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We aimed (1) to estimate the short-term effect (postintervention period) of neurodynamic techniques on pain, symptom severity, functional status, electrophysiological status, grip strength, and pinch strength in people with carpal tunnel syndrome (CTS); and (2) to estimate the effect of neurodynamic techniques compared to other physical therapy modalities and surgical interventions.Intervention systematic review with meta-analysis.We searched the MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, Physiotherapy Evidence Database, and Scopus databases from their inception to September 2020.We included randomized controlled trials reporting the effect of neurodynamic techniques on pain, symptom severity, function, distal motor latency, grip strength, and pinch strength in people with CTS.Using the DerSimonian-Laird method, we estimated pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of the evidence of each pairwise comparison.There were 22 trials included (n = 1203 people with CTS; mean age, 26.0 to 57.9 years; mean symptom duration, 4.1 to 62.8 months). There was very low-certainty evidence of neurodynamic techniques improving pain (SMD, -0.54; 95% CI: -0.95, -0.13) and function (SMD, -0.35; 95% CI: -0.61, -0.09). There was no significant effect on symptom severity (very low certainty), distal motor latency (very low certainty), and grip and pinch strength (low certainty).Neurodynamic techniques were effective for improving pain and function in people with CTS, albeit with very low-certainty evidence.

This study was supported by the Spanish Ministry of Universities (FPU14/04172, FPU16/01093 and FPU18/03357). This study was partially supported by the University of Granada - Plan Propio de Investigacion 2016 Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES), Plan Propio de Investigacion 2018-Beca de iniciacion a la investigacion para estudiantes de masteres oficiales, and Plan Propio de Investigacion 2019-Programa Contratos-Puente, by the Junta de Andalucia, Consejeria de Conocimiento, Investigacion y Universidad, by the European Regional Development Fund (ERDF), ref. SOMM17/6107/UGR, and by Redes Tematicas de Investigacion Cooperativa RETIC grant Red SAMID RD16/0022., To determine the acute effect of a single high-intensity interval training (HIIT) session on testosterone and cortisol levels in healthy individuals, a systematic search of studies was conducted in MEDLINE and Web of Science databases from inception to February 2020. Meta-analyses were performed to establish the acute effect of HIIT on testosterone and cortisol levels immediately after a single HIIT session; after 30 min and 60 min (primary outcomes); and after 120 min, 180 min, and 24 h (secondary outcomes, only for pre-post intervention groups). Potential effect-size modifiers were assessed by meta-regression analyses and analyses of variance. Study quality was assessed using the Cochrane's risk of bias tool and the Physiotherapy Evidence Database scale. The meta-analyses of 10 controlled studies (213 participants) and 50 pre-post intervention groups (677 participants) revealed a significant increase in testosterone immediately after a single HIIT session (d = 0.92 and 0.52, respectively), which disappeared after 30 min (d = 0.18 and -0.04), and returned to baseline values after 60 min (d = -0.37 and -0.16). Significant increases of cortisol were found immediately after (d = 2.17 and 0.64), after 30 min (d = 1.62 and 0.67) and 60 min (d = 1.32 and 0.27). Testosterone and cortisol levels decreased significantly after 120 min (d = -0.48 and -0.95, respectively) and 180 min (d = -0.29 and -1.08), and returned to baseline values after 24 h (d = 0.14 and -0.02). HIIT components and participant's characteristics seem to moderate the effect sizes. In conclusion, testosterone and cortisol increase immediately after a single HIIT session, then drop below baseline levels, and finally return to baseline values after 24 h. This meta-analysis provides a better understanding of the acute endocrine response to a single HIIT session, which would certainly be valuable for both clinicians and coaches in the prescription of exercise programs to improve health and performance. Testosterone and cortisol may be used as sensitive biomarkers to monitor the anabolic and catabolic response to HIIT., Spanish Ministry of Universities FPU14/04172 FPU16/01093 FPU18/03357, University of Granada - Plan Propio de Investigacion 2016 Excellence actions: Units of Excellence, Unit of Excellence on Exercise and Health (UCEES), Junta de Andalucia, European Commission SOMM17/6107/UGR, Redes Tematicas de Investigacion Cooperativa RETIC grant Red SAMID RD16/0022, University of Granada - Plan Propio de Investigacion 2018-Beca de iniciacion a la investigacion para estudiantes de masteres oficiales, University of Granada - Plan Propio de Investigacion 2019-Programa Contratos-Puente

The purpose of this systematic review was to provide updated evidence synthesis of the effectiveness of exercise training in patients with obesity undergoing bariatric surgery to improve cardio-metabolic risk. We systematically searched the MEDLINE, EMBASE, Scopus, Cochrane, and Web of Science databases. The studies selected were those in which an exercise-based intervention was performed after bariatric surgery, a control group was present, and at least one of the following outcomes was investigated: VO2max or VO2peak, resting heart rate (RHR), blood pressure, lipid profile, glucose, and insulin. The study quality was assessed using the PEDro scale and the data were meta-analyzed with a random effects model, comparing control groups to intervention groups using standardized measurements. Twenty articles were included in the systematic review and fourteen (70%) in the meta-analysis. Significant differences were observed between the control and intervention groups (always in favor of exercise) for absolute VO2max / VO2peak (ES = 0.317; 95% CI = 0.065, 0.569; p = 0.014), VO2max / peak relative to body weight (ES = 0.673; 95% CI = 0.287, 1.060; p = 0.001), HDL cholesterol (ES = 0.22; 95% CI = 0.009, 0.430; p = 0.041) and RHR (ES = -0.438; 95% CI = -0.753, -0.022; p = 0.007). No effects were observed for either systolic or diastolic blood pressure. Exercise training for patients undergoing bariatric surgery appears to be effective in improving absolute and relative VO2max / VO2peak, HDL cholesterol and reducing the RHR. More intervention studies using (better) exercise interventions are needed before discarding their effects on other cardiometabolic risk factors. This systematic review and meta-analysis has been registered in Prospero (CRD42020153398).

Aims Physical exercise has been associated with a reduction in arterial stiffness, a subclinical process underlying cardiovascular disease. However, the effect of different types of exercise (aerobic, resistance, combined, interval training, stretching, or mind–body modalities) on arterial stiffness is unclear. This network meta-analysis aimed to examine the effectiveness of different types of exercise on arterial stiffness as measured by pulse wave velocity in adults. Methods and results We searched Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE (via Pubmed), Embase, and Web of Science databases, for randomized clinical trials including at least a comparison group, from their inception to 30 June 2020. A frequentist network meta-analysis was performed to compare the effect of different types of physical exercise on arterial stiffness as measured by pulse wave velocity. Finally, 35 studies, with a total of 1125 participants for exercise intervention and 633 participants for the control group, were included. In the pairwise meta-analyses, the exercises that improved arterial stiffness were: interval training [effect size (ES) 0.37; 95% confidence interval (CI) 0.01–0.73], aerobic exercise (ES 0.30; 95% CI 0.13–0.48) and combined exercise (ES 0.22; 95% CI 0.04–0.40). Furthermore, the network meta-analysis showed that mind–body interventions were the most effective type of exercise to reduce the pulse wave velocity (ES 0.86; 95% CI 0.04–1.69). In addition, combined exercise (ES 0.35; 95% CI 0.08–0.62), aerobic exercise (ES 0.33; 95% CI 0.09–0.57), and interval training (ES 0.33; 95% CI 0.02–0.64) showed significant improvements. Conclusion Our findings showed that aerobic exercise, combined exercise, interval training, and mind–body exercises were the most effective exercise modalities for reducing arterial stiffness, assuming an important role in the prevention of cardiovascular diseases.

To estimate the comparative effect of open and percutaneous hallux valgus (HV) surgery on patients’ quality of life (QoL) using the American Orthopedic Foot and Ankle Society (AOFAS) scale including total score and individual domains (pain, function, and alignment). MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2020 for studies on the effect of HV surgery on patients’ QoL using the AOFAS score. A standardized mean difference score was calculated on the total AOFAS score and on each AOFAS domain (pain, function, and alignment) using Cohen’s d index. Considering the 53 published studies included, the pooled effect size (ES) estimates for the AOFAS total score were 3.69 (95% CI 3.37–4.01; I2 = 95.5%) for open surgery and 3.40 (95% CI 2.99–3.80, I2 = 88.2%) for percutaneous surgery. The total pooled ES estimate was 3.61 (95% CI 3.35–3.87, I2 = 94.5%). Considering the pain domain, the pooled ES estimates were 2.21 (95% CI 1.98–2.43, I2 = 64%) for open surgery and 2.52 (95% CI 1.83–3.20, I2 = 92.6%) for percutaneous surgery. For the function domain, the pooled ES estimates were 1.37 (95% CI 0.93–1.81, I2 = 91%) for open surgery and 2.28 (95% CI 1.10–3.47, I2 = 96.8%) for percutaneous surgery. Finally, the pooled ES estimates for the alignment domain were 3.99 (95% CI 3.51–4.47, I2 = 85.7%) for open surgery and 2.66 (95% CI 2.23–3.09, I2 = 78.5%) for percutaneous surgery. Our data support that HV surgery increases the total AOFAS score as well as the AOFAS scores by domain (pain, function, and alignment). Furthermore, our data show that HV surgery increases patients’ QoL, after both open and percutaneous surgery, without differences between them.

