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the aim of this study was to know the attitudes toward the physical activity and sport practice oriented to health in a representative sample of Spanish adolescents. A descriptive cross-sectional study was implemented and the survey about behaviours, attitudes and values related to physical activity and sport practice developed in the AVENA study was used. The sample size was 2859 Spanish students from public and private secondary schools in 5 Spanish cities: Granada, Madrid, Murcia, Santander and Zaragoza. The main results verify that both boys and girls have a greater orientation towards process-related attitudes (PA) of physical activity and sport that outcome-related attitudes (AR) of the practice. In boys and girls, both AP and AR both genders, there is a progressive decrease when increasing the age. Adolescents who engaged in physical activity had higher levels of attitudes than non-practitioners. In conclusion, AP became more important than AR in young adolescents; both AP and AR were higher in boys than in girls and attitude values decreased with increasing age. The knowledge of attitudes might allow to develop effective and long-term successful intervention programmes for adopting healthy lifestyles in the current young people

Hip fracture results in an older person's loss of independence. Limited healthcare resources make mobile Health (mHealth) an alternative. Engaging key stakeholders in health technology development is essential to overcome existing barriers. The aim of this study was to establish perspectives of older adults with hip fracture, family caregivers and health professionals (stakeholders) on the development of a mHealth system. Qualitative study guided by user-centered design principles with focus groups to engage stakeholders during the development. Seven focus groups were conducted [older adults with hip fracture (n = 2), caregivers (n = 3), and health providers (n = 2)] with 45 participants (14 older adults, 21 caregivers and 10 health providers). Inclusion criteria were older adults ≥ 65 years who sustained a hip fracture in the previous 3 months; family caregiver of a person with hip fracture; and health providers with 2+ years of clinical experience working older adults with hip fracture. We followed standard methods for focus groups, including recording sessions, transcription and conducting an inductive content analysis. The same moderator, with clinical and research experience, conducted all focus groups. Three themes were generated to consider for a future mHealth intervention: (1) user-friendly design; (2) content to include recovery and prevention information; and (3) implementation factors. Our mHealth system was developed based on feedback from participants. Co-creating mHealth technology with stakeholders is essential for uptake and adherence. We provide an overview of the development of ActiveHip+, an mHealth system for the clinical care of older adults with hip fracture. Designing mHealth tools through a co-creation process with the main stakeholders is a way of facilitating the use of health information and communication technology, especially for older adults. Creating a user-friendly and intuitive mobile application is a critical point for a feasible implementation. Including relevant information about the entire process of a hip fracture recovery and an easy way of communicating with health providers are important aspects for patients and caregivers' support. [ABSTRACT FROM AUTHOR]

Introduction: Telerehabilitation has emerged in the last decade as a promising alternative to conduct the rehabilitation process at home. However, there are no studies testing the effects of telerehabilitation interventions for patients with hip fracture on quality of life nor psychological factors, whereas the evidence on fitness level is scarce. Thus, the aim of this study is to test the effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients who had suffered a hip fracture. Methods: The present study is a non-randomized clinical trial that includes patients older than 65 years old with a hip fracture and their family caregivers (ClinicalTrials.gov; Identifier: NCT02968589). Per-protocol (64 participants) and intention-to-treat (71 participants) analyses were performed, the first being the main analysis. The intervention group received a home-based multidisciplinary telerehabilitation intervention, called @ctivehip, that lasted 12 weeks. The control group received the traditional care and rehabilitation provided by the Andalusian Public Health Care System. The outcomes measured were the patients' quality of life through the EuroQol Quality of Life Questionnaire (EQ-5D), physiological factors (anxiety and depression) using the Hospital Anxiety and Depression Scale (HADS) and the fitness level, assessed with the International Fitness Scale. Results: The quality of life of the telerehabilitation group increased, while the control group scored worsened at the 3-month follow-up (medium effect size: 0.66 SDs; p = 0.006). The telerehabilitation group demonstrated a greater decrease than the control group in the total HADS score (medium effect size: −0.50 SDs; p = 0.015). Lastly, the telerehabilitation group recovered a fitness level close to the pre-hip fracture in comparison with the control group (small effect size: 0.49 SDs; p = 0.022). Discussion: The @ctivehip telerehabilitation program seems to be a promising treatment to improve the quality of life and psychological factors (i.e. anxiety and depression) of older adults after a hip fracture, as well as to recover their previous fitness level. [ABSTRACT FROM AUTHOR]

