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
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
International exercise recommendations in older adults (ICFSR): expert consensus guidelines
(Springer, 2021) Izquierdo Redín, Mikel; Merchant, R.A.; Morley, John E.; Anker, S.D.; Aprahamian, I.; Arai, H.; Aubertin-Leheudre, M.; Bernabei, R.; Lusa Cadore, Eduardo; Cesari, Matteo; Chen, L.-K.; Souto Barreto, Philipe de; Duque, Gustavo; Ferrucci, L.; Fielding, R.A.; García Hermoso, Antonio; Gutiérrez Robledo, L.M.; Harridge, S.D.R.; Kirk, B.; Kritchevsky, S.; Landi, F.; Lazarus, N.; Martin, F.C.; Marzetti, E.; Pahor, M.; Ramírez Vélez, Robinson; Rodríguez Mañas, Leocadio; Rolland, Y.; Ruiz, J.G.; Theou, O.; Villareal, D.T.; Waters, D.L.; Won Won, C.; Woo, J.; Vellas, Bruno; Fiatarone Singh, Maria; Ciencias de la Salud; Osasun Zientziak
The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living-experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.
Open Access
Measurement of physical activity and sedentary behavior in national health surveys, South America
(PAHO, 2022) Silva, Danilo R.; Leite Silva, Luciana; Baldew, Se-Sergio; Anza-Ramirez, Cecilia; Ramírez Vélez, Robinson; Gomes, Thayse N.; Sadarangani, Kabir P.; García Hermoso, Antonio; Nieto-Martinez, Ramfis; Ferrari, Gerson; Miranda, Jaime; Werneck, André de Oliveira; Ciencias de la Salud; Osasun Zientziak
Objetivos. Describir cómo se han medido la actividad física y el sedentarismo en las encuestas nacionales de salud en los países de América del Sur. Métodos. Se llevó a cabo una extensa búsqueda de encuestas nacionales de salud de los doce países sudamericanos en sitios web de salud, oficinas nacionales de estadística y mediante el contacto con investigadores y responsables de formular políticas. Para escoger las encuestas se emplearon los siguientes criterios de selección: realizada en un país sudamericano; muestra representativa a nivel nacional de ≥ 18 años; coordinada por el sector público, el sector privado o mixto público-privado; y evaluación de la actividad física o el sedentarismo. Se extrajeron datos como información general de las encuestas, detalles específicos de la evaluación de la actividad física y el sedentarismo, y otras preguntas relacionadas con la actividad física. Resultados. En total, se incluyeron 36 encuestas, dos de las cuales se realizaron en varios países. Todas las encuestas evaluaron la actividad física; 27, el sedentarismo. La mayoría de las encuestas (23/36; 64%) tividad física mediante preguntas sobre el tiempo invertido delante de pantallas o el tiempo diario sentado. Ninguna encuesta aplicó medidas basadas en dispositivos para obtener datos sobre estos comportamientos. Conclusiones. Las diferencias entre los instrumentos empleados y las modificaciones limitan la comparabilidad de los datos en todos los países. Esto pone de relieve la importancia de estandarizar la evaluación en América del Sur de las secciones dedicadas a la actividad física y al sedentarismo en las encuestas nacionales, con el objetivo general de contribuir a la creación de una estrategia estandarizada para la vigilancia de la actividad física y el sedentarismo en América del Sur.
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.