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
Consequences of low sleep duration in anthropometric and body composition parameters of Chilean preschoolers
(MDPI, 2021) Álvarez, Cristian; Paredes-Arévalo, Lorena; Obando, Isabel; Leal, Marlys; Ávila, Yennifer; Sadarangani, Kabir P.; Delgado Floody, Pedro; Alonso Martínez, Alicia; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Reduced sleep duration in schoolchildren has been associated with poor health outcomes at the scholar level; however, there is little information on the effects of sleep loss on Chilean preschoolers. The aim of this study was to describe and compare cardiometabolic outcomes according with the sleep duration in Chilean preschoolers. A second aim was to identify potential risk outcomes (i.e., in odds ratios) for suffering anthropometric and body composition alterations related with participants' sleep duration. A total of 99 (n = 54 boys; n = 45 girls) preschoolers (mean age (95% CI) 3.1 (2.7, 3.4 years), mean weight 16.1 (15.5, 16.6 kg)) were included in this study. Sleep duration was assessed using standardized questionnaires with the parents. Socio-demographic parents’ information, as well as anthropometric, nutritional, and handgrip strength outcomes in preschoolers were distributed by tertiles (T1; < 10 h, T2; 10 to < 11 h, and T3; ≥ 11 h) of sleep time. Children in the lowest tertile of sleep duration had significantly higher body mass indices (p = 0.036), weight-for-height Z-scores (p < 0.0001), waist–hip ratios (p = 0.041), and body fat in percent (p = 0.035) and kg (p = 0.044) compared to those in the top tertile. Low sleep duration was associated with significantly greater risks of overweight/obesity (OR 1.3 (0.9, 1.8)), low height (OR 1.2 (0.8, 1.6)), and increased BMI (OR 1.5 (0.4, 1.4)), but not with reductions in grip strength. Chilean preschoolers with low sleep duration showed higher cardiometabolic markers (anthropometric/body composition) and were more likely to be classified as obese than youth with longer sleep duration.
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
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
Evaluación de los dominios de la actividad física y los componentes de la condición física en niños de 4-5 años en un centro de salud
(Lúa Ediciones 3.0, 2023) Legarra Gorgoñón, Gaizka; García Alonso, Yesenia; Ramírez Vélez, Robinson; Erice Echegaray, Blanca; Moreno González, Paula; Izquierdo Redín, Mikel; Alonso Martínez, Alicia; Ciencias de la Salud; Osasun Zientziak
Introducción: la falta de actividad física y el sedentarismo en niños se asocia con una mayor adiposidad, bajo nivel de aptitud cardiovascular y riesgo de enfermedades cardiovasculares. Sin embargo, cumplir con las recomendaciones de actividad física se relaciona con mejoras en la salud mental, disminución de la ansiedad y depresión, así como adopción de hábitos saludables. Objetivos: evaluar la relación entre los diferentes dominios de la actividad física y del sedentarismo, medidos de forma objetiva, y los componentes de la condición física en niños españoles de 4 y 5 años. Población y métodos: estudio transversal dentro del proyecto 'Observatorio y programa de intervención de ejercicio físico y estilos de vida en familia para niños y niñas de 4 a 5 años en Atención Primaria' (https://observatorioactividadfisica.es). La condición física se evaluó con la batería PREFIT y la cantidad e intensidad de actividad física mediante un acelerómetro tri-axial GENEActiv durante 7 días consecutivos las 24 horas del día. Resultados: la muestra evaluada fue de 70 niños (38 niños y 32 niñas) con una media (intervalo de confianza [IC] del 95%) de 4,83 años. No se observaron diferencias significativas en la condición física entre niños y niñas. Los niños realizaron una actividad física de mayor intensidad y tiempo que las niñas. Además, se encontró una fuerte relación significativa entre los componentes de la condición física y los dominios de la actividad física. Conclusiones: estos hallazgos resaltan la importancia de promover estilos de vida activos desde temprana edad y la necesidad de programas de entrenamiento estructurado para reducir el sedentarismo y mejorar la condición física en esta población.