Telerehabilitation interventions administered via a smartphone may provide new feasible and effective rehabilitation options at home for patients with hip fracture. However, to date, no such interventions have been shown to be effective in the recovery key health outcomes of these patients. The present multicentre randomized controlled trial (RCT) aims to test the effect of the ActiveHip+ m‐Health system in the recovery of physical performance, functional level, quality of life, and other health‐related outcomes in both patients with hip fracture and their family caregivers. A total of 104 patients older than 65 years, with hip fracture, and their family caregivers will be randomized into the ActiveHip+ rehabilitation (N = 52) or the control group (N = 52). ActiveHip+ is a 12‐week smartphone‐based rehabilitation program conducted in Granada and Cádiz (Spain) that includes: (1) 24 sessions of physical exercise and 12 sessions of occupational therapy; (2) seven educational modules for patients and for caregivers; and (3) general recommendations in activities of daily living. The control group will receive the usual rehabilitation protocol offered by the Andalusian Public Healthcare System. The primary outcome is the patient's physical performance, while the secondary outcomes are the patient's functional level, quality of life, pain, fear of falling, fitness perception, pre‐fracture functional level, emotional status, and caregiver burden. The present project will substantially contribute to the existing knowledge by testing for the first time the efficacy and feasibility of a multidisciplinary m‐Health system in the rehabilitation of patients with hip fracture. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to 1) analyze the criterion validity of the Slaughter equations (Slg-Eq) and bioelectrical impedance analysis (BIA) to estimate body fat percentage (BFP) and fat mass index (FMI) at different degrees of obesity in children compared with dual-energy x-ray absorptiometry (DXA) and 2) determine their agreement over time.Methods: Ninety-two children with overweight or obesity (10.0 [SD 1.2] years; 34.8% girls) participated in this 20-week study. Anthropometric, BIA, and DXA measurements were performed.Results: Both Slg-Eq and BIA methods underestimated BFP and FMI against DXA, and the bias was markedly larger with BIA (mean absolute percentage error = 11% for Slg-Eq vs. 18%-21% for BIA); a larger underestimation was observed in girls compared with boys for Slg-Eq (P ≤ 0.001), and the observed underestimation in adiposity was reduced as weight status increased. Systematic errors were kept constant over time, so no large differences between methods were observed in the change in adiposity.Conclusions: At the group level, Slg-Eq provides a more valid estimation of BFP and FMI than BIA. At the individual level, Slg-Eq shows larger estimation errors. The validity of these methods might differ in sex and weight status. Nevertheless, both methods seem to be valid for monitoring changes in adiposity. [ABSTRACT FROM AUTHOR]

A few studies have recently reported that higher cardiorespiratory fitness is associated with higher volumes of subcortical brain structures in children. It is, however, unknown how different fitness measures relate to shapes of subcortical brain nuclei. We aimed to examine the association of the main health-related physical fitness components with shapes of subcortical brain structures in a sample of forty-four Spanish children aged 9·7 (sd 0·2) years from the NUtraceuticals for a HEALthier life project. Cardiorespiratory fitness, muscular strength and speed agility were assessed using valid and reliable tests (ALPHA-fitness test battery). Shape of the subcortical brain structures was assessed by MRI, and its relationship with fitness was examined after controlling for a set of potential confounders using a partial correlation permutation approach. Our results showed that all physical fitness components studied were significantly related to the shapes of subcortical brain nuclei. These associations were both positive and negative, indicating that a higher level of fitness in childhood is related to both expansions and contractions in certain regions of the accumbens, amygdala, caudate, hippocampus, pallidum, putamen and thalamus. Cardiorespiratory fitness was mainly associated with expansions, whereas handgrip was mostly associated with contractions in the structures studied. Future randomised-controlled trials will confirm or contrast our findings, demonstrating whether changes in fitness modify the shapes of brain structures and the extent to which those changes influence cognitive function. [ABSTRACT FROM AUTHOR]

