Open Access
Resistance training and clinical status in patients with postdischarge symptoms after COVID-19: protocol for a randomized controlled crossover trial 'The EXER-COVID Crossover Study'.
(BMC, 2022) Ramírez Vélez, Robinson; Oteiza Olaso, Julio; Casas Fernández de Tejerina, Juan Manuel; García Alonso, Nora; Legarra Gorgoñón, Gaizka; Oscoz Ochandorena, Sergio; Arasanz Esteban, Hugo; García Alonso, Yesenia; Correa Rodríguez, María; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Background: physical exercise induces a coordinated response of multiple organ systems, including the immune system. In fact, it has been proposed that physical exercise may modulate the immune system. However, the potential effect of an exercise program on COVID-19 survivors has not been investigated. Thus, the aim of this study is to evaluate the modifications in immunological parameters, physical condition, inflammatory profile, and perceived persistent symptoms after 6 weeks of supervised resistance training (RT), in addition to the standard care on the clinical status of patients with persistent COVID-19 symptoms. The objective of this protocol is to describe the scientific rationale in detail and to provide information about the study procedures. Methods/design: a total of 100 patients with postdischarge symptoms after COVID-19 will be randomly allocated into either a group receiving standard care (control group) or a group performing a multicomponent exercise program two times a week over a period of 6 weeks. The main hypothesis is that a 6-week multicomponent exercise program (EXER-COVID Crossover Study) will improve the immunological and inflammatory profile, physical condition, and persistent perceived symptoms (fatigue/tiredness, musculoskeletal pain, and shortness of breath) in patients with postdischarge symptoms after COVID-19. Discussion: our results will provide insights into the effects of a multicomponent exercise program on immunological parameters, physical condition, inflammatory profile, and persistent perceived symptoms in patients with postdischarge symptoms after COVID-19. Information obtained by this study will inform future guidelines on the exercise training rehabilitation of patients with postdischarge symptoms after COVID-19.
Open Access
Effects of exercise interventions on inflammatory parameters in acutely hospitalized older patients: a systematic review and meta-analysis of randomized controlled trials
(MDPI, 2021) Ramírez Vélez, Robinson; García Hermoso, Antonio; Martínez Velilla, Nicolás; Zambom Ferraresi, Fabrício; López Sáez de Asteasu, Mikel; Recarey Rodríguez, Anel Eduardo; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa; Gobierno de Navarra / Nafarroako Gobernua
The purpose of this systematic review and meta-analysis was to appraise the acute effects of exercise training on inflammatory parameters in hospitalized older adults. We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Web of Science, Medline and PubMed were searched for studies published until August 2020. The review included all randomized controlled trials (RCTs) that evaluated and compared the effect of exercise versus usual care on inflammatory parameters in acutely hospitalized older adults. Two reviewers independently assessed the studies. The quality of all the included studies was assessed using the DerSimonian–Laird random-effects inverse-variance model. Five studies (275 participants) met the inclusion criteria. The exercise interventions included resistance or multicomponent intervention programs. The results indicate that, compared with usual care, exercise interventions have a positive impact on overall inflammatory parameters, including C-reactive protein (CRP) and insulin-like growth factor-I (IGF-1) (Hedge's g = −0.19, 95% confidence interval [CI] −0.33 to −0.04, p = 0.011, I2 = 0%). However, analyses of individual inflammatory parameters revealed a non-significant trend for reductions in CRP (Hedge's g = −0.20, 95% CI −0.47 to 0.07, p = 0.151, I2 = 31.2%) and IGF-I (Hedge's g = −0.34, 95% CI −0.79 to 0.11, p = 0.138, I2 = 0%). On the basis of this review, we conclude that exercise during acute hospitalization offers a mild improvement in the inflammatory profile over usual care in older patients. Nevertheless, due to limited number of RCTs, our findings must be interpreted with caution and confirmed in future studies.