ObjectiveMyofascial pain syndrome is one of the primary causes of health care visits. In recent years, physical exercise programs have been developed for the treatment of myofascial trigger points, but their effect on different outcomes has not been clarified. Thus, this study aimed to assess the effect of physical exercise programs on myofascial trigger points.MethodsA systematic search was conducted in Pubmed, Web of Science, and Scopus. Articles analyzing the effect of physical exercise programs on pain intensity, pressure pain threshold, range of motion, and disability were included. Risk of bias was assessed using the Cochrane RoB2 tool. The DerSimonian-Laird method was used to compute the pooled effect sizes (ES) and their 95% confidence interval (95% CI) for pain intensity, pressure pain threshold, range of motion, and disability.ResultsA total of 24 randomized controlled trials were included in this systematic review and meta-analysis. The pooled ES were –0.47 (95% CI = –0.61 to –0.33) for pain intensity, 0.63 (95% CI = 0.31 to 0.95) for pressure pain threshold, 0.43 (95% CI = 0.24 to 0.62) for range of motion, and –0.18 (95% CI = –0.45 to 0.10) for disability.ConclusionsPhysical exercise programs may be an effective approach in the treatment of pain intensity, pressure pain threshold, and range of motion among patients with myofascial trigger points.

Background: Motor competence, defined as a person’s ability to execute different motor skills, is directly associated with children’s physical, mental, and social development and may be essential i...

Background and purpose — The quality of life (QoL) of patients with hallux valgus (HV) usually improves postoperatively. Evidence regarding the effect of HV surgery on different domains of patient QoL remains inconclusive. This systematic review and meta-analysis estimates the effect of HV surgery on patient QoL through distinguishing effects on physical domains (comprising physical function and body pain domains) using the EuroQol-5D, short form (SF) health survey-12, and SF-36 QoL scales and a visual analogue scale (VAS) score and mental and social domains using QoL scales. Patients and methods — MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2019 for studies on the effect of HV surgery on patient QoL. A standardized mean difference score was calculated for each specific QoL domain (mental, social, pain, physical, and VAS) using Cohen’s d index. The pooled effect size (ES) was estimated using a random-effects model based on the DerSimonian and Laird method. Results — From 12 published studies selected, the estimated pooled ES for QoL was 1.01 (95% confidence interval [CI] 0.52–1.51; I2 = 87%) for body pain and 0.43 (CI 0.31–0.55, I2 = 35%) for physical function. Regarding the composite mental and social domains of QoL, the pooled ES estimates were 0.24 (CI 0.00–0.47, I2 = 80%) and 0.42 (CI 0.21–0.63, I2 = 6.4%), respectively. The pooled difference in means for the VAS score was –4.1 (CI –4.5 to –3.6, I2 = 90%). Interpretation — Our data showed that HV surgery decreased patients’ perceptions regarding pain. Furthermore, the data confirmed that HV surgery increased patients’ QoL, particularly concerning physical and social domains.

The university stage is a critical developmental period for young adults, where lifestyles can determine future health. A cross-sectional study including 481 college students was conducted, with the following objectives: 1) to examine the prevalence of risk of developing eating disorders in college students, 2) to assess differences in obesity and physical fitness in those with and without risk of eating disorders, and 3) to determine whether cardiorespiratory fitness, muscular fitness or fat mass were associated with the risk of eating disorders. We measured fat mass percentage (by densitometry), risk of feeding or eating disorders (by SCOFF questionnaire), cardiorespiratory fitness levels and a muscular fitness index. The prevalence of risk of eating disorders in women (32.4%) was higher than in men (17.4%) (p

BACKGROUND Exclusive breastfeeding has been examined as a determinant factor of cardiorespiratory fitness in children and adolescents; however, previous research has reported certain gaps and controversial conclusions related to the real effect of breastfeeding on cardiorespiratory fitness. The aim of this systematic review and meta-analysis was to assess the relationship between breastfeeding, in terms of duration and exclusivity, and cardiorespiratory fitness in schoolchildren and adolescents aged four to 18 years. METHODS MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched systematically from their inception to December 2019. Observational studies addressing the association between breastfeeding and cardiorespiratory fitness in children and adolescents were included. The random-effects method was used to estimate the pooled effect sizes and their respective 95% confidence intervals for all exclusive breastfeeding categories and cardiorespiratory fitness. Positive values indicated a direct relationship between exclusive breastfeeding and cardiorespiratory fitness. RESULTS Eight published articles were included (a total of 16 862 children and adolescents, aged from seven to 15 years). The pooled effect sizes for exclusive breastfeeding categories on cardiorespiratory fitness were as follows: 0.01 (-0.07 to 0.09) for less than 3 months; 0.09 (0.00 to 0.19) for 3-6 months; 0.07 (-0.01 to 0.16) for less than 6 months; and 0.14 (0.02 to 0.27) for more than 6 months. CONCLUSIONS The best current evidence indicates that longer exclusive breastfeeding is positively associated with higher cardiorespiratory fitness during childhood and adolescence.

This study aims to quantify the association between aerobic fitness and academic achievement, and determine how different aerobic fitness tests and individual demographic characteristics may modify this association. It includes 41 cross-sectional and 7 longitudinal studies focusing on children and adolescents, from MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database and Web of Science. Pooled effect sizes (ES) were estimated for the association between aerobic fitness and specific domains of academic achievement. Subgroup analyses and meta-regressions were based on aerobic fitness tests and demographic characteristics. The ES for the association between aerobic fitness with language/reading-skills, mathematics-related skills and composite scores, were 0.23 (95% CI: 0.12; 0.34); 0.27 (95% CI: 0.19; 0.36) and 0.28 (95% CI: 0.12; 0.45), respectively. Subgroup analyses by aerobic fitness test modified these associations; additionally, analyses by sex or age showed differences between boys and girls as well as between children and adolescents. Finally, meta-regressions revealed a slight effect of body mass index on these associations. Cardiorespiratory fitness is positively associated with academic achievement. Associations were dependent on demographic and aerobic fitness test characteristics, being stronger in boys than in girls, and in children than in adolescents.

This study examined the association between key components of physical fitness with inhibition and cognitive flexibility in preschoolers. This was a cross-sectional study of 362 Spanish preschoolers. The key components of physical fitness and executive functioning were measured. The partial correlation controlling for body mass index and family socioeconomic status showed that inhibition was positively related to cardiorespiratory fitness. No association was found between muscular strength (i.e., standing long jump and dynamometry) and speed/agility with inhibition or between physical fitness components and cognitive flexibility. The inhibition mean scores were significantly higher in preschoolers with higher cardiorespiratory than in their peers who were in lower categories, after adjustments were made for confounders. Additionally, the results showed that cardiorespiratory fitness was a significant predictor of inhibition, but for cognitive flexibility, age was the only significant predictor. Our data suggest that cardiorespiratory fitness is associated with inhibition in preschoolers. Likewise, our results also suggest that cognitive flexibility is an executive function that is more dependent on changes associated with age at this development stage. These findings are important for supporting initiatives that aimed at stimulating healthy brain development, and promote the improvement of cardiorespiratory fitness at early ages.