Summary Background & aim A diet quality index (DQI) is a tool that provides an overall score of an individual's dietary intake when assessing compliance with food-based dietary guidelines. A number of DQIs have emerged, albeit their associations with health-related outcomes are debated. The aim of the present study was to assess whether adherence to dietary intervention, and the overall quality of the diet, can predict body composition changes. Methods To this purpose, overweight/obese adolescents (n = 117, aged: 13–16 years; 51 males, 66 females) were recruited into a multi-component (diet, physical activity and psychological support) family-based group treatment programme. We measured the adolescents' compliance and body composition at baseline and after 2 months (intensive phase) and 13 months (extensive phase) of follow-up. Also, at baseline, after 6 months, and at the end of follow-up we calculated the DQI. Results Global compliance with the dietary intervention was 37.4% during the intensive phase, and 14.3% during the extensive phase. Physical activity compliance was 94.1% at 2-months and 34.7% at 13months and psychological support compliance were growing over the intervention period (10.3% intensive phase and 45.3% during extensive phase). Adolescents complying with the meal frequency criteria at the end of the extensive phase had greater reductions in FMI z-scores than those did not complying (Cohen's d = 0.53). A statistically significant association was observed with the diet quality index. DQI-A variation explained 98.1% of BMI z-score changes and 95.1% of FMI changes. Conclusions We conclude that assessment of changes in diet quality could be a useful tool in predicting body composition changes in obese adolescents involved in a diet and physical activity intervention programme backed-up by psychological and family support. [ABSTRACT FROM AUTHOR]

Home‐based tele‐rehabilitation programs are under development and may be a future option for some patients. The objectives of this non‐randomized clinical trial are to design a home‐based multidisciplinary tele‐rehabilitation protocol for patients with hip fracture, and to compare this protocol versus the home‐based usual outpatient rehabilitation protocol. Seventy patients treated for an acute hip fracture, aged 65 years or older, with a high pre‐fracture functional level (Functional Independence Measure score >90), without severe cognitive impairment, absence of terminal disease, discharged to their own home or a relativés home postoperatively, allowed weight‐bearing, and with signed informed consent, will be allocated into a tele‐rehabilitation group (n = 35) or a control group (n = 35). The inclusion criterion for the intervention group will be to have a caregiver with the ability to access the Internet who is willing to perform exercises and activities with the patient at home. The intervention includes a program of physical exercise and occupational therapy (five weekly sessions during 12 weeks), and recommendations for patients and their caregivers, all delivered through a website. The patient's functional level (Functional Independence Measure), quality of life (Euro‐Qol), physical performance (Timed Up and Go), caregiver burden (Zarit Interview), and other descriptive data will be assessed at hospital discharge, 4 weeks, and 12 weeks. This project will add to the knowledge concerning the feasibility of tele‐rehabilitation as an option to promote recovery of the pre‐fracture functional level for some patients with a hip fracture. ClinicalTrials.gov Identifier: NCT02968589NCT. [ABSTRACT FROM AUTHOR]

This study aimed to describe morphological characteristics of elite female volleyball players from the highest Spanish league, with special focus on differences by performance level and playing positions. Nearly all female players playing in the highest Spanish volleyball league during season 2003/2004 participated in this study (N=148 elite players, 92% of the total). Anthropometric, body composition and somatotype parameters according to performance and playing positions were analysed. The players’ characteristics were as follows; body mass 72.3±8.4 kg; stature 179.8±7.1 cm; body fat 24.0±3.1% and skeletal muscle mass 27.3±2.9 kg. Mean somatotype was 3.1±0.7; 3.4±0.9; 3.1±0.9 characterised as central with a tendency to balanced mesomorph. Top level players (whose teams were better classified in the team performance ranking) were taller, had higher skeletal muscle mass and ectomorphy, and had a lower level of adiposity markers, compared with lower level players. Players selected for their respective National teams (individual performance) were taller, heavier, had higher muscle mass and lower endomorphy than non-selected players. Differences according to playing positions were found. This study provides a complete set of reference data on anthropometry, body composition and somatotype of elite female volleyball players. Morphological differences have been identified according to performance level and playing position. [ABSTRACT FROM AUTHOR]

