA, and SWB over two years in youths with T1DM. This longitudinal study involved83 participants (aged 6–18 years; 44.6% girls) from the Diactive-1 Cohort. Physical fitness was assessed by spirometry (peak ox-ygen consumption) and dynamometry (handgrip strength). PA domains were measured using triaxial accelerometers, whereasthe number of days participating in muscle-strengthening activities was assessed using a question. The Cuestionario Único deBienestar Escolar was used to determine SWB. Glycaemic stability was determined when glycosylated hemoglobin < 7%, coef-ficient of variability ≤ 36%, and time-in-range target > 70% were met. The linear mixed models used considered three assess-ments and subject variability, showing significant associations between overall physical fitness (unstandardized beta coefficient[B] = 1.778, 95% confidence interval [CI] 0.413–3.158; p = 0.012) and total PA (B = 0.034, 95% CI 0.005–0.063; p = 0.020) withSWB. Although time did not moderate the association with physical fitness (p = 0.116), this was true for PA only in the secondyear (p = 0.020). In contrast, glycaemic stability did not moderate the associations (p > 0.05). In conclusion, physical fitness andPA are associated with greater SWB in young people with T1DM, which may play a role in the psychological aspects of diseasemanagement.
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    Physical fitness and sleep-related problems among adolescents: findings from the EHDLA study
    (Wiley, 2025-03-19) Muñoz Pardeza, Jacinto; Ezzatvar, Yasmin; Gutiérrez Espinoza, Héctor; Páez-Herrera, Jacqueline; Olivares-Arancibia, Jorge; Yáñez-Sepúlveda, Rodrigo; García Hermoso, Antonio; López Gil, José Francisco; Ciencias de la Salud; Osasun Zientziak
    Physical fitness, particularly cardiorespiratory fitness, has been shown to positively impact sleep quality. However, the relation-ship between overall physical fitness and sleep-related problems in adolescents remains underexplored. Therefore, the aim ofthis study was to analyze the association between overall physical fitness and sleep-related problems in adolescents. This cross-sectional study included 812 adolescents (median age: 14 years [interquartile range = 12–17]; 54.9% girls) from the Eating Healthyand Daily Life Activities (EHDLA) data. Physical fitness was measured objectively using the Assessing the Levels of PHysicalActivity and fitness (ALPHA-Fit) battery for children and adolescents and a flexibility test, while sleep-related problems wereevaluated using the BEARS sleep screening tool (B = Bedtime problems, E = Excessive daytime sleepiness, A = Awakenings dur-ing the night, R = Regularity and duration of sleep, S = Snoring). Generalized linear models were used to examine the associationof overall physical fitness with the different components of sleep-related problems. The odds of experiencing sleep-related prob-lems decreased significantly with each kilogram increase in handgrip strength (odds ratio [OR] = 0.97, 95% confidence interval[CI] 0.94–0.99), and with each standard deviation increase in overall physical fitness (OR = 0.76, 95% CI 0.59–0.99). In contrast,despite not statistically significant, an increase in long jump appeared to reduce the sleep-related problems (OR = 0.91; 95% CI0.82–1.02), while a longer time in the 4×10-m shuttle run test might increase sleep problems (OR = 1.12; 95% CI 0.98–1.28). Inconclusion, greater levels of physical fitness, particularly muscular strength, may be key for reducing sleep-related problems,emphasizing the importance of personalized training programs.