OBJECTIVE To synthesize evidence regarding the association between interpregnancy weight change and hypertensive disorders of pregnancy. DATA SOURCES MEDLINE, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov databases were systematically searched from the databases' interception until April 2019. Search strategy included the terms: "interpregnancy," "intergestational," "hypertension" and "hypertensive disorders." METHODS OF STUDY SELECTION Studies that assessed the relationship between interpregnancy weight change and hypertensive disorders of pregnancy were included. Twelve studies and 415,605 women were included in this systematic review and meta-analysis. We used Mendeley reference manager during the review process. Odds ratios (ORs) for the most adjusted models reported by the included articles and the corresponding 95% CIs were calculated. The no weight change category defined by each study was used as the reference category. TABULATION, INTEGRATION, AND RESULTS Overall, there was an increased risk of hypertensive disorders of pregnancy associated with interpregnancy weight gain (OR 1.37; 95% CI 1.21-1.53; I=62.1%; P

OBJECTIVE The HEPAFIT study was aimed at examining the impact of a 6-month physical education intervention, considering various levels of exercise intensity, on hepatic fat and cardiometabolic health outcomes in adolescents with excess adiposity. METHODS Adolescents (n = 120), 11-17 years with excess adiposity by body fat >30%, were randomly assigned to one of the following 4 groups for 6 months: (1) standard physical education lessons, control (CTRL); (2) high-intensity physical education (HIPE); (3) low-to-moderate intensity physical education (LIPE) and (4) combined HIPE and LIPE (PLUS). The primary outcome was hepatic fat content measured by vibration-controlled transient elastography (controlled attenuation parameter [CAP]). Secondary outcomes were traditional cardiovascular health markers (body composition, serum lipids, aminotransferases and health-related physical fitness components). RESULTS Adjusted mixed effects linear models revealed a significant decrease in CAP levels in HIPE (-20.02 dB/m, p

CONTEXT High-intensity interval training (HIIT) has been widely used to prevent and treat cardiovascular risk factors in adolescents and adults; nevertheless, the available evidence in children is scarce. OBJECTIVE To synthesize evidence regarding the effectiveness of HIIT interventions on improving cardiovascular risk factors and cardiorespiratory fitness (CRF) in children from 5 to 12 years old. DATA SOURCES We searched 5 databases, Medline, Embase, SPORTDiscus, the Cochrane Library, and Web of Science. STUDY SELECTION Randomized controlled trials (RCTs) evaluating the effectiveness of HIIT interventions on cardiometabolic risk factors and CRF in children were included. DATA EXTRACTION Meta-analyses were conducted to determine the effect of HIIT on body composition, cardiometabolic and CRF variables in comparison with nontraining control groups. RESULTS A total of 11 RCTs and 512 participants were included. The results of the meta-analysis revealed a significant improvement in peak oxygen uptake (standardized mean difference [SMD] = 0.70, 95% confidence interval [CI] = 0.28 to 1.12; P = 0.001], in total cholesterol [SMD = −1.09, 95% CI = −1.88 to −0.30; P = 0.007], in low-density lipoprotein cholesterol [SMD = −1.28, 95% CI = −2.34 to −0.23; P = 0.017] and triglycerides [SMD = −0.71, 95% CI = −1.15 to −0.28; P = 0.001) levels. LIMITATIONS Because of the small number of available RCTs, it was not possible to conduct a subgroup analysis or a linear meta-regression analysis. CONCLUSIONS HIIT is a feasible and time-efficient approach for improving CRF, total cholesterol, low-density lipoprotein cholesterol, and triglycerides levels in children.

IntroductionMonitoring type 1 diabetes (T1D) trends across most European countries using objectively measured data and how this incidence has evolved over the past three decades should be considered a public health priority. This study protocol provides a standardised and transparent methodology to assess TD1 trends among 0–14-year-old children and adolescents across Europe from 1994 to 2021.Methods and analysisThis protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the Cochrane Collaboration Handbook. The literature search will be conducted using MEDLINE, Embase, CINAHL and Web of Science databases from 1994 to 2021. Observational cohort studies providing incidence rates for European children and adolescents diagnosed with T1D aged ≤14.9 years and studies written in English, Spanish or Portuguese will be included. The risk of bias of the included studies will be assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the National Heart, Lung, and Blood Institute. Subgroup analyses will be performed based on gender, age, study year, country or European region. Metaregression analysis will be conducted using economic and geographic variables, such as gross national income of the country or geographic latitude.Ethics and disseminationThe systematic review based on this protocol will provide a comprehensive description of T1D incidence trends in children and adolescents across Europe from 1994 to 2021. The results will be disseminated in a peer-reviewed journal and in mass media. This study will exclusively use data from published research, so institutional ethical approval is not required.PROSPERO registration numberCRD42021239480.

Context Egg consumption is one of the main dietary sources of cholesterol, but whether individuals who eat more eggs have a worse blood lipid profile remains controversial. Objective We examined the relationship between egg consumption and lipid parameters and explored whether this relationship changes according to the presence of chronic metabolic disorders. Methods A multicenter cross-sectional study was conducted with adult participants in the EVIDENT II trial. Adjusted linear regression models were stratified by the main chronic metabolic disorders. Results Among the 728 participants (61.9% women, mean age 52.1 ± 11.9 years), the mean egg consumption was equivalent to 5 to 6 eggs per week for a 70-kg individual. In the fully adjusted analysis, no association was found of egg consumption with total and high-density lipoprotein cholesterol (HDL-c), and triglyceride levels. Furthermore, compared with the first quartile of consumption, the fourth quartile was associated with lower low-density lipoprotein cholesterol (LDL-c) levels (coefficient –7.01; 95% CI –13.39, –0.62) and a lower LDL-c/HDL-c ratio (coefficient –0.24, 95% CI –0.41, –0.06). In the analyses stratified by chronic metabolic diseases, higher egg consumption was not associated with lipid profile in those with obesity, hypertension, type 2 diabetes, dyslipidemia, or treated with hypolipidemic drugs, and was associated with a better lipid profile in participants without these conditions. Conclusion Higher egg consumption was not associated with blood lipids in individuals with chronic metabolic disorders. In individuals without such conditions, the lipid profile was better among those who consumed more eggs. Our findings support current guidelines recommending eggs as part of a healthy diet.

Background Although the pharmacological approach may help with motor symptoms in Parkinson's disease (PD), they are clearly not the complete solution. Thus, for the treatment of PD motor symptoms, physical activity has been proposed as an effective intervention. Methods A systematic search in MEDLINE, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials databases was conducted to identify randomized controlled trials testing the effectiveness of exercise interventions on motor symptoms of PD. Physical exercise interventions were divided into 9 categories: endurance, resistance, combined, balance, dance, alternative exercises, body weight supported, sensorimotor interventions including endurance exercise, and sensorimotor interventions not including endurance exercise. A pairwise meta-analysis for direct and indirect comparisons between intervention and control/nonintervention groups was carried out. Results Fifty-six studies met the inclusion criteria, including 2740 participants, aged between 57.6 and 77.7 years. Results of our analyses showed that sensorimotor training including endurance (effect size [ES]-1.09; 95% confidence interval [CI], -1.68 to -0.50), resistance (ES-0.82; 95% CI, -1.23 to -0.41), and dance (ES-0.64; 95% CI, -1.24 to -0.05) were the most effective physical activity interventions for mitigating PD motor symptoms. Conclusion Physical activity interventions are an effective strategy for the management of motor symptoms in patients with PD. Among the different exercise intervention programs, those including more complex and demanding activities (sensorimotor training including endurance, resistance, and dance) seem to be the most effective physical activity interventions.

Context It seems that nut consumption does not lead to weight gain in the general population. However, fewer studies have explored this relationship in individuals with type 2 diabetes (T2D). Purpose To synthesize evidence on the effects of nut (specifically, tree nuts and peanuts) consumption on adiposity-related measures in individuals diagnosed with T2D. Data Sources and Study Selection Four databases were searched up to December 31, 2020. Randomized controlled trials that examined the effects of nut consumption vs a control diet on body weight, body mass index, waist circumference, and percent body fat were included. Data Extraction The pooled effect sizes (p-ESs) and 95%CIs of nut consumption were estimated using random effects models. Data Synthesis A total of 15 randomized controlled trials including 899 individuals were included. No significant effects of nut-enriched interventions were found for body weight (p-ES = −0.04; 95%CI: −0.16 to 0.08), body mass index (p-ES = −0.05; 95%CI: −0.17 to 0.08), waist circumference (p-ES = −0.02; 95%CI: −0.20 to 0.15), or percent body fat (p-ES = −0.03; 95%CI: −0.28 to 0.21). Conclusion Nut consumption has no effect, positive or negative, on weight or adiposity parameters in people with T2D.

Being overweight is associated with pregnancy-related disorders such as gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and excessive maternal weight gain (MWG). Exercise and metformin reduce the risk of these disorders. This network meta-analysis (NMA) aims to compare the effect of metformin and different types of exercise (aerobic, resistance and combined) on the risk of GDM, HDP, and MWG among overweight/obese pregnant women. Medline, EMBASE, Web of Science and Cochrane Library were searched from inception to June 2021. Meta-analyses and NMAs were performed. Sixteen randomized controlled trials were included. In the NMA, aerobic exercise showed an effect on GDM (RR = 0.51, 95% CI = 0.26, 0.97), and metformin a reduction in MWG (MWG = −2.93 kg, 95% CI = −4.98, −0.87). No intervention showed any effect on the reduction of HDP. Our study suggests that aerobic exercise may have the greatest effect in reducing the risk of GDM, and perhaps, the MWG. Strategies should be developed to increase adherence to this type of intervention among overweight women without contraindications. Although metformin could reduce MWG, medicalization of pregnancy in healthy women is not justified with the present results. More research is needed on the effect of the intensity and frequency of exercise sessions and the length of interventions.

