Open 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.
Embargo
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.
Open Access
Is greater social support from parents and friends related to higher physical activity levels among adolescents?
(MDPI, 2023) Camargo, Edina Maria de; Costa, Cristiane Galvão da; Piola, Silva Piola; Araújo Bacil, Eliane Denise; López Gil, José Francisco; Campos, Wagner de; Ciencias de la Salud; Osasun Zientziak
Increasing physical activity levels during adolescence have been put on the agenda by several researchers. This study verified the association between social support from parents and friends and different amounts of moderate-to-vigorous physical activity (MVPA) among adolescents in public school. The present study had a cross-sectional design and included a representative sample of 1984 adolescents (aged 15–17). The ASAFA (Apoio Social para prática de Atividade Física para Adolescentes) scale and the QAFA (Questionário de Atividade Física para Adolescentes) were used to determine social support and physical activity, respectively. For statistical analysis, a conceptual model for structured equations and weighted least squares mean and variance adjusted were applied. Social support from parents increased the odds of engaging in 180 min/week of MVPA by 46.7%, 47.8% for 300 min/week, and 45.5% for 420 min/week. Social support from friends showed similar relations trends: 23.8% for 180 min/week, 23.6% for 300 min/week, and 21.2% for 420 min/week. Social support from parents and friends increased the probability of adolescents reaching the amounts of physical activity investigated. The results indicate that greater social support (from parents and friends) was associated with a higher level of MVPA in Brazilian adolescents.
Open 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.
Open Access
Specific versus general exercise programme in adults with subacromial impingement syndrome: a randomised controlled trial
(BMJ Publishing Group, 2023) Gutiérrez Espinoza, Héctor; Araya-Quintanilla, Felipe; Pinto Concha, Sebastián; Valenzuela-Fuenzalida, Juan; López Gil, José Francisco; Ramírez Vélez, Robinson; Ciencias de la Salud; Osasun Zientziak
Objectives. Current evidence on the clinical effectiveness about the different types of exercises in the subacromial impingement syndrome (SIS) remains controversial. This study aims to compare the short-term (at 5 weeks) effects of a specific exercise programme with a general exercise programme on shoulder function in adults with SIS. Methods. In total, 52 adults with SIS were randomly allocated to 5 weeks to perform specific exercises (experimental group, n=26) or general exercises (control group, n=26). The primary outcome was change in shoulder function, it was assessed using the Shoulder Pain and Disability Index (SPADI) from baseline to 5 weeks. Secondary end points included changes in upper limb function (Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire), pain intensity (Visual Analog Scale (VAS)) and kinesiophobia (Tampa Scale of Kinesiophobia (TSK)). Results. All participants completed the trial. The between-group differences at 5 weeks were: SPADI, 13.5 points (95% CI: 4.3 to 15.6; ƞ2=0.22; p=0.001); DASH, 10.1 points (95% CI: 5.6 to 15.2; ƞ2=0.27; p<0.001); VAS at rest, 0.2 cm (95% CI: 0.1 to 0.3; ƞ2=0.07; p=0.553); VAS on movement, 1.7 cm (95% CI: 0.9 to 2.2; ƞ2=0.24; p<0.001); and TSK, 16.3 points (95% CI: 13.2 to 15.3; ƞ2=0.33; p<0.001). All differences favoured the experimental group and effect sizes were medium to large for most outcomes. Mediation analyses showed that the effect of the specific exercises on shoulder function was mediated by kinesiophobia (β=2.800; 95% CI: 1.063 to 4.907) and pain on movement (β= −0.690; 95% CI: −1.176 to −0.271). Conclusion. In adults with SIS, specific exercises may have a larger effect than general exercises. However, most differences did not reach the minimum threshold to be considered clinically important and the evidence to support exercise as standard treatment warrant further study.
