Open Access
Revisiting skeletal myopathy and exercise training in heart failure: emerging role of myokines
(Elsevier, 2023) Ramírez Vélez, Robinson; González, Arantxa; García Hermoso, Antonio; Latasa Amézqueta, Íñigo; Izquierdo Redín, Mikel; Díez, Javier; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Exercise intolerance remains a major unmet medical need in patients with heart failure (HF). Skeletal myopathy is currently considered as the major limiting factor for exercise capacity in HF patients. On the other hand, emerging evidence suggest that physical exercise can decrease morbidity and mortality in HF patients. Therefore, mechanistic insights into skeletal myopathy may uncover critical aspects for therapeutic interventions to improve exercise performance in HF. Emerging data reviewed in this article suggest that the assessment of circulating myokines (molecules synthesized and secreted by skeletal muscle in response to contraction that display autocrine, paracrine and endocrine actions) may provide new insights into the pathophysiology, phenotyping and prognostic stratification of HF-related skeletal myopathy. Further studies are required to determine whether myokines may also serve as biomarkers to personalize the modality and dose of physical training prescribed for patients with HF and exercise intolerance. In addition, the production and secretion of myokines in patients with HF may interact with systemic alterations (e.g., inflammation and metabolic disturbances), frequently present in patients with HF. Furthermore, myokines may exert beneficial or detrimental effects on cardiac structure and function, which may influence adverse cardiac remodelling and clinical outcomes in HF patients. Collectively, these data suggest that a deeper knowledge on myokines regulation and actions may lead to the identification of novel physical exercise-based therapeutic approaches for HF patients.
Open Access
What is the role of adherence to 24-hour movement guidelines in relation to physical fitness components among adolescents?
(Wiley, 2023) Tapia-Serrano, Miguel Ángel; López Gil, José Francisco; Sevil-Serrano, Javier; García Hermoso, Antonio; Sánchez-Miguel, Pedro Antonio; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa–1225/2022
Background: Physical inactivity, excessive sedentary time, and lack of sleep time have been independently associated with lower health-related physical fitness. However, little is known about the combined association between 24-h movement guidelines (i.e., physical activity, recreational screen time, and sleep duration) and components of physical fitness. Objective: The main aim was to examine the likelihood of having high/very high levels on different components of physical fitness based on meeting with 24-h movement guidelines. Methods: In this cross-sectional study, 1276 Spanish youths (13.07±0.86; 55.88% boys), aged 11–16 years, completed self-reported questionnaires on physical activity, recreational screen time, and sleep duration. Physical fitness components were assessed by 20-m shuttle-run test, standing long jump test, handgrip strength test, and 4×10-m shuttle-run test. Meeting 24-h movement guidelines was defined as: 9–11h/day (children aged 5–13) or 8–10h/day (adolescents aged 14–17) of sleep, ≤2h/day of recreational screen time and at least 60min/day of moderateto-vigorous physical activity. The probability of having a high/very high score for each physical fitness components (i.e., ≥60th centile according to the normative cut-off points for European adolescents) in relation to adherence to 24-h movement guidelines was analyzed using a series of binary logistic regressions. Results: Participants who met the three 24-h movement guidelines were more likely to have high/very high for cardiorespiratory fitness (OR=3.31; 95% CI: 1.79, 6.14; p<0.001), standing long jump (OR=1.91; 95% CI: 1.06, 3.45; p=0.031), muscular fitness (OR=2.05; 95% CI: 1.09, 3.86; p=0.048) and physical fitness (OR=1.99; 95% CI: 1.08, 3.66; p=0.012), but not for handgrip strength (OR=1.15; 95% CI: 0.64, 2.01; p=0.636) and speed/agility (OR=1.65; 95% CI: 0.92, 2.96; p=0.093), compared to those who did not meet all three recommendations. Conclusion: Since meeting the three 24-h movement guidelines increased the likelihood of having higher levels in most physical fitness components, it seems necessary to promote these movement behaviors early in life, as they could serve as a gateway for improving health-related fitness in future generations.