Objective Patients with myofascial trigger points (MTPs) frequently manifest restricted range of motion (ROM) during physical evaluation. Multiple manual therapy interventions have been developed for the treatment of MTPs, but their effect on ROM has not been clarified through a systematic review and meta-analysis. Thus, this systematic review aimed to assess the effect of manual therapy interventions on ROM among individuals with MTPs. Methods A systematic search was conducted in PubMed, Web of Science, Cochrane, Scopus, and Clinical Trials.gov. Articles analyzing the effect of manual therapy interventions on ROM were included. The risk of bias was assessed with the Cochrane Risk of Bias (RoB) 2 tool. The DerSimonian-Laird method was used to compute the pooled effect size (ES) and its 95% confidence interval (95% CI) for ROM. Results A total of 13 randomized controlled trials were included in this systematic review and meta-analysis. The pooled ES for ROM was 0.52 (95% CI: 0.42–0.63). The pooled ES for ROM evaluated in centimeters was 0.36 (95% CI: 0.14–0.59), and the pooled ES for ROM evaluated in degrees was 0.57 (95% CI: 0.47–0.68). Conclusion Manual therapy interventions may be an effective approach for improving ROM among individuals with MTPs.

The main objective of this study was to estimate the association between nut consumption and body composition-related measures and to examine whether this relationship is mediated by cardiorespiratory fitness (CRF) and the muscle strength index (MSI) in young adults. A cross-sectional study involving college students (n = 354) aged 18–30 years from a Spanish public university was conducted. Body composition and fitness components were assessed using standard methods. Nut consumption was evaluated using a Food-Frequency Questionnaire. ANCOVA models were used to assess the mean differences in physical fitness and body composition by nut consumption categories. Hayes’s PROCESS macro was applied for mediation and interaction analyses adjusted for the main confounders. Young adults with high nut consumption (≥5 portions of 30 g/week) showed significantly higher values of physical fitness components and fat-free mass and lower values of adiposity-related measures than their peers in the lowest categories of nut consumption (˂1 portion/week) (p &lt, 0.05). No significant interaction between CRF and nut consumption on body composition was found. In the mediation analysis, CRF and MSI acted as full mediators of the relationship of nut consumption with fat-free mass and waist circumference/height index. Otherwise, CRF and MSI partially mediated the relationship between nut consumption and body mass index and percent of fat mass. Finally, nut consumption, per se, does not appear to have a significant impact on body composition indicators because these associations have been shown to be partially (for BMI and %BF) or entirely (for ratio WC/height and fat-free mass) explained by CRF and MSI.

To jointly assess the safety and effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on cardiorenal outcomes and all-cause mortality in type 2 diabetes mellitus (T2DM) with or at high risk of cardiovascular disease (CVD). We performed a systematic review and network meta-analysis, systematically searching the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science databases up to September 2020. Primary outcomes were composite major adverse cardiovascular events (MACEs), hospitalization for heart failure, all-cause mortality and a composite renal outcome. We performed a random effects network meta-analysis estimating the pooled hazard ratio (HR), risk ratio and number needed to treat (NNT). Six trials evaluating empagliflozin, canagliflozin, dapagliflozin and ertugliflozin met the inclusion/exclusion criteria, which comprised 46,969 patients, mostly with established CVD. Pooled estimates (95% CI) of benefits of SGLT2i in terms of HR and NNT were as follows: for all-cause mortality, 0.85 (0.75, 0.97) and 58 (28, 368); for MACE, 0.91 (0.85, 0.97) and 81 (44, 271); for hospitalization for heart failure, 0.70 (0.62, 0.78) and 32 (20, 55); and for composite renal outcome, 0.61 (0.50, 0.74) and 20 (11, 44). Pooled estimates for serious adverse events were 0.92 (95% CI 0.89, 0.95). In patients with T2DM at cardiovascular risk, ertugliflozin is a less potent drug than empagliflozin, canagliflozin or dapagliflozin to prevent cardiorenal events and all-cause mortality. In addition, our data endorse that empagliflozin is the best treatment option among SGLT2i for this type of patient, but the evidence is not consistent enough.

The network meta-analysis and systematic review conducted aim to comparatively assess the effects of tree nuts and peanuts on body weight (BW), body mass index (BMI), waist circumference (WC), and body fat percentage (BF%). A systematic search up to 31 December 2020 was performed. A random-effects network meta-analysis was conducted following the PRISMA-NMA statement. A total of 105 randomized controlled trials (RCTs) with measures of BW (n = 6768 participants), BMI (n = 2918), WC (n = 5045), and BF% (n = 1226) were included. The transitivity assumption was met based on baseline characteristics. In the comparisons of nut consumption versus a control diet, there was no significant increase observed in any of the adiposity-related measures examined except for hazelnut-enriched diets, which raised WC. Moreover, almond-enriched diets significantly reduced WC compared to the control diet and to the pistachio-, mixed nuts-, and hazelnut-enriched diets. In subgroup analyses with only RCTs, designed to assess whether nut consumption affected weight loss, almonds were associated with reduced BMI and walnuts with reduced %BF. The evidence supports that: (1) tree nut and peanut consumption do not influence adiposity, and (2) compared to a control diet, the consumption of almond-enriched diets was associated with a reduced waist circumference.

Background Hallus valgus (HV) negatively impacts health-related quality of life (HRQoL). Patient-reported outcome measures (PROMs) are increasingly used in clinical studies of the foot and ankle. We aimed to evaluate the effect of HV surgery on PROMs (i.e., pain scales, general HRQoL, and region-specific scales) and radiological angles. Additionally, we aimed to determine whether the effect on these outcomes depends on the type of surgery (including open and percutaneous techniques) and if it is influenced by potential confounding factors (i.e., age, HVA, 1–2 IMA, body mass index (BMI), and distal metatarsal articular angle (DMAA). MethodsThis was a longitudinal prospective study. We collected the clinical data of all patients who underwent surgery for symptomatic HV deformity in the orthopedic department of the Virgen de la Luz Hospital of Cuenca (Spain).The clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Hallux metatarsophalangeal-interphalangeal (HMI) scale, visual analogue scale (VAS), Manchester Oxford foot questionnaire (MOXFQ), short form health survey (SF-12) and European Quality of Life-5 Dimensions (EQ-5D). ResultsA total of 72 patients (70 women, 97.2%) were included in the study 72 (72 feet).The AOFAS pre–post-surgery score changed from 42.16 (SD: 10.11) to 83.31 (SD: 6.23). Considering AOFAS domains, the pre–post change was from 14.17 (SD: 9.15) to 33.19 (SD: 4.69) for pain, from 27.22 (SD: 3.90) to 37.94 (SD: 2.78) for function, and from 0.78 (SD: 2.38) to 12.18 (SD: 3.45) for alignment. For other clinical outcomes was VAS score from 5.01(SD: 1.26) to 1.26 (SD: 0.96) and MOXFQ score from 61.44 (SD: 7.09) to 12.35 (SD: 4.85). SF-12 (physical) changed from 36.26 (SD: 5.32) to 47.06 (SD: 4.82), SF-12 (mental) from 38.23 (SD: 8.04) to 46.49 (SD: 4.16), and EQ5-D from 0.64 (SD: 0.008) to 0.90 (SD: 0.10). ConclusionsOur data confirmed the improvements in the clinical and radiological outcomes after HV surgery, and provided some evidence of these improvements not depending on the type of surgery or on some potential confounding factors such as BMI, HVA, 1–2 IMA, and DMAA.

BackgroundThe ageing population brings about the appearance of age-related health disorders, such as osteoporosis or osteopenia. These disorders are associated with fragility fractures. The impact is greater among postmenopausal women due to an acceleration of bone mineral density (BMD) loss.ObjectiveTo estimate the effectiveness of Pilates or Yoga on BMD in adult women.MethodsFive electronics databases were searched up to April 2021. Randomized controlled trials (RCTs), non-RCTs and pre-post studies were included. The main outcome was BMD. Risk of bias was evaluated using the Cochrane risk of bias tool. A random effects model was used to pool data from primary studies. Subgroup analyses based on the type of exercise were conducted.ResultsEleven studies including 591 participants aged between 45 and 78 years were included. The mean length of the interventions ranged from 12 to 32 weeks, and two studies were performed for a period of at least one year. The pooled effect size for the effect of the intervention (Pilates/Yoga) vs the control group was 0.07 (95% Confidence interval [CI]: -0.05 to 0.19; I2= 0.0%), and 0.10 (95% CI: 0.01 to 0.18; I2= 18.4%) for the secondary analysis of the pre-post intervention.ConclusionsDespite of the non-significant results, the BMD maintenance in the postmenopausal population, when BMD detrimental is expected, could be understood as a positive result added to the beneficial impact of Pilates-Yoga in multiple fracture risk factors, including but not limited to, strength and balance.