Open Access
Higher cardiorespiratory fitness levels may attenuate the detrimental association between weight status, metabolic phenotype and C-reactive protein in adolescents—a multi-cohort study
(MDPI, 2020) Agostinis-Sobrinho, César; Rosário, Rafaela; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ramírez Vélez, Robinson; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua, CENEDUCA1/2019; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Results from several studies show that only obese, unfit subjects, but not obese, fit subjects, are at higher mortality risk than are normal-weight fit subjects. The aim of the study was two-fold: (1) to examine the differences in C-reactive protein levels across different metabolic phenotypes (healthy and unhealthy) of weight status and (2) ascertain whether high levels of cardiorespiratory fitness (CRF) attenuate the association of C-reactive protein and metabolic phenotypes of weight status. This was a pooled study, which included data from three cross-sectional projects (1706 youth (921 girls) aged 12–18 years). We used a Shuttle run test to assess CRF. Adolescents were classified into six metabolic phenotypes (healthy and unhealthy) of weight status (non-overweight, overweight and obese), based on age-and sex-specific cutoff points for triglycerides, systolic blood pressure, HDL-cholesterol, glucose and body mass index. High-sensitivity assays were used to obtain the C-reactive protein as inflammatory biomarker. After adjustment for potential confounders (age, sex, pubertal stage and country), the analysis of covariance (ANCOVA) shows that C-reactive protein is directly associated with metabolic phenotypes of weight status. Subjects with obesity, regardless of their metabolic profile, had higher levels of C-reactive protein Z-score. In addition, (after adjustments for potential confounders) a two-way ANCOVA showed that high levels of CRF attenuated the associations of C-reactive protein levels in metabolic healthy nonoverweight and in adolescents with obesity. In conclusion, higher CRF levels may attenuate the detrimental association between obesity and C-reactive protein independently of metabolic phenotype. Findings from this study are important for prevention, clinical practice on issues associated with adiposity and metabolic disorders.
Open Access
The dietary inflammatory index and hepatic health in the US adult population
(The British Dietetic Association Ltd, 2021) Ramírez Vélez, Robinson; García Hermoso, Antonio; Izquierdo Redín, Mikel; Correa Rodríguez, María; Ciencias de la Salud; Osasun Zientziak
Background: There is limited evidence on the role of an anti‐/pro‐inflammatory diet in the prevention of non‐alcoholic fatty liver disease (NAFLD). We aimed (i) to assess the anti‐inflammatory diet profile and its association with transient elastography parameters, including liver stiffness measurement (LSM) and controlled attenuation parameter (CAP), and (ii) to analyse the relationship between the anti‐inflammatory diet and surrogate markers of liver disease in a multiethnic US population. Methods: A cross‐sectional study was conducted on a nationally representative population of 4189 US adults aged 20–80 years. A FibroScan® 502 V2 device (Echosens) was used to estimate the CAP and LSM. Liver markers, including the aspartate transaminase (AST) to alanine transaminase (ALT) ratio, fatty liver index (FLI) and fibrosis‐4 score, were also calculated. The Dietary Inflammatory Index (DII) was calculated using a 24‐h diet recall. Results: Lower DII scores (anti‐inflammatory diet) were associated with a lower AST:ALT ratio (p < 0.001) and FLI (p < 0.036) after adjusting for covariates. Linear regression analysis revealed that gamma‐glutamyl transferase levels (β = 1.702, 95% confidence interval [CI] = 0.325–3.080, p = 0.015), ALT levels (β = −0.616, 95% CI = −1.097 to −0.135, p = 0.012), AST:ALT ratio (β = 0.025, 95% CI = 0.014–0.036, p < 0.001) and FLI (β = 1.168, 95% CI = 0.224–2.112, p = 0.015) were significantly associated with the DII in the multivariable‐adjusted model. Participants in the highest anti‐inflammatory tertile had the lowest odds ratio (OR) for NAFLD assessed by FLI in both unadjusted (OR = 0.652, 95% CI = 0.539–0.788, p ≤ 0.001) and adjusted models (OR = 0.722, 95% CI = 0.537–0.972, p = 0.032). For the transient elastography parameters (LSM and CAP), no significant associations were identified. Conclusions: There was no relationship between the transient elastography parameters and the anti‐inflammatory diet profile, although our study showed an association between higher pro‐inflammatory properties of diet and poorer hepatic health assessed by surrogate markers of liver disease. Therefore, strategies to promote an anti‐inflammatory diet should be considered to prevent NAFLD in adults.

Ramírez Vélez, Robinson

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