Open Access
Validación del instrumento chileno de alfabetización física percibida (Ch-PPLI) en niñas, niños y adolescentes chilenos entre 10 y 18 años
(Federación Española de Asociaciones Docentes de ·Educaión Física (FEADEF), 2025-02-17) Inostroza-Mondaca, Mauricio; Ramírez Campillo, Rodrigo; García Hermoso, Antonio; Pardo Tamayo, Carolina; Muñoz-Hinrichsen, Fernando; Ciencias de la Salud; Osasun Zientziak
Introducción: La alfabetización motriz favorece la participación y mantenimiento de un nivel adecuado de actividad física durante el ciclo vital, reduce comportamiento sedentario, mejora marcadores de salud y calidad de vida en niñas, niños y adolescentes (NNA). Por tanto, se requieren instrumentos válidos y confiables para determinar la alfabetización motriz en NNA. Objetivo: Examinar la validez y confiabilidad del cuestionario “Chilean Perceived Physical Literacy Instrument” (Ch-PPLI) en NNA chilenos de 10 a 18 años. Metodología: Se desarrolló un proceso de adaptación cultural y validación de contenido con tres expertos bajo metodología Delphi, coeficiente de validación de contenido, y validación de constructo por análisis factorial exploratorio (AFE), con participantes de sexo femenino (n=134; 13,8±2,05 años) y masculino (n=146; 14,4±2,17 años). Resultados: La validación de expertos presentó coeficientes de validación de contenido entre 0,81 a 0,94 (i.e. “buenos” a “excelentes”). Las medidas de ajuste del modelo presentaron valores “satisfactorios” (Error de aproximación cuadrático medio [RMSEA=0,07; p<0,001]). El AFE agrupó ítems en un solo factor, presentando valores de confiabilidad “alta” (α=0,822 y ω=0,829). En ítems 1 a 5, y total del Ch-PPLI, los niños presentaron valores mayores versus niñas (todos p<0,05). En ítems 2 a 5, 7, 9 y total del Ch-PPLI, la población activa (cuestionario de niveles de actividad física >5 puntos) presentó valores mayores versus población inactiva físicamente (todos p<0,05). Conclusiones: El Ch-PPLI mostró validez y confiabilidad en NNA chilenos de 10 a 18 años. El Ch-PPLI identificó diferencias de alfabetización motriz entre hombres y mujeres, y entre individuos activos e inactivos físicamente.
Open Access
Development and validation of a scale measuring perceived barriers to physical activity in Spanish for children and adolescents with type 1 diabetes: the Physical Activity Barriers Scale for pediatric type 1 diabetes (PABS-1) questionnaire
(Elsevier, 2025-06-01) García Hermoso, Antonio; Huerta Uribe, Nidia; Hormazábal Aguayo, Ignacio; Muñoz Pardeza, Jacinto; Chueca-Guindulain, María J.; Burillo Sánchez, Elisabeth; Ezzatvar, Yasmin; López Gil, José Francisco; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Aims: To develop and validate the psychometric properties, reliability, and criterion validity of the Physical Activity Barriers Scale for pediatric type 1 diabetes (PABS-1) in Spanish-speaking children and adolescents with type 1 diabetes. Method: A cross-sectional study was conducted with a sample of 93 Spanish-speaking children and adolescents with type 1 diabetes. The PABS-1 questionnaire was developed by experts and refined with patient feedback. Its validity was assessed by comparing results with accelerometer data, linking scores to objective physical activity measures. Results: The PABS-1 showed good internal consistency, with a Cronbach’s alpha (α) coefficient of 0.89, indicating strong reliability. Confirmatory factor analysis supported a four-factor structure, with physical, diabetes-related, psychological, and environmental barriers showing good fit indices (comparative fit index [CFA] = 0.94, root mean square error of [RMSEA] = 0.06, standardized root mean square residual [SRMR] = 0.05). Although the associations were small, the total PABS-1 score was significantly negatively correlated with cardiorespiratory fitness (Spearman’s rho [ρ]= -0.15, p = 0.035) and moderate-to-vigorous physical activity (ρ = − 0.12, p = 0.039). Among the four factors, motivational barriers exhibited the strongest associations with physical activity and fitness, showing significant negative correlations. Conclusions: The PABS-1 is a valid and reliable tool for assessing perceived barriers to physical activity in Spanish-speaking children and adolescents with type 1 diabetes.