Background Cardiorespiratory fitness is a strong predictor of all-cause morbidity and mortality; nevertheless, the association between cardiorespiratory fitness and the risk of cancer remains unclear. Thus, the aim of this study was to synthetize the evidence on the relationship between cardiorespiratory fitness and the risk of several sites of cancer in men. Methods A computerised search in MEDLINE, EMBASE and Web of Science databases from their inception to 13th February 2019 was performed. Both fixed and random-effects models were used to calculate the pooled hazard ratio (HR) estimates and their 95% confidence intervals (CIs) to examine the effect of high and moderate versus low cardiorespiratory fitness on site-specific cancer (lung, colon/rectum, prostate) and all-sites cancer. Results Ten studies were included in the qualitative review, and seven of them were included in the meta-analysis. Using low cardiorespiratory fitness as the reference group, moderate and high levels of cardiorespiratory fitness were associated with a lower risk (HRs) of lung cancer, 0.53 (95% confidence interval [CI], 0.39 to 0.68) and 0.52 (95% CI, 0.42 to 0.61); colorectal cancer, 0.74 (95% CI, 0.55 to 0.93) and 0.77 (95% CI, 0.62 to 0.92) and all cancer sites, 0.86 (95% CI, 0.79 to 0.93) and 0.81 (95% CI, 0.75 to 0.87), respectively. Conclusions Among men, cardiorespiratory fitness plays an important role in protecting against the risk of lung and colorectal cancer. Additionally, this protective effect was observed for all-sites cancer risk. These results show the importance of good cardiorespiratory fitness as a potential factor in cancer prevention.

The effect of dairy product consumption on health has received substantial attention in the last decade. However, a number of prospective cohort studies have shown contradictory results, which causes uncertainty about the effects of dairy products on health. We conducted an overview of existing systematic reviews and meta-analyses to examine the association between dairy product consumption and all-cause mortality risk. A literature search was conducted in MEDLINE (via PubMed), EMBASE, the Cochrane Central Database of Systematic Reviews, and the Web of Science databases from their inception to April, 2018. We evaluated the risk of bias of each study included using the AMSTAR 2 tool. The risk ratios (RRs) for each meta-analysis were displayed in a forest plot for dose-response and for high compared with low dairy consumption. The initial search retrieved 2154 articles; a total of 8 meta-analyses were finally included after applying the inclusion and exclusion criteria. The number of included studies in each meta-analysis ranged from 6 to 26 cohort studies, which reported data from 6-28 populations. The sample sizes varied across studies from 24,466 participants reporting 5092 mortality cases to 938,817 participants reporting 126,759 mortality cases. After assessing the risk of bias, 25% of the studies were categorized as acceptable, 25% as good, and 50% as very good. The RRs reported by the meta-analyses ranged from 0.96 to 1.01 per 200 g/d of dairy product consumption (including total, high-fat, low-fat, and fermented dairy products), from 0.99 to 1.01 per 200-244 g/d of milk consumption, and from 0.99 to 1.03 per 10-50 g/d of cheese consumption. The RR per 50 g/d of yogurt consumption was 0.97 (95% CI: 0.85, 1.11). In conclusion, dairy product consumption is not associated with risk of all-cause mortality. This study was registered in PROSPERO as CRD42018091856.

Health-related quality of life (HRQOL) in childhood is defined as an individual’s subjective perception of the impact of health status on physical, psychological and social functioning. Nowadays, measuring of HRQOL has become an important outcome indicator in evaluating health-care. However, in younger children, the role of cardiorespiratory and other physical fitness components on HRQOL is unclear. The aims of this study were to analyse the association between components of physical fitness and HRQOL, as well as to determine which component of physical fitness was the best predictor of higher HRQOL. This was a cross-sectional study of 1413 schoolchildren (4 to 7 years old) from Spain. HRQOL was evaluated with the KINDL-R questionnaire for parents. Cardiorespiratory fitness, muscle strength and speed-agility were assessed using the ALPHA-Fitness battery. ANCOVA models were used to assess differences in HRQOL across physical fitness categories, controlling for age and BMI, by gender. Multiple linear regression was used to determine the independent association between the different physical fitness components and HRQOL. Children with high physical fitness levels had better scores in physical well-being, school and total HRQOL score than those who had low physical fitness levels. The best predictor of HRQOL (total score) was muscular strength in boys and speed-agility among girls. Children with high physical fitness levels have higher HRQOL, although the association between components of physical fitness and HRQOL varies according to gender. Improving physical fitness could be a good strategy for improving HRQOL in children.

Although physical activity (PA) integrated in schools’ classrooms have shown a positive effect on children’s behaviors, its effectiveness on cognitive functions, PA levels and other health variables remains unclear. This article outlines the rationale and methods of two classroom-based PA interventions (MOVI-da10!) on improving adiposity, executive function and motor competence in preschool children. A three-arm cluster-randomized controlled trial (RCT) was carried out including eight schools (rural and urban areas) from Cuenca province, Spain. The schools were allocated to one of three groups: MOVI-da10-Enriched! intervention (n = 3), MOVI-da10-Standard! intervention, (n = 2), and the control group (n = 3). Around 900 children aged 4 to 6 years old were assesed at baseline (September 2017) and at the end (June 2018) of the intervention. The primary outcomes were changes in body fat by bioimpedance, executive function and motor competence. During a school year (from October 2017 to May 2018), children belonging to the MOVI-da10-Enriched! group performed enriched PA integrated into the academic curriculum including two active breaks lasting 10 min, 5 days/week. The children belonging to the MOVI-da10-Standard! group performed PA breaks (with low cognitive demand, where curricular contents were not reinforced) including two active breaks lasting 10 min, 5 days/week. In the control group, regular PA continued. To our knowledge, MOVI-da10! is the first RCT to examine the effectiveness of two programs (enriched PA integrated into the academic curriculum and PA breaks only) versus a control group on improving adiposity, executive function and motor competence in preschool children. NCT03236363 (clinicaltrials.gov), 31st July 2017.

Background and purpose: Although several studies have assessed the importance of traditional risk factors in predicting stroke, none have concurrently addressed the stroke-predicting ability of these risk factors across the lifespan of subjects without a hypertension (HTN) diagnosis. Thus, this study aimed to assess the importance of blood-pressure-related risk indicators, cardiorespiratory fitness (CRF), weight status, diabetes mellitus (DM), and lifestyle factors as predictors of stroke in different stages of life among non-hypertensive subjects.Materials and methods: This study was a long-term follow-up study including 33,254 men and 10,598 women from the Aerobics Center Longitudinal Study (ACLS) who were 18-100 years old and did not have a HTN diagnosis at baseline. Logistic regression models were constructed using forward selection procedures for each age category, with stroke occurrence as the dependent variable, and pulse pressure (PP), mean arterial pressure (MAP), systolic blood pressure (SBP), smoking status, CRF, drinking behavior, DM status, and weight status as potential predictors.Results: In total, 507 subjects had a stroke during an average follow-up period of 17 years (range= 1-34 years). Logistic regression models showed that MAP values (P=0.043) in those aged 19-39 years; SBP (P < 0.001), CRF (P=0.001), weight status (P=0.005), and alcohol consumption (P=0.001) in those 40-60 years old; and CRF (P=0.002), weight status (P=0.005), and DM status (P=0.037) in those over 60 years old were predictors of stroke.Conclusion: These findings suggest that, among individuals without a baseline HTN diagnosis, classic modifiable risk factors for stroke change across different stages of life.

Objective A network meta-analysis (NMA) of current evidence was conducted to determine if physical exercise has a positive influence on multiple sclerosis (MS) fatigue and type of exercise with the largest effect on fatigue also according to disease severity. Data Sources MEDLINE, Embase, SPORTDiscus, Physiotherapy Evidence Database, Cochrane Library, and Web of Science. The search strategy combined relevant terms related to (1) MS; (2) clinical trials; (3) exercise; and (4) fatigue from inception to February 2021. Study Selection Randomized controlled trials concerning the effectiveness of different types of exercise on total and physical fatigue in people with MS were included. Data Extraction The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0), and the Grading of Recommendations, Assessment, Development, and Evaluation tool was used to evaluate the quality of the evidence. Data Synthesis A total of 58 studies were examined. Data were pooled using a random-effects model. A ranking of 7 and 8 different exercise interventions for physical and total fatigue scores, respectively, was achieved. The highest effects for pairwise comparisons were for combined exercise and resistance training vs control (ranging between −0.74 and −1.24). In the NMA, combined exercise (−1.51; 95% confidence interval [CI], −2.01 to −1.01) and resistance training (−1.15; 95% CI, −1.81 to −0.49) compared with the control group achieved the highest effects for physical and total fatigue, respectively. Conclusions Exercise should be considered an effective fatigue management strategy. Among the different exercise modalities, combined exercise is the most effective exercise modality for improving both physical and total fatigue. Resistance training is also an effective exercise for total fatigue among people diagnosed with MS.