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
Assessing basic motor competences, physical fitness, and executive function in 4-5-year-old children: a longitudinal study in a primary care setting
(BMC, 2024) Legarra Gorgoñón, Gaizka; García Alonso, Yesenia; Ramírez Vélez, Robinson; Alonso Martínez, Loreto; Izquierdo Redín, Mikel; Alonso Martínez, Alicia; Ciencias de la Salud; Osasun Zientziak
Background: To evaluate the progression of physical fitness (PF), basic motor competence (BMC), and executive function (EF) over one year in children aged 4-5 years at a health center. Methods: In this longitudinal analysis, children's BMC was evaluated using the MOBAK KG test for object and self-movement. The PREFIT Battery gauged PF through handgrip strength, standing long jump, and other fitness measures, while the Early Years Toolbox appraised EF. Results: Adjustments for confounding factors showed notable improvements in BMC, particularly in object movement (OM; mean difference 0.789, p=0.044) and self-movement (SM; mean difference 0.842, p=0.037), with overall MOBAK scores also increasing (mean difference 1.632, p=0.018). Enhancements in the standing long jump (mean difference 9.036 cm, p=0.014) and EF tasks "Mr. Ant" (mean difference 0.669, p<0.001) and "Go/No-Go" (mean difference 0.120, p<0.001) were evident, signifying substantial BMC gains and some progress in PF and EF. Conclusion: This research underscores the positive impact of regular training on BMC and PF in young children. Significant BMC development and associated improvements in PF and EF over the study period highlight the importance of structured activities in early childhood. These findings advocate for standardized training programs to enhance childhood health and encourage active lifestyles.
Open Access
Effects of exercise intervention on health-related physical fitness and blood pressure in preschool children: a systematic review and meta-analysis of randomized controlled trials
(Springer, 2020) García Hermoso, Antonio; Alonso Martínez, Alicia; Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Background: No previous systematic review has quantitatively examined the effect of physical exercise interventions on health-related physical fitness and blood pressure in children younger than 6 years old. Objective: To evaluate the effects of exercise interventions on health-related physical fitness (i.e., physical fitness components and body composition) and blood pressure in preschoolers. Methods: We searched four databases. Only randomized controlled trials (RCTs), evaluating the effectiveness of exercise intervention on weight-related outcomes, blood pressure, and physical fitness components in preschoolers (1–5.99 years old) were included. The effect sizes were reported as Hedges’ g using random-effects models. Results: A total of 19 RCTs were included. Exercise interventions favored reductions in body mass index (g = − 0.17; 95% confidence interval [CI], − 0.31 to − 0.03), waist circumference (g = − 0.25; 95% CI − 0.47 to − 0.03), and body fat percentage (g = − 0.31; 95% CI − 0.60 to − 0.23); as well as improvement in cardiorespiratory fitness (g = 0.25; 95% CI 0.08–0.42), muscular strength (g = 0.25; 95% CI 0.09–0.40), and speed–agility (g = − 0.51; 95% CI − 0.78 to − 0.24). Blood pressure was not reduced. The subgroup analysis revealed that physical exercise alone favored larger reductions in body mass index and waist circumference compared with physical exercise combined with another intervention. Also, changes in cardiorespiratory fitness, lower-body muscular strength and speed–agility were associated with larger decreases in body composition. Conclusion: Physical exercise whether combined or not with additional intervention has a small effect on both body weight and physical fitness in preschoolers. Also, it seems that interventions to prevent obesity should be directed towards improving physical fitness of preschoolers.
Open Access
Prevalence of meeting all three 24-h movement guidelines and its correlates among preschool-aged children
(Wiley, 2023) Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; López Gil, José Francisco; Rincón Pabón, David; Martínez-Jamioy, Edwar Nicolas; Rivera-Ruiz, Rosemberg; Castellanos-Montaña, Sebastián; Atencio Osorio, Miguel Alejandro; Carrillo Arango, Hugo Alejandro; Alonso Martínez, Alicia; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
The aim of the present study was twofold: first, to determine the meeting all three 24-h movement guidelines in Colombian preschool-aged children, and second, to explore the associations between different socio-ecological correlates and the meeting of these guidelines. This was a cross-sectional study with data from the Encuesta Nacional de Situación Nutricional (ENSIN-2015) in Colombia, 2015–2016. The sample comprised 3002 low-income preschoolers (3–4 years old, 50.7% boys). Data on physical activity, screen time, and sleep time were collected using the Cuestionario para la Medición de Actividad Física y Comportamiento Sedentario, reported by their parents. In total, 18 potential correlates (individual, interpersonal, organizational, and community level) were analyzed. Backward binary logistic regression analysis was performed with the potential correlates as independent variables and meeting all three 24-h movement guidelines as dependent variables. The prevalence of preschoolers meeting all three 24-h movement guidelines or none was 4.8% and 16.6%, respectively. In the final model, boys (odds ratio [OR] = 1.87, 95% confidence interval [CI] 1.00–3.50) and those who do not have television in their bedroom (OR = 2.09, 95%CI 1.05–4.14) were more likely to meet all three 24-h movement guidelines compared to with girls and those who have television, respectively. In conclusion, strategies to promote adherence to all 24-h movement guidelines among low-income preschoolers are warranted, and should focus on actions considering the importance of sex and home environment changes to support these movement behaviors.