Open Access
Lipidomic signatures from physically frail and robust older adults at hospital admission
(Springer, 2022) Ramírez Vélez, Robinson; Martínez Velilla, Nicolás; Correa Rodríguez, María; López Sáez de Asteasu, Mikel; Zambom Ferraresi, Fabrício; Palomino Echeverría, Sara; García Hermoso, Antonio; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua, 2186/2014; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa, 420/2019
Identifying serum biomarkers that can predict physical frailty in older adults would have tremendous clinical value for primary care, as this condition is inherently related to poor quality of life and premature mortality. We compared the serum lipid profile of physically frail and robust older adults to identify specific lipid biomarkers that could be used to assess physical frailty in older patients at hospital admission. Forty-three older adults (58.1% male), mean (range) age 86.4 (78–100 years) years, were classified as physically frail (n = 18) or robust (n = 25) based on scores from the Short Physical Performance Battery (≤ 6 points). Non-targeted metabolomic study by ultra-high performance liquid chromatography coupled to mass spectrometry (UHPLC-MS) analysis with later bioinformatics data analysis. Once the significantly different metabolites were identified, the KEGG database was used on them to establish which were the metabolic pathways mainly involved. Area under receiver-operating curve (AUROC) analysis was used to test the discriminatory ability of lipid biomarkers for frailty based on the Short Physical Performance Battery. We identified a panel of five metabolites including ceramides Cer (40:2), Cer (d18:1/20:0), Cer (d18:1/23:0), cholesterol, and hosphatidylcholine (PC) (14:0/20:4) that were significantly increased in physically frail older adults compared with robust older adults at hospital admission. The most interesting in the physically frail metabolome study found with the KEGG database were the metabolic pathways, vitamin digestion and absorption, AGE-RAGE signaling pathway in diabetic complications, and insulin resistance. In addition, Cer (40:2) (AUROC 0.747), Cer (d18:1/23:0) (AUROC 0.720), and cholesterol (AUROC 0.784) were identified as higher values of physically frail at hospital admission. The non-targeted metabolomic study can open a wide view of the physically frail features changes at the plasma level, which would be linked to the physical frailty phenotype at hospital admission. Also, we propose that metabolome analysis will have a suitable niche in personalized medicine for physically frail older adults.
Open Access
Physical fitness and activity levels as predictors of subjective well-being in youths with type 1 diabetes mellitus: a 2-year longitudinal analysis of the diactive-1 cohort study
(Wiley, 2025-03-05) Muñoz Pardeza, Jacinto; López Gil, José Francisco; Huerta Uribe, Nidia; Hormazábal Aguayo, Ignacio; Yáñez-Sepúlveda, Rodrigo; Ezzatvar, Yasmin; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
Subjective well-being (SWB), including cognitive and affective components, may be influenced by the management of type 1diabetes mellitus (T1DM). Physical fitness and adherence to physical activity (PA) are associated with better glycaemic stabilityand diabetes management. However, the relationship with SWB is not yet understood. The aim of the study was to determinethe relationship between physical fitness, PA, and SWB over two years in youths with T1DM. This longitudinal study involved83 participants (aged 6–18 years; 44.6% girls) from the Diactive-1 Cohort. Physical fitness was assessed by spirometry (peak ox-ygen consumption) and dynamometry (handgrip strength). PA domains were measured using triaxial accelerometers, whereasthe number of days participating in muscle-strengthening activities was assessed using a question. The Cuestionario Único deBienestar Escolar was used to determine SWB. Glycaemic stability was determined when glycosylated hemoglobin < 7%, coef-ficient of variability ≤ 36%, and time-in-range target > 70% were met. The linear mixed models used considered three assess-ments and subject variability, showing significant associations between overall physical fitness (unstandardized beta coefficient[B] = 1.778, 95% confidence interval [CI] 0.413–3.158; p = 0.012) and total PA (B = 0.034, 95% CI 0.005–0.063; p = 0.020) withSWB. Although time did not moderate the association with physical fitness (p = 0.116), this was true for PA only in the secondyear (p = 0.020). In contrast, glycaemic stability did not moderate the associations (p > 0.05). In conclusion, physical fitness andPA are associated with greater SWB in young people with T1DM, which may play a role in the psychological aspects of diseasemanagement.
