Open Access
Concurrent aerobic plus resistance exercise versus aerobic exercise alone to improve health outcomes in paediatric obesity: a systematic review and meta-analysis
(BMJ, 2018) García Hermoso, Antonio; Ramírez Vélez, Robinson; Ramírez Campillo, Rodrigo; Peterson, Mark Dean; Martínez Vizcaíno, Vicente; Ciencias de la Salud; Osasun Zientziak
Objective To determine if the combination of aerobic and resistance exercise is superior to aerobic exercise alone for the health of obese children and adolescents. Design Systematic review with meta-analysis. Data sources Computerised search of 3 databases (MEDLINE, EMBASE, and Cochrane Controlled Trials Registry). Eligibility criteria for selecting studies Studies that compared the effect of supervised concurrent exercise versus aerobic exercise interventions, with anthropometric and metabolic outcomes in paediatric obesity (6–18 years old). The mean differences (MD) of the parameters from preintervention to postintervention between groups were pooled using a random-effects model. Results 12 trials with 555 youths were included in the meta-analysis. Compared with aerobic exercise alone, concurrent exercise resulted in greater reductions in body mass (MD=−2.28 kg), fat mass (MD=−3.49%; and MD=−4.34 kg) and low-density lipoprotein cholesterol (MD=−10.20 mg/dL); as well as greater increases in lean body mass (MD=2.20 kg) and adiponectin level (MD=2.59 μg/mL). Differences were larger for longer term programmes (>24 weeks). Summary Concurrent aerobic plus resistance exercise improves body composition, metabolic profiles, and inflammatory state in the obese paediatric population. Trial registration number CRD42016039807.
Open Access
Endocrinology and adolescence: Aerobic exercise reduces insulin resistance markers in obese youth: a meta-analysis of randomized controlled trials
(Oxford University Press, 2014-10-01) García Hermoso, Antonio; Saavedra, José M.; Escalante, Yolanda; Sánchez López, Mairena; Martínez Vizcaíno, Vicente; Ciencias de la Salud; Osasun Zientziak
Objective: The purpose of this meta-analysis was to examine the evidence for the effectiveness of aerobic exercise interventions on reducing insulin resistance markers in obese children and/or adolescents. A secondary outcome was change in percentage of body fat. Methods: A computerized search was made from seven databases: CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, ERIC, MEDLINE, PsycINFO, and Science Citation Index. The analysis was restricted to randomized controlled trials that examined the effect of aerobic exercise on insulin resistance markers in obese youth. Two independent reviewers screened studies and extracted data. Effect sizes (ES) and 95% confidence interval (CI) were calculated, and the heterogeneity of the studies was estimated using Cochran's Q-statistic. Results: Nine studies were selected for meta-analysis as they fulfilled the inclusion criteria (n=367). Aerobic exercise interventions resulted in decreases in fasting glucose (ES=-0.39; low heterogeneity) and insulin (ES=-0.40; low heterogeneity) and in percentage of body fat (ES=-0.35; low heterogeneity). These improvements were specifically accentuated in adolescents (only in fasting insulin), or through programs lasting more than 12 weeks, three sessions per week, and over 60 min of aerobic exercise per session. Conclusions: This meta-analysis provides insights into the effectiveness of aerobic exercise interventions on insulin resistance markers in the obese youth population.
Open Access
Predictive ability of waist circumference and waist-to-height ratio for cardiometabolic risk screening among Spanish children
(MDPI, 2020-02-05) Arellano-Ruiz, Paola; García Hermoso, Antonio; García-Prieto, Jorge C.; Sánchez López, Mairena; Martínez Vizcaíno, Vicente; Solera-Martínez, Montserrat; Ciencias de la Salud; Osasun Zientziak
An excess of fat mass has been associated with adverse cardiometabolic risk factors. Different anthropometric measures have been proposed as alternative non-invasive measures for obesity-related cardiometabolic risk. To evaluate the magnitude of association between waist circumference (WC) and waist-to-height ratio (WtHR) with cardiometabolic risk factors and metabolic syndrome and to determine the WtHR cuto associated with a more favorable cardiometabolic risk profile in Spanish children, data were taken from a cross-sectional survey conducted in 2010 among 848 schoolchildren aged 8¿11 years from 20 public schools in the province of Cuenca (Spain). Anthropometric variables, glucose, insulin, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), systolic (SBP) and diastolic blood pressure (DBP) and metabolic syndrome (MetS) were also analyzed. WtHR and WC had a good accuracy for TG, insulin, and MetS. The diagnostic odds ratio ranged from 2.95 to 9.07 for WtHR and from 5.30 to 27.40 for WC. The main result of the present study suggests that both WtHR and WC could be used as a screening tool to identify children with cardiometabolic abnormalities.