Our aim was to investigate the effects of an intervention that comprised a brief counseling session on lifestyle habits together with the use of the EVIDENT (Lifestyles and arterial aging) application on the modification of markers that indicated different hemodynamic functions, such as arterial stiffness, blood pressure or wave reflections. The EVIDENT II study (Lifestyles and arterial aging) is a randomized clinical trial with two parallel groups. Each participant had an initial visit and two follow-up visits at 3 and 12 months where the peripheral augmentation index-PAIx75 was measured by tonometry, while an oscillometric method was used for the cardio-ankle vascular index-CAVI and brachial-ankle pulse wave velocity-baPWV. Both groups (intervention-IG and control-CG) were briefly counseled on diet and exercise. The IG also received instructions on the use of the EVIDENT II application during the 3 months. The sample (N = 597; 52 ± 11 years; 64% women) was randomized into IG = 291 and CG = 306. Comparing groups, there was a decrease in the PAIx75 favorable to the IG at 3 months (-4.9%, 95% CI: -7.7 to -2.1) and 12 months (-3.9%, 95% CI: -6.8 to -1.0). There was also a nonsignificant reduction of the CAVI at 3 months in the IG. A group effect was observed in the measurement of the PAIx75 over the 12-month follow-up (p = 0.003). This interaction was only observed in women (p = 0.017). In conclusion, the use of the EVIDENT II application achieved a modification of the PAIx75, a marker of wave reflection and vascular tone, in women through lifestyle improvements (physical activity and adherence to the Mediterranean diet). No significant results were found regarding blood pressure or arterial stiffness markers.

Background No review to date has evaluated the association between physical fitness and health-related quality of life (HRQoL) in healthy children and adolescents. The aims of this systematic review and meta-analysis were to examine the relationship between both cardiorespiratory fitness (CRF) and muscular fitness (MF) and HRQoL in healthy subjects under 18 years of age and to describe the dimensions of HRQoL in which these relationships are more robust. Methods The Medline, Embase, Cochrane Library, SCIELO, SPORTDiscus and PEDro databases were systematically searched to collect observational studies that examined the relationship between CRF and HRQoL and between MF and HRQoL in participants under 18 years of age without any diagnosed medical condition. Pooled effect sizes (ES) were estimated for the associations between both CRF and MF and the various HRQoL dimensions. Results The pooled ES (95% CI) estimates for the relationship between CRF and HRQoL were as follows: 0.19 (0.10 to 0.27) for physical well-being, 0.19 (0.07 to 0.32) for psychological well-being, 0.20 (− 0.14 to 0.55) for perceived health status, 0.10 (0.00 to 0.20) for self-perception/self-esteem, 0.07 (− 0.05 to 0.19) for quality of family relationship, 0.14 (0.04 to 0.25) for quality of peer relationship, 0.17 (0.04 to 0.29) for everyday functioning at school and 0.20 (0.12 to 0.28) for total HRQoL score. The pooled ES (95% CI) estimates for the relationship between MF and HRQoL were: 0.25 (0.12 to 0.37) for physical well-being, 0.11 (0.04 to 0.17) for psychological well-being, 0.08 (0.01 to 0.15) for quality of family relationship, 0.14 (0.03 to 0.25) for quality of peer relationship, and 0.09 (0.03 to 0.14) for total HRQoL score. Conclusions Our data suggest that both CRF and MF are positively associated with HRQoL, mainly in physical, psychological and peer relationships. Moreover, CRF is positively associated with school dimensions and MF is positively associated with family relationships. Trail registration Protocol PROSPERO registration number: CRD42015025823.

Background Although brain-derived neurotrophic factor (BDNF) has been identified as a molecular biomarker of the neurophysiological effects induced by exercise, the acute effects of high-intensity exercise (HIE) on BDNF levels are inconclusive. This study aims to estimate the immediate effects of HIE on BDNF levels in healthy young adults. Methods A systematic search was conducted in the MEDLINE, Scopus, Cochrane CENTRAL, and SportDiscus databases up to December 2020. Randomized controlled trials (RCTs) and non-RCTs reporting pre–post changes in serum or plasma BDNF after an acute intervention of HIE compared to a control condition were included. Pooled effect sizes (p-ESs) and 95% confidence intervals (95%CIs) were calculated for RCTs using a random effects model with Stata/SE (Version 15.0; StataCorp, College Station, TX, USA). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. PROPERO registration number: CRD42020221047. Results A total of 22 studies with 552 individuals (age range: 20–31 years; 59.1% male) were included. The meta-analysis included 10 RCTs that reported valid outcome data. Higher BDNF levels were observed when HIE interventions were compared with non-exercise (p-ES = 0.55, 95%CI: 0.12–0.98; I2 = 25.7%; n = 4 studies) and light-intensity exercise (p-ES = 0.78, 95%CI: 0.15–1.40; I2 = 52.4%; n = 3 studies) but not moderate-intensity exercise (p-ES = 0.93, 95%CI: –0.16 to 2.02; I2 = 88.5%; n = 4 studies) conditions. Conclusion In comparison to non-exercise or light-intensity exercises, an immediate increase in BDNF levels may occur when young adults perform HIE. Given the benefits obtained maximizing circulating BDNF when performing HIE and its potential effects on brain health, our findings suggest that HIE could be recommended by clinicians as a useful exercise strategy to healthy adults.

The prevalence of obesity and related disorders has been growing at an alarming rate in both wealthy and middle–low-income countries [...]

This work was aimed to synthetize the evidence available about the relationship between resting heart rate (RHR) and the risk of cancer mortality. A computerized search in the Medline, EMBASE, Web of Science, and Cochrane Library databases from their inception to 24 September 2020 was performed. We performed three meta-analyses: (1) cancer mortality comparing the “less than 60 bpm” and “more than 60 bpm” categories; (2) cancer mortality comparing “less than 60 bpm”, “60 to 80 bpm”, and “more than 80 bpm” categories; and (3) analysis for 10–12 and 20 bpm increase in RHR and risk of cancer mortality. Twenty-two studies were included in the qualitative review, and twelve of them met the inclusion criteria for the meta-analysis. Our results showed a positive association between RHR and the risk of cancer mortality. This association was shown in a meta-analysis comparing studies reporting mean RHR values below and above 60 bpm, when comparing three RHR categories using less than 60 bpm as the reference category and, finally, in dose response analyses estimating the effect of an increase of 10–12 bpm in RHR, both in men and in women. In conclusion, a low RHR is a potential marker of low risk of cancer mortality.

The fat but fit paradox has suggested that obese individuals with good fitness levels have lower cardiometabolic risk compared to individuals with normal weight but lower fitness levels. This paradigm has not been explored in the context of bone health. The aim of this study was to test whether categories of fat but fit paradigm assessed by body fat percentage and handgrip strength holds up in young adults and to analyze the relationship between fat but fit categories and bone outcomes. Cluster cross-sectional analyses of data from 499 young adults aged 18 to 30 from Toledo and Cuenca, Spain were conducted. Body fat percentage, handgrip strength, bone mineral content (BMC), bone mineral density (BMD), and dietary nutrients such as, proteins, magnesium, calcium, phosphorus, potassium, and vitamin D were assessed. Cluster analysis of body fat percentage and handgrip z scores resulted in a classification of four clusters that could be interpreted according to Fat Unfit (FU), Unfat Unfit (UU), Fat Fit (FF) and Unfat Fit (UF) categories. ANCOVA models showed that young adults in clusters with higher handgrip strength levels (FF, UF) and with higher key bone nutrients levels (UF) had significantly higher total BMC values than their peers in the UU and FU cluster categories, after controlling for sex, age and height. This study provides two novel conclusions in relation to the fat but fit paradigm: first, it confirms the construct of the four clusters of body fat percentage and handgrip strength, and second, it reinforces the predictive validity of the fat but fit paradigm categories, indicating the positive effect, although it may not just be a causal relationship, of muscular strength and key bone nutrients on counteracting the negative effect of obesity on bone health., European Regional Development Fund (ERDF) (Fondo Europeo de Desarrollo Regional (FEDER)], University of Castilla-La Mancha: S.R.-G. (2020-PREDUCLM-15596) and S.N.d.A.-A. (2020-PREDUCLM-16704)

Purpose This study aimed at providing prevalence trend estimates of underweight among children and adolescents in Europe from 2000 to 2017. Methods MEDLINE, Web of Science, Scopus and CINAHL were searched from their inception up to March 2020. Moreover, searches were conducted on health institutions’ websites to identify studies not published in scientific journals. Underweight was defined according to the body mass index (BMI) cut-offs proposed by the International Obesity Task Force (IOTF) and the World Health Organization (WHO) definition criteria. The Mantel–Haenszel method was used to compute the pooled prevalence estimates whenever there was no evidence of heterogeneity; otherwise, the DerSimonian and Laird random-effects method was used. Subgroup analyses by sex, age range (2–13 and 14–18 years old), study year (2000–2006 and 2007–2017), country and European region were conducted. Results A total of 49 studies with data from 323,420 children and adolescents aged 2 to 18 years, from 26 countries were included. From 2000 to 2017, according to the IOTF criteria, the prevalence of underweight showed an increasing trend in Eastern, Northern and Southern Europe, where the underweight prevalence ranged from 9.1 to 12.0%, from 4.1 to 6.8%, and from 5.8 to 6.7%, respectively. In Western Europe, the prevalence of underweight tended to decrease, from 14.0 to 11.8%. No significant differences were found by sex or age range. Conclusion The prevalence of underweight is considerable (overall, around 8–9%), particularly in Eastern Europe, and follows a slight upward trend during the past decade. Systematic review registration PROSPERO CRD42017056924. This study was funded by FEDER funds.

