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Background: This study aimed to investigate the associations of grip strength with incidence and mortality from dementia and whether these associations differ by sociodemographic and lifestyle factors., Methods: A total of 466 788 participants of the UK Biobank (median age 56.5 years, 54.5% women). The outcome was all-cause dementia incidence and mortality and the exposure was grip strength. Grip strength was assessed using a Jamar J00105 hydraulic hand dynamometer., Results: Excluding the first 2 years of follow-up (landmark analysis), mean follow-up was 9.1 years (inter-quartile range: 8.3; 9.7) for incidence and 9.3 (inter-quartile range: 8.7; 10.0) for mortality. During this time, 4087 participants developed dementia, and 1309 died from it. Lower grip strength was associated with a higher risk of dementia incidence and mortality independent of major confounding factors (P < 0.001). Individuals in the lowest quintile of grip strength had 72% [95% confidence interval (CI): 1.55; 1.92] higher incident dementia risk and 87% [95% CI: 1.55; 2.26] higher risk of dementia mortality compared with those in the highest quintile. Our PAF analyses indicate that 30.1% of dementia cases and 32.3% of dementia deaths are attributable to having low grip strength. The association between grip strength and dementia outcomes did not differ by lifestyle or sociodemographic factors., Conclusions: Lower grip strength was associated with a higher risk of all-cause dementia incidence and mortality, independently of important confounding factors., (© 2022 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.)

Objectives: We examined the associations of history and duration in high occupational physical activity (OPA) with long-term total and cause-specific mortality., Methods: The sample included 322 126 participants (135 254 women) from the National Institutes of Health-AARP Diet and Health Study, established in 1995-1996. History and duration in high OPA were reported by participants. All-cause, cardiovascular, cancer and other cause mortality records available through 31 December 2011., Results: The prevalence of high OPA was 52.1% in men and 16.1% in women. During 13.6 years (SD, 3.3) of follow-up, 73 563 participants (25 219 women) died. In age-adjusted models, the risk of death was higher among men (HR 1.14, 95% CI 1.12 to 1.16) and women (HR 1.22, 95% CI 1.18 to 1.26) with a history of high OPA. However, these associations were substantially attenuated in women (HR 1.04, 95% CI 1.00 to 1.07, an 81.8% attenuation) and eliminated in men (HR 1.02, 95% CI 0.99 to 1.04, 85.7% attenuation) after multivariable adjustments. Similar important attenuation results were found when examining duration in high OPA, as well as using cause-specific deaths as the outcomes. Educational attainment and smoking patterns were the main contributors in the excess mortality among people working in highly physically active jobs in both men and women., Conclusion: Participating in high OPA was not consistently associated with a higher mortality risk, after adjustments for education and smoking factors. Workers in high OPA should be aware that they might not be getting all well-known health benefits of being physically active if they are only very active at work., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The aim was to determine the independent associations of muscular fitness (MF), cardiorespiratory fitness (CRF) and waist circumference (WC) with blood pressure (BP) levels over 2 years in children and adolescents., Methods: 1089 children (517 females) and 787 adolescents (378 females) with complete data on fitness, WC and BP (systolic [SBP] and diastolic [DBP]) were included. Upper MF was assessed through the handgrip strength test, and lower MF using the standing long jump test. The 20-m shuttle run test was used to assess CRF. WC was obtained following standardized methods. Different regression models were fitted by introducing fitness and WC at baseline and their changes as exposures and BP at follow-up and their changes as outcomes., Results: WC at baseline was positively and independently associated with each BP variable at follow-up in children and adolescents (β=0.094-0.260; p≤0.05), and CRF was negatively associated with DBP in adolescents (β=-0.096; p=0.034). WC changes were associated with BP variables 2 years later in children (β=0.121-0.142; p<0.01). In adolescents, changes in upper MF (β=-0.116; p=0.001) and WC (β=0.080-0.098; p<0.05) were associated with SBP at follow-up. WC changes were independently associated with changes in each BP variable in children (β=0.111-0.145; all p<0.05) and SBP changes in adolescents (β=0.103 to 0.117; all p<0.01)., Conclusions: WC, but neither MF nor CRF, is independently associated with BP and its changes over 2 years. The attainment or maintenance of optimal fatness levels in the pediatric population should be highly encouraged for the prevention of future hypertension., (Copyright © 2021 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

