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
Liver fat content and body fat distribution in youths with excess adiposity
(MDPI, 2018) Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; Correa Bautista, Jorge Enrique; Correa Rodríguez, María; Schmidt Río-Valle, Jacqueline; González Jiménez, Emilio; González Ruiz, Katherine; Ciencias de la Salud; Osasun Zientziak
This study had two main objectives: To examine the association between body fat distribution and non-alcoholic fatty liver disease (NAFLD) and liver fat content, and to determine whether the relationship between NAFLD and regional body fat distribution, with respect to liver fat content in youths with excess adiposity, is independent of cardiorespiratory fitness (CRF) and a healthy diet. Liver fat content (controlled attenuation parameter (CAP)), body fat distribution (body mass index (BMI) z-score, waist circumference, waist-to-height ratio, fat mass/height, body fat percentage, total fat mass, android-to-gynoid fat mass ratio, visceral adipose tissue (VAT), and lean mass index, determined by dual-energy X-ray absorptiometry (DXA)), CRF (20-m shuttle-run test), and healthy diet (adherence to the Mediterranean diet by KIDMED questionnaire) were measured in 126 adolescents (66% girls) aged between 11 and 17 years. Participants were assigned to two groups according to the presence or absence of hepatic steatosis (CAP values >225 dB/m or <225 dB/m of liver fat, respectively). Considering the similar total fat values for the two groups (>30% by DXA), youths with NAFLD had higher fat distribution parameters than those without NAFLD, regardless of sex, age, puberty stage, lean mass index, CRF, and healthy diet (p < 0.01). In the non-NAFLD group, the association between hepatic fat and fat distribution parameters presented a similar pattern, although the association was statistically insignificant after adjusting for a potential confounding variable (ps > 0.05), except for the case of VAT. Body fat distribution parameters were higher in youths with NAFLD compared to those without NAFLD. Additionally, body fat distribution showed a significant association with liver fat content as assessed by CAP in youths with NAFLD independent of CRF and adherence to the Mediterranean diet, supporting the notion that upper body fat distribution might play a pivotal role in the development of NAFLD in adolescents. These results may have implications for the clinical management of youths with excess adiposity given the high prevalence of NAFLD in children and young adults.
Open Access
Effect of high-intensity interval training on body composition, cardiorespiratory fitness, blood pressure, and substrate utilization during exercise among prehypertensive and hypertensive patients with excessive adiposity
(Frontiers Media, 2020) Delgado Floody, Pedro; Izquierdo Redín, Mikel; Ramírez Vélez, Robinson; Caamaño Navarrete, Felipe; Moris, Roberto; Jerez Mayorga, Daniel; Andrade, David C.; Álvarez, Cristian; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Regular exercise training is a recognized lifestyle strategy to lower resting blood pressure (BP), but little is known about substrate metabolism in population with high BP. Thus, the purpose of this study was to investigate the effects of 16-weeks of HIIT on body composition, BP, cardiorespiratory fitness by (Formula presented.) O2max, and substrate utilization during exercise among prehypertensive and hypertensive patients with excessive adiposity. We also aimed to test the potential association between changes in cardiorespiratory fitness, substrate utilization during exercise and BP. Forty-two physically inactive overweight/obese participants participated in 16-weeks of HIIT intervention. The HIIT frequency was three times a week (work ratio 1:2:10, for interval cycling: rest period: repeated times; 80–100% of the maximum heart rate). Groups were distributed based on their baseline BP: HIIT-hypertensive (H-HTN: age 47.7 ± 12.0 years; body mass index [BMI] 30.3 ± 5.5 kg/m2; systolic [SBP]/diastolic BP [DBP] 151.6 ± 10/81.9 ± 4.2 mmHg), HIIT-pre-hypertensive (H-PreHTN: age 37.6 ± 12.0 years; BMI 31.9 ± 5.3 kg/m2; SBP/DBP 134.4 ± 3.2/74.9 ± 7.0 mmHg), and a normotensive control group (H-CG: age 40.7 ± 11.0 years; BMI 29.5 ± 4.2 kg/m2; SBP/DBP 117.0 ± 6.2/72.4 ± 4.1 mmHg). Anthropometry/body composition, BP, and metabolic substrate utilization during exercise (fat [FATox], carbohydrate [CHOox] oxidation, respiratory exchange ratio [RER], and (Formula presented.) O2max), were measured before and after the 16-week HIIT intervention. Adjusted mixed linear models revealed a significant improved in (Formula presented.) O2max were + 3.34 in the H-CG, + 3.63 in the H-PreHTN, and + 5.92 mL⋅kg–1⋅min–1, in the H-HTN group, however, the Time × Group interaction were not significant (p = 0.083). All the exercise types induced similar decreases on SBP (−8.70) in the H-HTN, (−7.14) in the H-CG, and (−5.11) mmHg in the H-PreHTN, as well as DBP levels (−5.43) mmHg in H-CG group (p = 0.032 vs. H-HTN group). At 16-week, no significant correlations were noted for the changes of blood pressure, cardiorespiratory fitness or exercise metabolism substrates outcomes. In conclusion, our results suggest that a 16-week HIIT-intervention improved (Formula presented.) O2max and blood pressure BP, but these changes are independent of substrate utilization during exercise in normotensive and hypertensive participants with excessive adiposity.
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
Tracking of physical fitness levels from childhood and adolescence to adulthood: a systematic review and meta-analysis
(AME Publishing, 2022) García Hermoso, Antonio; Izquierdo Redín, Mikel; Ramírez Vélez, Robinson; Ciencias de la Salud; Osasun Zientziak
Background: prospective and large studies indicate that high physical fitness levels during young are beneficial for health during adulthood. The aim of the study was to investigate the tracking of physical fitness components from childhood and/or adolescence to adulthood. Methods: two authors systematically searched MEDLINE and Web of Science electronic databases for relevant articles. Studies with apparently healthy youth aged 6-18 years who track their physical fitness to adulthood were included. Our study carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Correlation coefficients (r) were used as effect size. Random-effects models were used to estimate the pooled effect size. Correlation coefficients were interpreted as follows: <0.30 low stability, 0.30 to 0.60 moderate stability, and >0.60 high stability. Risk of bias of each study was determined by The Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. Results: twenty-one prospective studies were included in the meta-analysis (n=6,197 participants at follow-up, 47.4% women). The mean length of follow-up was 20.8 years. Overall, cardiorespiratory fitness (r=0.38; 95% CI: 0.29-0.48; I2=92.7%), muscular strength (r=0.51; 95% CI: 0.43-0.59; I2=87.9%), and muscular endurance (r=0.50; 95% CI: 0.36-0.86; I2=94.5%) show moderate tracking from childhood and/or adolescence to adulthood, independent of test used and length of follow-up. This moderate tracking was slightly stronger in women than in men and from adolescence compared to childhood. Trunk flexibility component, assessed with the sit and reach test, exhibits high stability (r=0.69; 95% CI: 0.58-0.81; I2=92.9%). Interestingly, meta-regression analysis shows positive association between correlation coefficient for flexibility and the length of follow-up (β =0.017; 95% CI: 0.012-0.021). Discussion: although the current study found inconsistency between results, the findings suggest that acquiring high physical fitness levels should be targeted already from childhood and adolescence given that low levels of fitness in adulthood are related with several chronic diseases and mortality.
