Open Access
High muscular fitness has a powerful protective cardiometabolic effect in adults: influence of weight status
(BioMed Central, 2016) Ramírez Vélez, Robinson; Correa Bautista, Jorge Enrique; Lobelo, Felipe; Izquierdo Redín, Mikel; Alonso Martínez, Alicia; Rodríguez Rodríguez, Fernando; Cristi Montero, Carlos; Ciencias de la Salud; Osasun Zientziak
Background: Low levels of muscular fitness (MF) are recognized as an important marker of nutritional status and a predictor of metabolic complications, cardiovascular disease and death, however, the relationship between MF, body mass index (BMI) and the subsequent cardiometabolic protective effects has been less studied among Latin American populations. This study identified an association between MF and the cardiometabolic risk score index (CMRSI) and the lipid-metabolic cardiovascular risk index (LMCRI) in a wide sample of university students grouped according to their BMI. Methods: Six thousand ninety five healthy males (29.6 ± 11.7 year-old) participated in the study. Absolute strength was measured using a T.K.K. analogue dynamometer (handgrip), and the participant’s strength was then calculated relative to their body mass (MF/BM). The LMCRI was derived from the levels of triglycerides, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and glucose levels in a blood sample. The CMRSI was calculated by summing the standardized residuals (z-score) for waist circumference, total cholesterol, LDL-c, triglycerides, HDL-c, and median blood pressure. Subjects were divided into six subgroups according to BMI (normal vs. overweight/obese) and MF/BM tertiles (unfit, average, fit). Results: The group of participants with low and moderate levels of MF/BM showed higher CMRSI values independent of BMI (P < 0.001). The group with normal BMI and high MF/BM had the highest levels of cardiometabolic protection. All overweight/obese BMI groups had significantly higher LMCRI values independent of the level of MF/BM (P < 0.001). Conclusions: Participants with high MF/BM showed reduced cardiometabolic risk, which increased significantly when they were within normal parameters.
Open Access
Schoolbag weight carriage in Portuguese children and adolescents: a cross-sectional study comparing possible influencing factors
(BMC, 2019) Barbosa, João; Marqués, Mário C.; Izquierdo Redín, Mikel; Neiva, Henrique P.; Barbosa, Tiago M.; Ramírez Vélez, Robinson; Alonso Martínez, Alicia; García Hermoso, Antonio; Aguado Jiménez, Roberto; Marinho, Daniel; Ciencias de la Salud; Osasun Zientziak
Background Schoolbags and the consequences of carrying them, particularly those associated with overload, are often studied as a health concern. Modifications in gait and posture were reported when children carried loads that corresponded to more than 10% of their body weight (BW). The aims of this study were to verify the load that is carried by Portuguese students and how it is influenced by factors such as school grade, school schedule, lunch site, physical education, sex and body mass index (BMI). Acquiring a more specific knowledge of the Portuguese context and understanding the influence of these factors may allow us to generate proposals to control them in ways that benefit students.MethodsThe load carried by students in the 5th grade (10.60.4years) and 9th grade (14.70.6years) were weighed with a luggage scale on all days of the week, resulting in 680 evaluations. Data related to the school day were also collected, such as the student's lunch site, how he or she got to school and his or her school schedule for that day. Individual height and weight were also assessed. Results The 5th grade students carried greater loads than the 9th grade students, resulting in a substantial difference relative to their BW. The school loads of the 5th grade students were mostly greater than 10% of their BWs. Girls tended to carry heavier loads than boys, and overweight students also tended to carry heavier loads. Students who could eat lunch at home carried less weight, and on physical education days, the total load carried increased, but the backpacks of the 5th grade students were lighter.Conclusions The results of the current study describe excessive schoolbag weight among Portuguese students and expound on some of the factors that influence it, which can help researchers and professionals design a solution to decrease children's schoolbag loads.
Open Access
Association of cardiorespiratory fitness levels during youth with health risk later in life: a systematic review and meta-analysis.