Open Access
Exploring the link between home garden use and severe obesity: insights from a nationwide survey in Tuvalu
(International Society of Global Health, 2023) Lin, PoJen; Lee, Irene (Tai-Lin); Hershey, María Soledad; Shih, Wei-Chih; Tausi, Selotia; Sosene, Vine; Maani, Pauke P.; Tupulaga, Malo; Wu, Stephanie M.; López Gil, José Francisco; Lo, Yuan-Hung; Shiau, Shi-Chian; Hsu, Yu-Tien; Chang, Chia-Rui; Wei, Chihfu; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa, 1225/2022
Background Obesity is prevalent and increasing but understudied across Pacific Islanders. Tuvalu is a South Pacific country with a high obesity rate and faces multiple threats of food insecurity. Home garden serves as a sustainable food source and can be a possible intervention for the obesity pandemic in Tuvalu. This study investigated Tuvaluans’ home garden use and obesity, and explored factors associated with increased use of home gardens. Methods We conducted a nationwide, cross-sectional study in Tuvalu during 2022. Structured questionnaires were administered during the in-person interviews, and trained interviewers measured the height and weight of each participant. The association between home garden use, obesity and severe obesity were tested with univariate and multivariable logistic regression. We also applied overlapping weights to balance the distribution of baseline demographic factors. Results The average body mass index was 34.87 kilogrammes (kg)/square metre (m2 ) among the study population of 1024 adults (630 from Funafuti and 394 from other islands in Tuvalu). Overall, people having home gardens was associated lower odds for severe obesity compared to those without a home garden in overlap weighting models (odds ratio (OR)=0.946, 95% CI=0.897-0.997, P=0.039) and the association was stronger in Funafuti (OR=0.927, 95% CI = 0.866-0.991, P= 0.027) than in the outlying islands (OR= 0.967, 95% CI = 0.889-1.052, P = 0.435). Furthermore, increased age was positively associated with having a home garden in Funafuti, and smoking showed an inverse association. Conclusions Having a home garden is associated with lower odds of severe obesity in Tuvalu, and the association is stronger in Funafuti. Smokers are less likely to have home gardens, and increased age is positively associated with having home gardens. These findings promote more home garden utilisation and provide evidence for targeted interventions in Tuvalu.
Open Access
The moderating role of recreational substance use in the association of mediterranean diet with academic performance among adolescents
(Nature Research, 2023) López Gil, José Francisco; Smith, Lee; Gaya, Anelise; Victoria-Montesinos, Desirée; Gutiérrez Espinoza, Héctor; Herrera-Gutiérrez, Eva; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
No study has examined the potential moderating role of recreational substance use in the relationship between the Mediterranean diet (MedDiet) and academic performance. The aim of this study was to test the potential moderating role of recreational substance use (i.e., alcohol, tobacco, and cannabis) in the association of adherence to the MedDiet with academic performance among adolescents. This cross-sectional study included a sample of 757 adolescents (55.6% girls) aged 12–17 years from the Valle de Ricote (Region of Murcia). The Region of Murcia is an autonomous community of Spain located in the southeast of the Iberian Peninsula, along the coast of the Mediterranean Sea. Adherence to the MedDiet was assessed by the Mediterranean Diet Quality Index for Children and Teenagers (KIDMED). Recreational substance use (i.e., tobacco, alcohol, cannabis) was self-reported by adolescents. Academic performance was assessed by the school records at the end of the academic year. The relationship between adherence to the MedDiet and academic performance was moderated by both tobacco and alcohol use (for grade point average and all school records). In conclusion, higher adherence to the MedDiet was related to greater academic performance in adolescents, but recreational substance use could moderate this association.
Open Access
Relationship between free-time physical activity and sleep quality in brazilian university students
(Nature Research, 2023) Santos, Mayara; Sirtoli, Rafaela; Rodrigues, Renne; López Gil, José Francisco; Martínez Vizcaíno, Vicente; Guidoni, Camilo Molino; Mesas, Arthur; Ciencias de la Salud; Osasun Zientziak
Poor sleep quality and low or no free-time physical activity (FTPA) practice are highly prevalent among university students, but the association between these conditions is still unclear. This cross-sectional study analyzed the relationship between FTPA and sleep quality. An online questionnaire was conducted with university students from a public university in southern Brazil in 2019. The weekly frequency of FTPA was self-reported, and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression and ANCOVA models were performed and adjusted for confounders. Among the 2,626 students analyzed, 52.2% did not practice the FTPA, and 75.6% had poor sleep quality (PSQI > 5). In the adjusted analysis, practicing FTPA 4¿7 times/week was associated with poor sleep quality (odds ratio = 0.71; 95% confidence interval = 0.52, 0.97) compared with not practicing FTPA. In addition, those who practiced FTPA had significantly lower means of the global PSQI, subjective sleep quality and duration, sleep disturbances, and daytime dysfunction scores than those who did not practice FTPA. In conclusion, the FTPA may contribute to better sleep quality among university students.
Open 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.
Open 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.