Embargo
Physical fitness and sleep-related problems among adolescents: findings from the EHDLA study
(Wiley, 2025-03-19) Muñoz Pardeza, Jacinto; Ezzatvar, Yasmin; Gutiérrez Espinoza, Héctor; Páez-Herrera, Jacqueline; Olivares-Arancibia, Jorge; Yáñez-Sepúlveda, Rodrigo; García Hermoso, Antonio; López Gil, José Francisco; Ciencias de la Salud; Osasun Zientziak
Physical fitness, particularly cardiorespiratory fitness, has been shown to positively impact sleep quality. However, the relation-ship between overall physical fitness and sleep-related problems in adolescents remains underexplored. Therefore, the aim ofthis study was to analyze the association between overall physical fitness and sleep-related problems in adolescents. This cross-sectional study included 812 adolescents (median age: 14 years [interquartile range = 12–17]; 54.9% girls) from the Eating Healthyand Daily Life Activities (EHDLA) data. Physical fitness was measured objectively using the Assessing the Levels of PHysicalActivity and fitness (ALPHA-Fit) battery for children and adolescents and a flexibility test, while sleep-related problems wereevaluated using the BEARS sleep screening tool (B = Bedtime problems, E = Excessive daytime sleepiness, A = Awakenings dur-ing the night, R = Regularity and duration of sleep, S = Snoring). Generalized linear models were used to examine the associationof overall physical fitness with the different components of sleep-related problems. The odds of experiencing sleep-related prob-lems decreased significantly with each kilogram increase in handgrip strength (odds ratio [OR] = 0.97, 95% confidence interval[CI] 0.94–0.99), and with each standard deviation increase in overall physical fitness (OR = 0.76, 95% CI 0.59–0.99). In contrast,despite not statistically significant, an increase in long jump appeared to reduce the sleep-related problems (OR = 0.91; 95% CI0.82–1.02), while a longer time in the 4×10-m shuttle run test might increase sleep problems (OR = 1.12; 95% CI 0.98–1.28). Inconclusion, greater levels of physical fitness, particularly muscular strength, may be key for reducing sleep-related problems,emphasizing the importance of personalized training programs.
Open Access
Incidence of type 1 diabetes mellitus in children and adolescents under 20 years of age across 55 countries from 2000 to 2022: a systematic review with meta-analysis
(Wiley, 2023) Hormazábal Aguayo, Ignacio; Ezzatvar, Yasmin; Huerta Uribe, Nidia; Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
Aims: the aim of this study was to determine the global incidence of type 1 diabetes mellitus (T1DM) in children and adolescents under 20 years of age from 2000 to 2022. Materials and methods: two reviewers searched three electronic databases (PubMed, Web of Science, and CINAHL) for studies published between January 2000 and November 2022. Pooled estimates of T1DM incidence with a 95% confidence interval (CI) per 100,000 person-years were calculated by country/region, sex, age, and COVID-19 pandemic period (pre-COVID-19 and pandemic). Results: the study included 126 studies from 55 countries and 18 regions. The incidence rate (IR) of T1DM from 2000 to 2022 was 14.07 (95%CI, 12.15-16.29) per 100,000 person-years. Finland and high-income North America had the highest IR, with 56.81 (95%CI, 55.91-57.73) and 28.77 (95%CI, 26.59-31.13) per 100,000 person-years, respectively. The IR was 13.37 (95%CI, 10.60-16.88) per 100,000 person-years in boys and 13.87 (95%CI, 11.51-16.70) per 100,000 person-years in girls. There were statistically significant differences among different age ranges: 0-4 versus 5-9 and 10-14 years old (p < 0.001); 5-9 versus 15-19 (p < 0.001) and 10- 14 versus 15-19 years old (p = 0.003). Finally, during the pandemic period (2020-2022), the IR was 24.84 (95%CI, 17.16-35.96) per 100,000 person-years, which was higher but not significant compared with the prepandemic period (2017-2019) of 13.56 (95%CI, 7.49-24.56) per 100,000 person-years (p = 0.090). Conclusions: the IR of T1DM in children and adolescents under 20 years of age is substantial, especially during the pandemic period, although it varies across regions. More reliable data from additional countries are needed to determine the worldwide incidence of T1DM.
Open Access
Tailored exercise is safe and beneficial for acutely hospitalised older adults with COPD
(European Respiratory Society, 2020) Martínez Velilla, Nicolás; Valenzuela, Pedro L.; Zambom Ferraresi, Fabrício; López Sáez de Asteasu, Mikel; Ramírez Vélez, Robinson; García Hermoso, Antonio; Lucía, Alejandro; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
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.