Arterial stiffness has been shown to be a subclinical marker associated with cardiovascular disease. Meanwhile, long-term exercise has been demonstrated to reduce arterial stiffness, providing a decrease in cardiovascular risk. However, the acute effect of exercise on arterial stiffness is unclear. This systematic review and meta-analysis aimed to assess the acute effect of exercise interventions on arterial stiffness in healthy adults. We searched the Cochrane Central Register of Controlled Trials, MEDLINE (via Pubmed), Scopus, and Web of Science databases, from their inception to 30 June 2020. A meta-analysis was performed to evaluate the acute effect of exercise on arterial stiffness using random-effects models to calculate pooled effect size estimates and their corresponding 95% CI. Pulse wave velocity was measured as an arterial stiffness index. The 30 studies included in the meta-analysis showed that pulse wave velocity was not modified immediately after exercise (0 min post) (ES: 0.02; 95% CI: −0.22, 0.26), but subsequently decreased 30 min after exercise (ES: −0.27; 95% CI: −0.43, −0.12). Thereafter, pulse wave velocity increased to its initial value 24 h after exercise (ES: −0.07; 95% CI: −0.21, 0.07). Our results show that, although there is a significant reduction in pulse wave velocity 30 min after exercise, the levels of arterial stiffness return to their basal levels after 24 h. These findings could imply that, in order to achieve improvements in pulse wave velocity, exercise should be performed on a daily basis.

Objective A positive relationship between breastfeeding and brain-derived neurotrophic factor (BDNF) in infants has been suggested due to the presence of BDNF in human milk. This study aimed to determine the relationship between exclusive breastfeeding and BDNF serum levels in Spanish schoolchildren. Methods A cross-sectional analysis including 202 schoolchildren, aged eight to 11 years, from Cuenca, Spain, was conducted. Information on sociodemographic and anthropometric variables, sexual maturation, birth weight and exclusive breastfeeding (‘no exclusive breastfeeding’, and exclusive breastfeeding for ≤6 and >6 months), and BDNF serum levels using an ELISA method were obtained. Covariance analyses (ANCOVA) were conducted to examine the relationship between serological BDNF and exclusive breastfeeding after controlling for potential confounders. Results ANCOVA models showed no significant differences in BDNF levels between children who were exclusively breastfed for more than six months versus those who were not (p > 0.05). No significant differences were observed by age group (eight to nine years versus 10 to 11 years; p > 0.05). Additionally, no clear negative trend in BDNF serum levels according to sexual maturation categories was found (p > 0.05). Conclusion These findings suggest that exclusive breastfeeding does not have a significant positive association on BDNF from eight to 11 years, since children who were exclusively breastfed did not have significantly higher BDNF levels than those who were not exclusively breastfed. Likewise, BDNF levels were not found to be negatively affected by hormonal development. Future research should examine the influence of exclusive breastfeeding on BDNF over the different developmental stages.

Objectives Metabolic syndrome (MetS) is a cluster of different cardiometabolic risk factors (CMRFs), and its different combinations with other CMRFs, such as arterial stiffness have been hypothesized to explain, at least partially, increased risk of cardiovascular disease. Thus, in this systematic review and meta-analysis, we aimed to synthesize the evidence regarding the association between the clustering of MetS-related CMRFs and arterial stiffness measured using pulse wave velocity (PWV). Methods Original studies analysing the association between arterial stiffness, measured using PWV, and MetS were systematically searched. Pooled effect size estimates and their respective 95% confidence intervals (CI) were calculated using the DerSimonian and Laird method for two separate analyses: the diagnosis of MetS and PWV values and the number of CMRFs and PWV values. Results Moderate effect size estimates were observed between MetS and PWV (0.68, 95% CI: 0.54-0.82) with a slightly higher effect size for the low-risk compared with the high-risk population group (0.75, 95% CI: 0.58-0.92; and 0.51, 95% CI: 0.32-0.82, respectively). A trend between the number of MetS-related CMRFs and PWV was found with the pooled effect size nearly doubling as the number of MetS-related CMRFs increased, 0.11 (95% CI: 0.04-0.17) for one MetS-related CMRF, 0.26 (95% CI: 0.13-0.4) for two, and 0.4 (95% CI: 0.2-0.6) for three or more. Conclusion These results demonstrated a clinically relevant association between MetS and PWV and an increasing trend in PWV values, such as a MetS-related CMRF increase. Although these results should be considered cautiously because of the considerable heterogeneity, our findings reinforce the rationale of MetS as an aggregation of risk factors with common causes, which could provide additional useful information to guide clinical management.

The authors thank the study participants and collaborators on the individual studies that provided data for this pooled IPD analysis., Objectives To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness. Design Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity. Participants Data for 6621 children and adolescents aged 4-18 years from 20 trials were included. Main outcome measures Peak oxygen consumption (VO2Peak mL/kg/min) and minutes of moderate and vigorous physical activity. Results Interventions modestly improved students’ cardiorespiratory fitness by 0.47 mL/kg/min (95% confidence interval 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness. Conclusions Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity, and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

Background There is overwhelming evidence regarding the beneficial effects of exercise on the management of symptoms, functionality and health-related quality of life (HRQoL) of people with multiple sclerosis (MS). However, few analyze have compared different types of exercise. Objective The aim of this network meta-analysis (NMA) was to assess which type of physical exercise has the greatest positive effect on HRQoL in people with MS. Methods MEDLINE, Cochrane Library, Embase, Web of Science, Physiotherapy Evidence Database and SPORTDiscus databases were searched from inception to June 2021 to identify randomized controlled trials (RCTs) examining the effect of physical exercise on HRQoL in people with MS. The NMA included pairwise and indirect comparisons. We ranked the effect of interventions calculating the surface under the cumulative ranking (SUCRA). Results We included 45 RCTs in this NMA (2428 participants; 76% women; mean age 45 years). Five types of physical exercises were ranked. Sensorimotor training had the highest effect size (0.87, 95% confidence interval [CI] 0.60; 1.15) and the highest SUCRA (87%) for total HRQoL. The highest effect size and SUCRA for physical and mental HRQoL were for aerobic exercise (0.85, 95% CI 0.28; 1.42) (89%) and mind-body exercises (0.54, 95% CI 0.03; 1.06) (89%). Sensorimotor training was the best exercise for mild disease and aerobic exercise for severe disease for total HRQoL. Conclusions Sensorimotor training seems the most effective exercise to improve HRQoL and aerobic and mind-body exercises to improve physical and mental HRQoL, respectively.

Background Gestational weight gain has been associated with some adverse perinatal outcomes, but few studies have examined the association between gestational weight gain and offspring’s cognition and their conclusions are inconsistent. Our systematic review and meta-analysis aimed to synthesize the evidence regarding the association between gestational weight gain and offspring’s cognitive skills. Methods In this systematic review and meta-analysis (PROSPERO number, CRD42017073266), we systematically searched MEDLINE, EMBASE, Web of Science and the Cochrane Library for studies examining association between gestational weight gain and offspring’s cognitive skills, without restriction in study design or language. Two reviewers extracted in an independent way the data. The Quality of Reporting of Observational Longitudinal Research scale was used to assess the quality of included studies. Effect size (ES) for adjusted models and their corresponding 95% confidence intervals were calculated for (i) intelligence quotient, (ii) language related skills and (iii) mathematic related skills comparing offspring’s cognitive skills when gestational weight gain was within recommendations (as reference) with those from mothers whose gestational weight gain was above or below the recommendations. Results Thirteen studies were included. There was a positive trend that associated gestational weight gain above recommendations with better offspring’s intelligence quotient, although not statistically significant (ES 0.02, 95% CI -0.00, 0.05; I2 = 0.00%). Conclusions There is a not significant positive association between gestational weight gain above recommendations and intelligence quotient and some studies reported associations between gestational weight gain and offspring’s cognitive skills. Our analyses confirm a wide variability in the results of studies published so far and highlights the need for conducting studies including specific samples of pregnant women by pre-pregnancy body mass index and trimester of pregnancy.