Open Access
Validity and reliability of the international fItness scale (IFIS) in preschool children
(Taylor & Francis, 2022) Sánchez López, Mairena; García Hermoso, Antonio; Ortega, Francisco B.; Moliner-Urdiales, Diego; Labayen Goñi, Idoia; Castro Piñero, José; Benito, Pedro J.; Vicente Rodríguez, Germán; Sanchís Moysi, Joaquín; Cantallops, Jaume; Artero, E. G.; Martínez Vizcaíno, Vicente; Ciencias de la Salud; Osasun Zientziak
Objectives Examine the validity and reliability of parent-reported International FItness Scale (IFIS) in preschoolers. Method A cross-sectional study of 3051 Spanish preschoolers (3-5 years). Fitness was measured by PREFIT battery and reported by parents using an adapted version of the IFIS. Waist circumference was evaluated, and the waist-to-height ratio (WHtR) was calculated. Seventy-six parents of randomly selected schoolchildren completed the IFIS twice for a reliability assessment. Results ANCOVA, adjusted for sex, age and WHtR, showed that preschoolers who were scored by their parents as having average-to-very good fitness had better levels of measured physical fitness than those preschoolers who were classified as having very poor/poor fitness levels (18.1laps to 22.1laps vs 15.6laps for cardiorespiratory fitness; 6.6 kg to 7.5 kg vs 5.3 kg for muscular fitness-handgrip-; 71.7 cm to 76.4 cm vs 62.0 cm for muscular fitness-standing long jump-; 17.2s to 16.2s vs 18.2s for speed/agility; and 11.2s to 15.6s vs 8.7s for balance; p < 0.001). The weighted kappa for concordance between parent-reported fitness levels and objective assessment was poor (kappa <= 0.18 for all fitness measures). Overall, the mean values of the abdominal adiposity indicators were significantly lower in high-level fitness categories reported by parents than in low-level fitness categories (p < 0.05). The test-retest reliability ranged from 0.46 to 0.62. Conclusions The reliability of the parent-reported IFIS are acceptable, but the concordance between parents reported and objectively measures fitness levels is poor, suggesting that parents' responses may not be able to correctly classify preschoolers according to their fitness level.
Open Access
Cross-cultural adaptation, reliability, and validation of the Spanish perceived physical literacy instrument for adolescents (S-PPLI)
(Elsevier, 2023) López Gil, José Francisco; Martínez Vizcaíno, Vicente; Tárraga López, Pedro J.; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
Objective: The aim of this study was to examine the reliability and validity of the Spanish Perceived Physical Literacy Instrument (S-PPLI) questionnaire in Spanish adolescents. Method: The participants of this study were 360 Spanish adolescents (aged 12-17 years) from three secondary schools in the Region of Murcia (Spain). A cultural adaptation process of the original version of the PPLI questionnaire was developed. Confirmatory factor analysis was applied to test the three-factor structure of physical literacy. Intraclass correlation coefficients were computed to estimate the test-retest concordance. Results: Using a confirmatory factor analysis, the factor loading of all items above the standard of 0.40 ranged from 0.53 to 0.77, suggesting that the observed variables sufficiently represented the latent variables. Analyses for convergent validity showed average variance extracted values that ranged from 0.40 to 0.52 and composite reliability values higher than 0.60. All the correlations were below the recommended cutoff point of 0.85, which indicated that the three physical literacy factors achieved adequate discriminant validity. Intraclass correlation coefficients ranged from 0.62 to 0.79 (p < 0.001 for all items), which indicated moderate/good reliability. Conclusions: Our results suggest that the S-PPLI is a valid and reliable measure of physical literacy among Spanish adolescents.