Open Access
Aerobic capacity and future cardiovascular risk in Indian community from a low-income area in Cauca, Colombia
(BioMed Central, 2017) Ramírez Vélez, Robinson; Correa Bautista, Jorge Enrique; Ramos Sepúlveda, Jeison Alexander; Piñeros Álvarez, Carlos Andrés; Giraldo, Lorena Isabel; Izquierdo Redín, Mikel; García Hermoso, Antonio; Rodríguez Rodríguez, Fernando; Cristi Montero, Carlos; Ciencias de la Salud; Osasun Zientziak
Background: Several studies indicates that children’s aerobic capacity levels are predictors of the future risk of non-communicable diseases. Therefore, the aim of this study was to establish the proportion of subjects whose aerobic capacity is indicative of future cardiovascular risk in Indian-Nasa community from a low-income area in Cauca, Colombia. Methods: We performed a cross-sectional analysis of morphological component (height, weight, body mass index (BMI), waist circumference, triceps skinfold, subscapular skinfold, and body fat percent [BF%]), and the cardiorespiratory component (course-navette 20 m, shuttle run test and estimation of maximal oxygen consumption by indirect VO2max) from 576 participants (319 boys and 257 girls) aged 10 to 17.9 years, using the standardized FUPRECOL test battery. Results: We showed that the boys performed better than the girls in cardiorespiratory fitness. The proportion of subjects with an aerobic capacity indicative of future cardiovascular risk was 7.3%. By sex, 3.8% of boys and 11.7% of girls (X2 p = 0.001) displayed an unhealthy aerobic capacity in this study. Conclusion: The findings of this study that provide the first data on aerobic capacity health for Colombian Nasa Indian children and adolescents aged 10–17.9 years. Although the known loss of aerobic capacity is a serious consequence of the future risk of non-communicable diseases, the deterioration of physical fitness deserves increased attention among indigenous population.
Open Access
Association between bullying victimization and physical fitness among children and adolescents
(Asociación Española de Psicología Conductual (AEPC), 2019) García Hermoso, Antonio; Oriol Granado, Xavier; Correa Bautista, Jorge Enrique; Ramírez Vélez, Robinson; Ciencias de la Salud; Osasun Zientziak
Antecedentes/Objetivo: el objetivo del estudio fue analizar la relación entre el bullying y la condición física, y determinar si un nivel físico saludable está relacionado con menor nivel de victimización en niños y adolescentes con sobrepeso y obesidad en comparación con suscompañeros con sobrepeso u obesidad no aptos. Método: se incluyó un total de 7.714 niños y adolescentes (9-17 años), categorizados en peso normal o sobrepeso/obeso y aptos o no aptos a través de puntos de corte específicos para la capacidad aeróbica y fuerza manual en esta población. El bullying (físico, verbal, exclusión social, acoso sexual y cyberbullying) se evaluó a través de autoinforme. Resultados: los jóvenes categorizados como aptos (capacidad cardio-respiratoria) padecen menos bullying en comparación con sus homólogos no aptos. Además, un nivel saludable de capacidad cardiorrespiratoria se relacionó con menor bullying tradicional entre los jóvenes con sobrepeso/obesidad en comparación con sus homólogos no aptos. Conclusiones: la capacidad cardiorrespiratoria se relaciona con un menor riesgo de sufrir acoso escolar tradicional en los jóvenes latinos con y sin obesidad, lo que enfatiza el papel del buen estado físico incluso entre los jóvenes con exceso de adiposidad.