High physical fitness in childhood and adolescence is positively associated with favourable health-related outcomes. Our aim was to examine the relationship between relatives’ (father, mother, brother, sister, and best friend) physical activity engagement and encouragement on adolescents’ physical fitness. Adolescents were part of the HELENA study, a multi-centre study conducted in 10 cities from nine European countries in 2006–2008. Participants were 3288 adolescents (48% boys, 52% girls) aged 12.5–17.5 years with valid data on at least one of the three fitness variables studied: muscular strength (standing long jump), speed/agility (4×10 m shuttle run), and cardiorespiratory fitness (20 m shuttle run). The adolescents reported their relatives’ physical activity engagement and encouragement. Analysis of covariance showed that relatives’ physical activity engagement (father, mother, brother, and best friend) was positively related to cardiorespiratory fitness (P < 0.05); and mother's and sisters’ physical activity engagement were positively associated with higher muscular strength in adolescents (P < 0.05). Furthermore, father's physical activity encouragement was positively linked to physical fitness (all fitness components) in adolescents (P < 0.05). Interventions aimed at improving physical fitness in young people might be more successful when family members, particularly mothers and fathers, are encouraged to engage in physical activity and support adolescents’ physical activity. [ABSTRACT FROM PUBLISHER]

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Identifying factors related to physical activity levels in young people is important for a more efficient health promotion. The aims of this study were to assess physical activity levels in a national sample of urban Spanish adolescents, and to examine the association between significant others' physical activity (father, mother, brother, sister, and close friends) and that of the adolescents. The present study comprised 2260 adolescents (1157 boys, 1103 girls) aged 13.0-18.5 years participating in the AVENA Study. Both the adolescents' physical activity and that of their relatives and close friends was assessed by questionnaire. The odds of being active were higher in boys than girls (odds ratio = 2.79, 95% confidence interval = 2.34-3.33) and tended to decrease across age groups in both boys and girls. Father's and older brother's physical activity was associated with boys' physical activity, while that of any significant other was associated with girls' physical activity. When both parents reported being active, boys had nearly two times higher odds of being active and girls had nearly three times higher odds of being active. The physical activity levels of Spanish adolescents are in line with those previously reported. Physical activity levels in girls are strongly related to the physical activity of any significant other, whereas physical activity levels in boys are only related to their male relatives' physical activity. [ABSTRACT FROM AUTHOR]

Increasing evidence underscores overlapping neurobiological pathways to addiction and obesity. In both conditions, reward processing of preferred stimuli is enhanced, whereas the executive control system that would normally regulate reward-driven responses is altered. This abnormal interaction can be greater in adolescence, a period characterized by relative immaturity of executive control systems coupled with the relative maturity of reward processing systems. The aim of this study is to explore neuropsychological performance of adolescents with excess weight (n = 27, BMI range 24–51 kg/m2) vs. normal-weight adolescents (n = 34, BMI range 17–24 kg/m2) on a comprehensive battery of executive functioning tests, including measures of working memory (letter-number sequencing), reasoning (similarities), planning (zoo map), response inhibition (five-digit test (FDT)–interference and Stroop), flexibility (FDT–switching and trail-making test (TMT)), self-regulation (revised-strategy application test (R-SAT)), and decision-making (Iowa gambling task (IGT)). We also aimed to explore personality traits of impulsivity and sensitivity to reward. Independent sample t- and Z Kolmogorov–Smirnov tests showed significant differences between groups on indexes of inhibition, flexibility, and decision-making (excess-weight participants performed poorer than controls), but not on tests of working memory, planning, and reasoning, nor on personality measures. Moreover, regression models showed a significant association between BMI and flexibility performance. These results are indicative of selective alterations of particular components of executive functions in overweight adolescents. [ABSTRACT FROM AUTHOR]