(American Medical Association, 2020-08-31) García Hermoso, Antonio; Ramírez Vélez, Robinson; García Alonso, Yesenia; Alonso Martínez, Alicia; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Importance Although the associations between cardiorespiratory fitness (CRF) and health in adults are well understood, to date, no systematic review has quantitatively examined the association between CRF during youth and health parameters later in life. Objectives To examine the prospective association between CRF in childhood and adolescence and future health status and to assess whether changes in CRF are associated with future health status at least 1 year later. Data Sources For this systematic review and meta-analysis, MEDLINE, Embase, and SPORTDiscus electronic databases were searched for relevant articles published from database inception to January 30, 2020. Study Selection The following inclusion criteria were used: CRF measured using a validated test and assessed at baseline and/or its change from baseline to the end of follow-up, healthy population with a mean age of 3 to 18 years at baseline, and prospective cohort design with a follow-up period of at least 1 year. Data Extraction and Synthesis Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Random-effects models were used to estimate the pooled effect size. Main Outcomes and Measures Anthropometric and adiposity measurements and cardiometabolic health parameters. Results Fifty-five studies were included with a total of 37 563 youths (46% female). Weak-moderate associations were found between CRF at baseline and body mass index (r = –0.11; 95% CI, –0.18 to –0.04; I2 = 59.03), waist circumference (r = –0.29; 95% CI, –0.42 to –0.14; I2 = 69.42), skinfold thickness (r = –0.34; 95% CI, –0.41 to –0.26; I2 = 83.87), obesity (r = –0.15; 95% CI, –0.23 to –0.06; I2 = 86.75), total cholesterol level (r = –0.12; 95% CI, –0.19 to –0.05; I2 = 75.81), high-density lipoprotein cholesterol (HDL-C) level (r = 0.11; 95% CI, 0.05-0.18; I2 = 69.06), total cholesterol to HDL-C ratio (r = –0.19; 95% CI, –0.26 to –0.13; I2 = 67.07), triglyceride levels (r = –0.10; 95% CI, –0.18 to –0.02; I2 = 73.43), homeostasis model assessment for insulin resistance (r = –0.12; 95% CI, –0.18 to –0.06; I2 = 68.26), fasting insulin level (r = –0.07; 95% CI, –0.11 to –0.03; I2 = 0), and cardiometabolic risk (r = –0.18; 95% CI, –0.29 to –0.07; I2 = 90.61) at follow-up. Meta-regression analyses found that early associations in waist circumference (β = 0.014; 95% CI, 0.002-0.026), skinfold thickness (β = 0.006; 95% CI, 0.002-0.011), HDL-C level (β = −0.006; 95% CI, −0.011 to −0.001), triglyceride levels (β = 0.009; 95% CI, 0.004-0.014), and cardiometabolic risk (β = 0.007; 95% CI, 0.003-0.011) from baseline to follow-up dissipated over time. Weak-moderate associations were found between change in CRF and body mass index (r = –0.17; 95% CI, –0.24 to –0.11; I2 = 39.65), skinfold thickness (r = –0.36; 95% CI, –0.58 to –0.09; I2 = 96.84), obesity (r = –0.21; 95% CI, –0.35 to –0.06; I2 = 91.08), HDL-C level (r = 0.05; 95% CI, 0.02-0.08; I2 = 0), low-density lipoprotein cholesterol level (r = –0.06; 95% CI, –0.11 to –0.01; I2 = 58.94), and cardiometabolic risk (r = –0.08; 95% CI, –0.15 to –0.02; I2 = 69.53) later in life. Conclusions and Relevance This study suggests that early intervention and prevention strategies that target youth CRF may be associated with maintaining health parameters in later life.
Open Access
Centile reference curves of the ultrasound-based characteristics of the rectus femoris muscle composition in children at 4–11 years old
(Frontiers Media, 2023) García Alonso, Yesenia; Alonso Martínez, Alicia; García Hermoso, Antonio; Legarra Gorgoñón, Gaizka; Izquierdo Redín, Mikel; Ramírez Vélez, Robinson; Ciencias de la Salud; Osasun Zientziak
Quantitative diagnostic ultrasound has been proposed as a way to characterize muscle structure, but there is a lack of normative data for children. This study aims to establish age-specific normal ranges for echo-intensity (EI), cross-sectional area (CSA), muscular thickness (MT), and subcutaneous adipose thickness (SAT) values of the rectus femoris muscle in typically developing children. The study recruited 497 children (288 boys and 209 girls) aged 4–10.9 years (mean age 7.39 years), and muscle parameters were measured using 2D B-mode ultrasound. Percentile values and reference curves were calculated using the Lambda, Mu, and Sigma method (LMS). The results showed small variation between measurements for boys compared to girls, with the most significant difference in EI, CSA, and MT values. EI decreased with age, with the most pronounced curve in boys. SAT increased in both sexes, with a slightly higher increase in girls after the age of 9.0 years. This study provides the first age-specific reference norms for the rectus femoris muscle architecture in children, and further research is needed to validate these curves and determine their clinical utility.