Open Access
Grip strength moderates the association between anthropometric and body composition indicators and liver fat in youth with an excess of adiposity
(MDPI, 2018) Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; Correa Bautista, Jorge Enrique; Tordecilla Sanders, Alejandra; Correa Rodríguez, María; Schmidt Río-Valle, Jacqueline; González Jiménez, Emilio; González Ruiz, Katherine; Ciencias de la Salud; Osasun Zientziak
Paediatric non-alcoholic fatty liver disease (NAFLD) is considered the most common early driver of chronic liver disease. The aim of this study was to examine whether grip strength moderates the association between anthropometric and body composition parameters and controlled attenuation parameter (CAP), an indicator of fat deposits in the liver, in children and adolescents with excess of adiposity. A total of 127 adolescents (67% girls) aged between 11 and 17, attending two public schools in Bogota (Colombia), who had an axiological evaluation of obesity were included in this study. A grip strength test was assessed as an indicator of muscular strength, and cardiorespiratory fitness by maximal oxygen uptake was assessed using the 20 m shuttle-run test. Waist circumference (WC), waist-to-height ratio (WHtR), fat mass, and visceral adipose tissue (VAT) (cm(3)) were included as anthropometric and body composition measures. CAP was determined with a FibroScan((R)) 502 Touch device (Echosens, Paris, France). The anthropometric and body composition parameters including WC, WHtR, fat mass, and VAT were positively associated with the CAP (range = 0.423 to 0.580), slightly reduced after being adjusted for handgrip strength/weight. The Johnson-Neyman technique revealed a significant inverse relationship between WC, WHtR, VAT, and CAP when grip strength normalized by body mass was above but not equal to or below 0.475 (8.1% of the sample), 0.469 (8.9% of the sample), and 0.470 (8.5% of the sample), respectively. In conclusion, grip strength adjusted by body mass, has a moderating effect on the association between anthropometric and body composition parameters (including WC, WHtR, and VAT) and CAP in in children and adolescents with excess of adiposity, suggesting the importance of promoting muscular strength during paediatric population in order to prevent NAFLD.
Open Access
A before-school physical activity intervention to improve cognitive parameters in children: The Active-Start study
(Wiley, 2019-08-19) García Hermoso, Antonio; Hormazábal Aguayo, Ignacio; Fernández Vergara, Omar; González-Calderón, Nicole; Russell-Guzmán, Javier; Vicencio-Rojas, Francisca; Chacana-Canas, Cesar; Ramírez Vélez, Robinson; Ciencias de la Salud; Osasun Zientziak
The aim of the study was threefold: (a) to test a before-school physical activity intervention (Active-Start) on academic performance, selective attention, and concentration capacity; (b) to test the effect of the Active-Start intervention on anthropometry, body composition, and physical fitness parameters; and (c) whether the physical fitness components are moderators of the effect of the Active-Start program on academic performance, selective attention, and concentration capacity in Chilean children. The Active-Start intervention was a RCT which comprised 170 children (8-10 years old) from three public schools with low socioeconomic status from the city of Santiago (Chile). The exercise intervention was delivered daily, before starting the first school-class (8:00-8:30 am) for 8 weeks. Changes in academic performance, selective attention and concentration capacity, anthropometric, body composition, and physical fitness parameters were measured. The analyses used were mixed regression models for repeated measures over time. No statistically significant changes in attention and concentration capacity were found. However, significant changes were seen in language (0.63; 95% CI 0.49-0.77) and mathematics (0.49; 95% CI 0.32-0.66) performance (P < .001). Also, improvements were seen in fat mass, fat-free mass, muscular, and cardiorespiratory fitness (all P < .05). The Johnson-Neyman technique revealed a significant relationship between the effect of intervention and attention and concentration when change in cardiorespiratory fitness was above, but not below, 3.05 and 0.70 mL/kg/min, respectively. Implementing before-school physical activity programs such as the Active-Start to enhance the cardiorespiratory fitness may benefit attention capacity and academic success among schoolchildren.
Open Access
Association of physical education with improvement of health-related physical fitness outcomes and fundamental motor skills among youths: a systematic review and meta-analysis
(American Medical Association (AMA), 2020-08-31) García Hermoso, Antonio; Alonso Martínez, Alicia; Ramírez Vélez, Robinson; Pérez Sousa, Miguel A.; Ramírez Campillo, Rodrigo; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
This systematic review and meta-analysis of 55 studies that included 37 563 youths revealed that cardiorespiratory fitness levels and change over approximately 1 year during youth were associated with lower risk of developing obesity and cardiometabolic disease later in life. These early associations detected from baseline to follow-up dissipated over time. The study suggests that prevention strategies that target youth cardiorespiratory fitness may be associated with improved health parameters in later life.