Background: Excessive television (TV) viewing might play an important role in the development of cardiovascular disease (CVD). The aim of this study was to examine the independent associations between TV viewing and CVD risk factors in adolescents. Methods: A sample of 425 adolescents, aged 13- to 18.5-year-old, was included in this study. Body mass index (BMI), waist circumference (WC), glucose, total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, apolipoprotein (apo) A-1, apo B-100, and lipoprotein(a) levels were determined. A composite CVD risk score was computed based on age-, sex-, sexual maturation- and race-standardized triglycerides, HDL-cholesterol, LDL-cholesterol and glucose. TV viewing was self-reported. Results: Two hundred and twenty-five adolescents (53%) who spent >3 hrs/day watching TV were considered as the "high TV viewing" group. Ninety-nine adolescents (23%) from the total sample were classified as overweight according to International age- and sex-specific BMI values. The high TV viewing group had significantly less favorable values of HDL-cholesterol, glucose, apo A1 and CVD score, independent of age, sex, sexual maturation, race and weight status. There was a significant interaction effect of TV viewing × weight status (P = 0.002) on WC, and the negative influence of TV viewing on WC persisted in the overweight group (P = 0.031) but was attenuated in non-overweight adolescents (P > 0.05). Conclusion: Excessive TV viewing seems to be related to an unfavorable CVD risk factors profile in adolescence. Reducing TV viewing in overweight adolescents might be beneficial to decrease abdominal body fat. [ABSTRACT FROM AUTHOR]

Background: Excessive television (TV) viewing might play an important role in the development of cardiovascular disease (CVD). The aim of this study was to examine the independent associations between TV viewing and CVD risk factors in adolescents.Methods: A sample of 425 adolescents, aged 13- to 18.5-year-old, was included in this study. Body mass index (BMI), waist circumference (WC), glucose, total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, apolipoprotein (apo) A-1, apo B-100, and lipoprotein(a) levels were determined. A composite CVD risk score was computed based on age-, sex-, sexual maturation- and race-standardized triglycerides, HDL-cholesterol, LDL-cholesterol and glucose. TV viewing was self-reported.Results: Two hundred and twenty-five adolescents (53%) who spent >3 hrs/day watching TV were considered as the "high TV viewing" group. Ninety-nine adolescents (23%) from the total sample were classified as overweight according to International age- and sex-specific BMI values. The high TV viewing group had significantly less favorable values of HDL-cholesterol, glucose, apo A1 and CVD score, independent of age, sex, sexual maturation, race and weight status. There was a significant interaction effect of TV viewing x weight status (P = 0.002) on WC, and the negative influence of TV viewing on WC persisted in the overweight group (P = 0.031) but was attenuated in non-overweight adolescents (P > 0.05).Conclusion: Excessive TV viewing seems to be related to an unfavorable CVD risk factors profile in adolescence. Reducing TV viewing in overweight adolescents might be beneficial to decrease abdominal body fat. [ABSTRACT FROM AUTHOR]

Osteoporotic hip fracture is a major health problem. Falls, the primary cause, might lead to a persistent fear of falling (FoF) among older adults, affecting their daily activities and rehabilitation. While in-person interventions exist, limited research is available on the effects of tele-rehabilitation on the FoF after a hip fracture. Thus, this study aims to test the association of the @ctivehip tele-rehabilitation programme on reducing the levels of FoF experienced by both older adults with hip fracture and their family caregivers.A non-randomised controlled trial (ClinicalTrials.gov; Identifier: NCT02968589) that compared a webpage-based tele-rehabilitation (@ctivehip) against usual care. Fear of falling was assessed using the Short Falls Efficacy Scale-International. Patients’ functional status was evaluated using the Functional Independence Measure. Physical performance was assessed by the Timed Up and Go test and Short Physical Performance Battery. We conducted a per-protocol analysis as the primary outcome, and an intention-to-treat approach as secondary analysis.A total of 71 patients with hip fracture (78.75 ± 6.12 years, 75% women) and their family caregivers participated. Participants in the intervention showed a higher decrease in FoF in comparison to those in the usual care (0.5 Cohen's d; p = 0.042). The reduction in FoF resulting from participation in the tele-rehabilitation programme was mediated by improvements in functional status by 79%. The @ctivehip programme did not decrease FoF of family caregivers.@ctivehip is associated with a reduction of the FoF in older adults with hip fractures, but not in their family caregivers, with the reduction being mostly explained by improvements in the patients’ functional status. Although the intervention seems promising, it should not be applied in clinical settings until confirmed by appropriate-designed randomised clinical trials. [ABSTRACT FROM AUTHOR]