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
Normative reference values for the 20 m shuttle-run test in a population-based sample of school-aged youth in Bogota, Colombia: the FUPRECOL study
(Wiley, 2017) Ramírez Vélez, Robinson; Palacios López, Adalberto; Prieto Benavides, Daniel Humberto; Correa Bautista, Jorge Enrique; Izquierdo Redín, Mikel; Alonso Martínez, Alicia; Ciencias de la Salud; Osasun Zientziak
Objectives: Our aim was to determine the normative reference values of cardiorespiratory fitness (CRF) and to establish the proportion of subjects with low CRF suggestive of future cardio‐metabolic risk. Methods: A total of 7244 children and adolescents attending public schools in Bogota, Colombia (55.7% girls; age range of 9–17.9 years) participated in this study. We expressed CRF performance as the nearest stage (minute) completed and the estimated peak oxygen consumption (V˙O2peak). Smoothed percentile curves were calculated. In addition, we present the prevalence of low CRF after applying a correction factor to account for the impact of Bogota's altitude (2625 m over sea level) on CRF assessment, and we calculated the number of participants who fell below health‐related FITNESSGRAM cut‐points for low CRF. Results: Shuttles and V˙O2peak were higher in boys than in girls in all age groups. In boys, there were higher levels of performance with increasing age, with most gains between the ages of 13 and 17. The proportion of subjects with a low CRF, suggestive of future cardio‐metabolic risk (health risk FITNESSGRAM category) was 31.5% (28.2% for boys and 34.1% for girls; X2 P = .001). After applying a 1.11 altitude correction factor, the overall prevalence of low CRF was 11.5% (9.6% for boys and 13.1% for girls; X2 P = .001).
Open 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.
Open Access
Gamified family-based health exercise intervention to improve adherence to 24-h movement behaviors recommendations in children: "3, 2, 1 Move on Study"
(BMC, 2023) Alonso Martínez, Alicia; Legarra Gorgoñón, Gaizka; García Alonso, Yesenia; Ramírez Vélez, Robinson; Alonso Martínez, Loreto; Erice Echegaray, Blanca; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa; Gobierno de Navarra / Nafarroako Gobernua
Background Evidence suggests that movement patterns, including physical activity, sedentary behavior, and sleep duration, throughout a 24-h period, have a signifcant impact on biological processes and health outcomes for both young and adult populations. However, 80% of adolescents worldwide are not sufciently active, and many children do not meet international physical activity recommendations for their age. Thus, the aim of this study is to evaluate the impact of a 12-week gamifed family-based health and exercise intervention on physical ftness, basic motor competencies, mental and behavioral health, and adherence to 24-h movement guidelines in children aged 4 to 5 years old. The study will evaluate changes in sedentary levels, physical ftness, basic motor competencies, mental and behavioral disorders, adherence to the exercise program, and compliance with physical activity recom‑ mendations. In addition, the aim of this protocol is to describe the scientifc rationale in detail and to provide informa‑ tion about the study procedures. Methods/design A total of 80 children, aged 4 to 5 years old, will be randomly assigned in a 1:1 ratio to one of two groups: the exercise group and the routine care group. The exercise group will undergo a 12-week exercise interven‑ tion, followed by a 12-week follow-up period. On the other hand, the routine care group will undergo a 12-week period of routine care, followed by a 12-week follow-up control period. The exercise program will be implemented in a family setting and facilitated through a gamifed web platform with online supervision, with the hypothesis that it will have a positive impact on physical ftness, anthropometric measures, basic motor competencies, and adherence to 24-h movement guidelines. Discussion The results of this study will provide valuable insights into the impact of a gamifed, family-oriented health and exercise program on various aspects of health, including physical ftness, basic motor competencies, mental and behavioral well-being, and adherence to 24-h movement guidelines. The fndings will contribute to clos‑ ing the gap in current knowledge on the efectiveness of these types of interventions for children and their parents. These fndings will also contribute to the development of future guidelines for promoting physical activity in children
Open Access
Effect of a gamified family-based exercise intervention on adherence to 24-hour movement behavior recommendations in preschool children: single-center pragmatic trial