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    PublicationOpen Access
    Trajectories of 24-h movement guidelines from middle adolescence to adulthood on depression and suicidal ideation: a 22-year follow-up study
    (BMC Public Health, 2022) García Hermoso, Antonio; Ezzatvar, Yasmin; Ramírez Vélez, Robinson; López Gil, José Francisco; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
    Background: The 24-h movement guidelines for youth and adults recommend the specific duration of physical activity, sedentary time, and sleep duration to ensure optimal health, but little is known about its relationship to mental health indicators. The aim of the study was to explore the association between 24-h movement guidelines in adolescence and its trajectories from middle adolescence (12–17 years old) to adulthood (33–39 years old) with depression and suicidal ideation in adulthood. Methods: This prospective cohort study included individuals who participated in Waves I (1994–1995) and V (2016–2018) of the National Longitudinal Study of Adolescent Health (Add Health) in the United States. Physical activity, screen time and sleep duration were measured using questionnaires. Adults were categorized as having depression if they had a self-reported history of depression and/or prescription medication-use for depression in the previous four weeks. Suicidal ideation was assessed by a self-reported single question in both waves. Poisson regression analyses were used to estimate the incidence rate ratio (IRR) of depression and suicidal ideation at adulthood, according to meeting specific and combinations of 24-h movement guidelines at Wave I and its trajectories from adolescence to adulthood. Results: The study included 7,069 individuals (56.8% women). Adolescents who met physical activity guidelines and all three guidelines at middle adolescence had lower risk of depression (IRR = 0.84, 95%CI 0.72 to 0.98) and suicidal ideation (IRR = 0.74, 95%CI 0.55 to 0.99) at adulthood than those who did not meet any of these guidelines, respectively. Individuals who met the guidelines for screen time and all three guidelines in both adolescence and adulthood had lower risk of depression (screen time, IRR = 0.87, 95% CI 0.72 to 0.98; all three, IRR = 0.37, 95% CI 0.15 to 0.92) and suicidal ideation (screen time, IRR = 0.74, 95% CI 0.51 to 0.97; all three, IRR = 0.12, 95% CI 0.06 to 0.33) than those who never met the guidelines. Additionally, individuals who did not meet all three guidelines in adolescence but met the guidelines in adulthood had lower risk of suicidal ideation than those who never met the guidelines (IRR = 0.81, 95%CI 0.45 to 0.89). Conclusion: Our findings highlight the importance of promoting and maintaining adherence to the 24-h movement guidelines from middle adolescence to adulthood to prevent mental health problems. However, our findings must be interpreted carefully due to declared limitations, e.g., the self-reported assessments which are subject to sources of error and bias or that the dataset used to gauge meeting a guidelines (1994–1996) was made later (2016).
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    PublicationOpen Access
    Twenty-four-hour movement guidelines during adolescence and its association with obesity at adulthood: results from a nationally representative study
    (Springer, 2022) García Hermoso, Antonio; Ezzatvar, Yasmin; Alonso Martínez, Alicia; Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; López Gil, José Francisco; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
    To determine the association between adherence to the 24-h movement guidelines during adolescence with obesity at adulthood 14 years later in a nationally representative cohort. We analyzed data from 6984 individuals who participated in Waves I (1994–1995) and IV (2008–2009) of the National Longitudinal Study of Adolescent Health (Add Health) in the USA. Obesity was defined by the International Obesity Task Force cut-off points at Wave I and adult cut-points at Wave IV (body mass index [BMI]≥30 kg/m2 and waist circumference [WC]≥102 cm in male and 88 cm in female). Physical activity, screen time and sleep duration were self-reported. Adolescents who met screen time recommendation alone (β = −1.62 cm, 95%CI −2.68 cm to −0.56), jointly with physical activity (β = −2.25 cm, 95%CI −3.75 cm to −0.75 cm), and those who met all three recommendations (β = −1.92 cm, 95%CI −3.81 cm to −0.02 cm) obtained lower WC at Wave IV than those who did not meet any of these recommendations. Our results also show that meeting with screen time recommendations (IRR [incidence rate ratio] = 0.84, 95%CI 0.76 to 0.92) separately and jointly with physical activity recommendations (IRR = 0.86, 95%CI 0.67 to 0.97) during adolescence is associated with lower risk of abdominal obesity at adulthood. In addition, adolescents who met all 24-h movement recommendations had lower risk of abdominal obesity later in life (IRR = 0.76, 95%CI 0.60 to 0.97). Conclusion: Promoting the adherence to the 24-h movement guidelines from adolescence, especially physical activity and screen time, seems to be related with lower risk of abdominal obesity later in life, but not for BMI.