Introduction: the main objectives of weight-loss interventions are to decrease fat mass while maintaining fatfree mass.Objective: our aim was to address effectiveness body composition changes in overweight adolescents assessed by different body composition methods following an obesity intervention programme.Material and Methods: the life-style intervention was multi-disciplinary, with 13 months follow-up. Participants were 13-to-16 year-old overweight, or obese, Spanish adolescents. The adolescents (n = 156; 54.8% females) had body composition measured with anthropometry, dual-energy X-ray absorptiometry and air-displacement plethysmography. All measurements were made at baseline, and after 2- and 13-months. Repeated measures analysis of covariance to compare mean anthropometric changes over time and the Bonferroni correction were applied. Imputation of anthropometric measures was performed.Results: a high significant decrease in fat mass index was achieved in males after 2-and 13-months of intervention as measured by anthropometry (1.16 and 1.56 kg / m2, respectively), X-ray absorptiometry (1.51 and 1.91 kg / m2) and plethysmography (2.13 and 2.44 kg/m2). Moreover, a short and long-term maintenance of fat-and fat-free mass index was observed by X-ray absorptiometry in females (0.94 and 0.68 kg/m2).Conclusion: our multidisciplinary approach to lifestyle intervention has a favourable impact on body fat mass and fat-free mass index as well as waist-to-height ratio, over 13 months intervention in overweight and obese adolescents. [ABSTRACT FROM AUTHOR]

Abstract Background Excessive television (TV) viewing might play an important role in the development of cardiovascular disease (CVD). The aim of this study was to examine the independent associations between TV viewing and CVD risk factors in adolescents. Methods A sample of 425 adolescents, aged 13- to 18.5-year-old, was included in this study. Body mass index (BMI), waist circumference (WC), glucose, total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, apolipoprotein (apo) A-1, apo B-100, and lipoprotein(a) levels were determined. A composite CVD risk score was computed based on age-, sex-, sexual maturation- and race-standardized triglycerides, HDL-cholesterol, LDL-cholesterol and glucose. TV viewing was self-reported. Results Two hundred and twenty-five adolescents (53%) who spent >3 hrs/day watching TV were considered as the "high TV viewing" group. Ninety-nine adolescents (23%) from the total sample were classified as overweight according to International age- and sex-specific BMI values. The high TV viewing group had significantly less favorable values of HDL-cholesterol, glucose, apo A1 and CVD score, independent of age, sex, sexual maturation, race and weight status. There was a significant interaction effect of TV viewing × weight status (P = 0.002) on WC, and the negative influence of TV viewing on WC persisted in the overweight group (P = 0.031) but was attenuated in non-overweight adolescents (P > 0.05). Conclusion Excessive TV viewing seems to be related to an unfavorable CVD risk factors profile in adolescence. Reducing TV viewing in overweight adolescents might be beneficial to decrease abdominal body fat.

We investigated which determinants (socioeconomic, early life factors, body composition changes, fitness changes and/or physical activity changes) best predicted longitudinal outcomes in cardiometabolic risk profile (Z-score change) in adolescents with OW/OB who underwent a 13-month multidisciplinary lifestyle intervention. A total of 165 adolescents (13-16 y; 46% boys) from the EVASYON study were included. Socioeconomic variables and early life factors were obtained from the medical records. Body composition was assessed using anthropometry. Fitness and physical activity were measured with field-based tests and questionnaires. Cardiometabolic risk factors (fasting glucose, HDL cholesterol, triglycerides, blood pressure and waist circumference) were derived from standard methods in the hospital. Body weight changes, sex and mother's education were selected in the stepwise process as the most important determinants of changes in cardiometabolic risk profile (R 2 = 0.26, p = 0.002; R 2 = 0.14, p = 0.013; and R 2 = 0.14, p = 0.017, respectively). Both boys and girls showed a lower cardiometabolic risk score with the reduction in body weight (r = 0.535, p = 0.009 and r = 0.506, p = 0.005, respectively). There was no interaction between sex and body weight change ( p = 0.614). In conclusion, the simple measure of changes in body weight should be considered to track changes in cardiometabolic risk profile in adolescents with OW/OB.