Open Access
Mediterranean diet-based interventions to improve anthropometric and obesity indicators in children and adolescents: a systematic review with meta-analysis of randomized controlled trials
(Elsevier, 2023) López Gil, José Francisco; García Hermoso, Antonio; Sotos-Prieto, Mercedes; Cavero-Redondo, Iván; Martínez Vizcaíno, Vicente; Kales, Stefanos N.; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa, 1225%2F2022
To our knowledge, no systematic review with meta-analysis has separately synthesized the effects of Mediterranean diet-based interventions in children and adolescents in relation to the effects on anthropometric measures. A better understanding of the effects of Mediterranean dietbased interventions on anthropometric variables could facilitate their implementation in efforts to prevent obesity in the young population. The aim of the present meta-analysis was to evaluate the effects of Mediterranean diet-based interventions on anthropometric and obesity indicators among children and adolescents. Four databases were systematically searched (PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews), including all studies up until 15 March, 2023. Eligible articles were randomized controlled trials measuring the effect of an intervention based on the promotion of the Mediterranean diet and obesity-associated parameters. The effect size of each study was estimated by Cohen’s d for continuous variables or risk difference for categorical variables. Compared to the control group, the Mediterranean diet-based interventions showed small and significant reductions in body mass index (d=- 0.14; 95% CI: 0.26, 0.01; I 2= 77.52%). Participants in the Mediterranean diet-based interventions had a significant reduction in the percentage of obesity (risk difference = 0.12; 95% CI: 0.01, 0.23; I 2= 84.56%) in comparison with the control group. Interventions had greater effects when aiming at participants with excess weight (that is, overweight or obesity), both for body mass index, waist circumference, waist-to-height ratio, percentage of obesity, and percentage of abdominal obesity. Mediterranean diet-based interventions have a significant effect on reducing the body mass index as well as reducing obesity in children and adolescents (aged 3–18 y). This trial was registered at PROSPERO as CRD42023386789.
Open Access
Muscular strength as a predictor of all-cause mortality in an apparently healthy population: a systematic review and meta-analysis of data from approximately 2 million men and women
(Elsevier, 2018-09-25) García Hermoso, Antonio; Cavero-Redondo, Iván; Ramírez Vélez, Robinson; Ruiz, Jonatan R.; Ortega, Francisco B.; Lee, Duck-Chul; Martínez Vizcaíno, Vicente; Ciencias de la Salud; Osasun Zientziak
Objectives: The aims of the present systematic review and meta-analysis were to determine the relationship between muscular strength and all-cause mortality risk and to examine the sex-specific impact of muscular strength on all-cause mortality in an apparently healthy population. Data Sources: Two authors systematically searched MEDLINE, EMBASE and SPORTDiscus databases and conducted manual searching of reference lists of selected articles. Study Selection: Eligible cohort studies were those that examined the association of muscular strength with all-cause mortality in an apparently healthy population. The hazard ratio (HR) estimates with 95% confidence interval (CI) were pooled by using random effects meta-analysis models after assessing heterogeneity across studies. Data Extraction: Two authors independently extracted data. Data Synthesis: Thirty-eight studies with 1,907,580 participants were included in the meta-analysis. The included studies had a total of 63,087 deaths. Higher levels of handgrip strength were associated with a reduced risk of all-cause mortality (HR=0.69; 95% CI, 0.64-0.74) compared with lower muscular strength, with a slightly stronger association in women (HR=0.60; 95% CI, 0.51-0.69) than men (HR=0.69; 95% CI, 0.62-0.77) (all P<.001). Also, adults with higher levels of muscular strength, as assessed by knee extension strength test, had a 14% lower risk of death (HR=0.86: 95% CI, 0.80-0.93; P<.001) compared with adults with lower muscular strength. Conclusions: Higher levels of upper- and lower-body muscular strength are associated with a lower risk of mortality in adult population, regardless of age and follow-up period. Muscular strength tests can be easily performed to identify people with lower muscular strength and, consequently, with an increased risk of mortality.