(JMIR Publications, 2025-03-04) Legarra Gorgoñón, Gaizka; García Alonso, Yesenia; Ramírez Vélez, Robinson; Alonso Martínez, Loreto; Izquierdo Redín, Mikel; Alonso Martínez, Alicia; Ciencias de la Salud; Osasun Zientziak; Ciencias humanas y de la educación; Giza eta Hezkuntza Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Background: Adherence to 24-hour movement behavior recommendations, including physical activity (PA), sedentary time, and sleep, is essential for the healthy development of preschool children. Gamified family-based interventions have shown the potential to improve adherence to these guidelines, but evidence of their effectiveness among children is limited. Objective: This study aimed to evaluate the effectiveness of a gamified family-based exercise intervention in promoting adherence to 24-hour movement behavior recommendations among preschool-aged children. Methods: This 12-week study is a single-center, pragmatic randomized controlled trial that included 80 preschool children (56% boys) and their families, who were randomly assigned to either the gamification group (n=40) or the control group (n=40). The “3, 2, 1 Move on Study” incorporates family-oriented physical activities and gamification techniques to increase PA domains, reduce sedentary behavior, and improve sleep patterns. The primary outcome was to increase moderate to vigorous PA (MVPA) by 5 minutes/day, as measured by accelerometer at follow-up. Accelerometer-determined daily time spent (PA domains, sedentary behavior, and sleep), physical fitness (cardiorespiratory, speed-agility, muscular, physical fitness z-score), basic motor competencies (self-movement and object movement), and executive function (memory, cognitive flexibility, and inhibitory control) were also included as secondary outcomes. Results: The 71 participants included in the per-protocol analyses (32 girls, 45%; 39 boys, 55%) had a mean (SD) age of 5.0 (0.5) years. Change in MVPA per day after the intervention (12 weeks) increased in both groups by +25.3 (SD 24.6) minutes/day in the gamification group and +10.0 (SD 31.4) minutes/day in the routine care group, but no significant between-group differences were observed (8.62, 95% CI –5.72 to 22.95 minutes/day, ηp2=.025; P=.23). The analysis of secondary outcomes showed significant between-group mean differences in the change in physical behaviors derived from the accelerometers from baseline to follow-up of 26.44 (95% CI 8.93 to 43.94) minutes/day in favor of light PA (ηp2=.138; P=.01) and 30.88 (95% CI 4.36 to 57.41) minutes/day in favor of total PA, which corresponds to a large effect size (ηp2=.087; P=.02). Likewise, the gamification group substantially increased their score in standing long jump and physical fitness z-score from baseline (P<.05). Conclusions: In the “3, 2, 1 Move on Study,” a gamified intervention showed a modest but relevant increase in MVPA and other domains of 24-hour movement behavior among preschool-aged children. Therefore, gamified family-based interventions may provide a viable alternative to improve adherence to 24-hour movement behavior recommendations.
Open Access
Cardiorespiratory fitness cut-points are related to body adiposity parameters in Latin American adolescents
(MDPI, 2019) Prieto Benavides, Daniel Humberto; García Hermoso, Antonio; Izquierdo Redín, Mikel; Alonso Martínez, Alicia; Agostinis-Sobrinho, César; Correa Bautista, Jorge Enrique; Ramírez Vélez, Robinson; Ciencias de la Salud; Osasun Zientziak
Background and Objectives: A deficiency exists in the criterion-referenced cut-points for field-based cardiorespiratory fitness (CRF) in Latin American youths. The aims of the present study were two-fold: (1) To identify the ability of CRF estimated by the 20-m shuttle-run test (20mSRT) to differentiate between 'healthy' and 'unhealthy' phenotypes (by adiposity) in adolescents; (2) to assess the association between obesity and relative peak oxygen uptake (VO2peak) in a large and diverse sample of Latin American youths. In total, 72,505 adolescents aged between 13 and 15 years were recruited from Chile and Colombia (47.5% girls). Materials and Methods: The waist circumference (WC) and waist-to-height ratio (WHtR) were used to identify body adiposity markers. CRF was measured using the 20mSRT (VO2peak). Receiver operating characteristic curves and logistic regression were used to determine the discriminatory ability of CRF to predict body adiposity parameters. Results: For boys and girls, VO2peak showed a significant predictive capacity to detect body fat (area under the curve [AUC] > 0.62). The sensitivity of VO2peak was medium (>63%) for all age- and sex-specific cut-points, with optimal cut-points in 13- to 15-year olds for obesity identified as 43.77 mL·kg-1·min-1 and 38.53 mL·kg-1·min-1 in boys and girls, respectively. Conclusions: According to these cut-points, adolescents with low CRF were more likely to be obese either by WC or WHtR. The CRF cut-points can be used as quantitative markers for a healthier body in Latin American adolescents.