To estimate the effect of eHealth interventions on increasing physical activity(PA) in healthy adults over 55 years, a systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE, Cochrane, Web of Science, SPORTDiscus and Scopus databases were searched, from inception to February 2020, for experimental studies reporting the effect of eHealth interventions on steps/day, daily moderate-to-vigorous physical activity (MVPA min/day), PA min/week and MVPA min/week among adults over 55 years. The DerSimonian and Laird method was used to compute a pooled effect size(ES) estimate and the respective 95% confidence interval(95% CI). Eighteen studies were included in this meta-analysis with adults whose age ranged from 58 to 74.2 years. The interventions lasted between four and 52 weeks. The ES estimates of eHealth interventions on increasing PA were 0.59 (95% CI: 0.15 to 1.02) for steps/day, 0.49 (95% CI: 0.17 to 0.80) for daily MVPA, 0.13 (95% CI: 0.01 to 0.24 ) for total weekly PA and 0.31 (95% CI: 0.13 to 0.48) for weekly MVPA. Considering clinical improvements, the mean change difference estimates were an increase of 1616.28 steps/day (95% CI: 386.25 to 2846.31), 7.41 minutes of daily MVPA (95% CI: 3.24 to 11.57), 40.54 minutes of total weekly PA (95% CI: -8.71 to 89.79) and 56.35 minutes of weekly MVPA (95% CI: 17.43 to 95.27). In conclusion, eHealth interventions are effective in increasing PA levels among adults over 55 years, resulting in increased steps/day, MVPA min/day, PA min/week and MVPA min/week.

Background: Studies of trends in excess weight among European children over the last few decades rendered somewhat mixed results. Additionally, some studies were outdated, were based on self-reported weight and height, covered narrow age groups, and included only a few European countries. Thus, this study assessed the trends in prevalence of measured overweight and obesity among children across Europe from 1999 to 2016 using a systematic methodology. Methods: We searched the MEDLINE, EMBASE, CINAHL, and Web of Science databases from their inception until May 2018. Moreover, searches in websites from health institutions were conducted to identify studies not published in scientific journals. Overweight and obesity were defined according to the International Obesity Task Force criteria. The Mantel-Haenszel method was used to compute the pooled prevalence estimate and its 95% confidence interval (95% CI) whenever there was no evidence of heterogeneity (I2 < 50%); otherwise, we used the DerSimonian and Laird random-effects method. Subgroup analyses by study year, country, or European region were conducted. Results: A total of 107 studies (n=479,031 children aged 2 to 13 years old) with data from 28 countries were included. Overall, the combined prevalence of overweight and obesity in children (aged 2-13 years) decreased from 22·7% (95% CI: 21·3-24·0) during 1999-2006 to 18·1% (95% CI: 17·3-18·9) during 2011-2016; however, the prevalence of obesity increased from 4·4% (95% CI: 4·1-4·7) to 5·5% (95% CI: 5·0-6·0) during the same time period. The combined prevalence of overweight and obesity in Spain and Portugal tended to decrease, from 30·3% (95% CI: 28·3-32·3) to 26·4% (95%CI: 20·4-34·2), but an overall increase was observed in the Mediterranean region (excluding Spain and Portugal) from 22·2% (95% CI: 17·7-27.8) to 28·7% (95% CI: 24·8-33·0). No substantial changes were observed in Atlantic Europe or Central Europe, where the overweight and obesity prevalence changed from 18·3% (95% CI: 14·0-23·9) to 19.3% (95%CI: 17·7-20·8), and from 15·8% (95% CI: 13·4-18·5) to 15·3% (95% CI: 11·6-20·3), respectively. Sex differences in levels and trends of excess weight were generally small. Conclusions: The prevalence of childhood overweight and obesity is very high, but trends have plateaued in most European countries. There are substantial between country differences in current levels and trends of overweight and obesity. The rising prevalence in some Mediterranean countries is worrisome. Funding Statement: MG-M and CA-B are supported by grants from the Ministerio de Educacion, Cultura y Deporte, (FPU15/03847 and FPU13/03137, respectively). IC-R is supported by a grant from the Universidad de Castilla-La Mancha (FPI13/01582). Declaration of Interests: "None declared." Ethics Approval Statement: The systematic review and meta-analysis were conducted according to the meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement (Figure 1). We have registered and published this review on the Prospero database (Registration number: CRD42017056924), and its protocol has been published elsewhere.

Objective To evaluate the fat but fit conceptual model, testing whether this paradigm for body mass index (BMI) and maximum rate of oxygen consumption (VO2max) exists in schoolchildren and whether executive functions mediate the relationship between fat but fit categories and academic achievement. Study design Cluster cross-sectional analyses of data from 554 children aged 9-11 from Cuenca, Spain. BMI, VO2max, core executive functions (inhibition, working memory, and cognitive flexibility) and academic achievement (language and mathematics). Results Cluster analysis of BMI and VO2max z-scores resulted in a 4-cluster solution that could be interpreted according to fat unfit, unfat unfit, fat fit, and unfat fit categories. ANCOVA models confirmed an increasing trend by cluster category in terms of VO2max levels and, conversely, a decreasing trend in terms of adiposity variables. These models also confirmed that children in the fat fit and unfat fit categories scored higher than their peers in the fat unfit and unfat unfit categories. Mediation analyses using fat but fit clusters as multicategory independent variable, executive functions as mediators, and academic achievement as outcome variable showed that the positive association between the BMI-VO2max clusters and academic achievement was mediated by inhibition levels in fat fit and unfat fit individuals, by working memory levels only in those classified as fat fit, and by cognitive flexibility only in unfat fit individuals. Conclusions This study confirms the validity of the 4-cluster conceptual model regarding BMI and VO2max and reinforces the predictive validity, proving that fitness levels are able to counteract the detrimental effect of obesity on academic achievement.

Background Falls are the leading cause of injury-related deaths in older adults. Physical exercise is a suitable strategy to reduce the risk of falls, but there is little research on the effectiveness of specific exercise modalities. Objectives To estimate the effectiveness of Pilates compared to habitual or non-exercise on physical performance and the risk of falls in older adults. Data sources Five databases were searched through April 15, 2021. Study selection Randomized controlled trial in people aged ≥60 years. Outcomes: balance, strength, flexibility, functionality, and risk of falls. Data synthesis Pooled standardized mean differences were calculated using a random-effects model. Subgroup analyses based on Pilates’ modality, the existence of a detailed exercise protocol, supervision by a certified instructor, and overall risk of bias were performed. Results Thirty-nine studies were included in the systematic review and meta-analyses. The meta-analyses indicated a moderate effect of Pilates on balance (ES = 0.36; 95% CI = 0.21 to 0.50), strength (ES = 0.63; 95% CI = 0.44 to 0.81), flexibility (ES = 0.41; 95% CI = 0.16 to 0.67), and functionality (ES = 0.51; 95% CI = 0.32 to 0.72) as well as a large effect on the risk of falls (ES = 0.90; 95% CI = 0.41 to 1.38) in older adults when compared with control groups. The level of certainty of the findings was low for balance, flexibility, and functionality and moderate for strength and falls. Conclusion and implications of key findings Pilates may promote the autonomy of older people in their daily living activities. Systematic Review Registration Number PROSPERO CRD42018116452

To examine the relationship between maternal education, cardiorespiratory fitness, and academic achievement in schoolchildren, specifically whether the association between maternal education and academic achievement is mediated by cardiorespiratory fitness.This is a secondary analysis of a cross-sectional study including 478 Spanish schoolchildren aged 8-11 years. ANOVA was used to test differences in cardiorespiratory fitness by maternal education level. ANCOVA was used to test the differences in academic achievement by the educational level of mothers and the cardiorespiratory fitness of children, controlling for each other. A mediation analysis was used to test if the relationship between maternal education and academic achievement was explained by cardiorespiratory fitness.A higher level of maternal education was associated with a higher cardiorespiratory fitness level and academic achievement in children; moreover, the cardiorespiratory fitness level in children was associated with better academic achievement (P .05). Finally, cardiorespiratory fitness acted as a partial mediator of the relationship between maternal education and academic achievement in boys (z = 1.81; P = .03) but not in girls (z = 0.86; P = .19), explaining 6.54% of this relationship for the total sample and 6.67% for boys.This study suggests that the benefits of maternal education on academic achievement are partially explained by the mediating role of cardiorespiratory fitness.