No studies have analyzed the longitudinal associations of change in physical fitness components and obesity with academic performance. The aim of the study was to examine longitudinal associations of changes in physical fitness components and body mass index with academic performance among youth, and whether the physical fitness components are moderators of the longitudinal association between obesity and academic performance in youth. Longitudinal analyses (2 years) included 1802 youths. Physical fitness components were assessed following the ALPHA health-related fitness test battery. Academic performance was assessed via school records. Youth in the persistently high cardiorespiratory fitness and motor ability categories (ie, fit at baseline and at 2-year follow-up) had higher academic performance at follow-up than those in the persistently low category. Further, youth with normal weight at baseline and overweight/obesity at follow-up had lower academic performance scores at follow-up compared to those with normal weight. Also, cardiorespiratory fitness may ameliorate the negative influence of excess body mass index on academic performance at follow-up. Promoting physical activity programs at school that include both aerobic exercise and motor tasks to improve physical fitness and reduce body mass index may not only improve physical health, but also contribute toward successful academic development., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The aim was to examine the bidirectional association between cardiorespiratory fitness (CRF) and fatness in a 2-year longitudinal study conducted in young people. A total of 1082 children (512 females) and 727 adolescents (342 females) with complete data at baseline and follow-up were included. CRF was determined by the 20-m shuttle run test. Height and weight were measured, and body mass index and fat mass index (kg/m 2 ) were calculated. Triceps and subscapular skinfolds were assessed to compute body fat percentage. Bidirectionality was tested by including CRF and each fatness index as exposures and outcomes, alternatively, in different regression models. CRF was prospectively associated with fatness index levels (ß from -0.186 to -0.528; P < .001), remaining significant in children after adjusting for baseline fatness indices. Fatness indices were prospectively associated with CRF (ß from -0.207 to -0.479; P < .001), with no substantial changes observed in children and female adolescents when baseline CRF was considered. Changes in CRF were prospectively associated with several fatness indices, regardless of body fatness at baseline (ß from -0.062 to -0.220; P < .05). Body fatness changes were associated with future CRF levels, independently of baseline CRF, especially in children of both sexes and male adolescents (ß from -0.079 to -0.260; P < .05). Overall, a bidirectional association was observed between CRF and fatness in children and adolescents. The attainment of optimal CRF and fatness levels in early ages should be promoted since it could result in favorable future fatness and CRF levels, respectively, which are two key determinants of health status., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Although clinical gait speed may indicate health and well-being in older adults, there is a lack of studies comparing clinical tests with ambulatory gait speed with regard to several health outcomes., Objective: The objective of this study was to examine the associations of clinical gait speed, measured by the 2.44-m walk test and the ambulatory gait speed with several physical, mental, and cognitive health outcomes in older adults., Design: A cross-sectional design was used., Methods: The study population comprised 432 high-functioning, community-dwelling older adults (287 women) aged between 65 and 92 years. Clinical and ambulatory gait speeds were measured using the 2.44-m walk test and a portable gait analysis device, respectively. Multiple linear regressions were used to examine the association of clinical and ambulatory gait speeds with several health outcomes (body mass index, waist circumference, systolic and diastolic blood pressure, chronic conditions, self-rated health, exhaustion, upper- and lower-body strength, physical and mental health status, cognitive status, and self-rated cognitive status)., Results: The results showed that the average gait speed for clinical and ambulatory measures cannot be directly compared. Clinical gait speed was associated with 7 health outcomes, and the ambulatory gait speed was associated with 6 health outcomes. The significant associations between measures of gait speed and the health outcomes converged in 5 of the 13 health outcomes studied; however, the strength of associations was singly different between measures., Limitations: The short monitoring time, the inability to distinguish between the ambulatory gait speed inside the home and outdoor gait speed, and the under-representative sample are limitations of the study., Conclusion: The results indicated differences in the number and strength of associations between clinical and ambulatory gait speed. Both measures have construct validity because they have been associated with physical and health outcomes; however, they may have different predictive validity. Further research should be conducted to compare their predictive validity in longitudinal designs., (© 2020 American Physical Therapy Association.)

Objective: This study examined the dose-response relationship between changes in physical activity (PA) and subsequent incidence or remission of overall and abdominal obesity., Methods: A total of 113,950 healthy individuals aged ≥ 18 years participating in the Taiwan MJ Cohort were included. Two-year changes in PA between the first and second examination were linked to subsequent development and remission of overall and abdominal obesity., Results: During a mean 5.6-year follow-up after the second examination, 9,991 and 11,488 individuals developed overall and abdominal obesity, respectively; also, 3,588 and 3,156 participants with obesity lost sufficient weight or reduced their waist circumference to be classified as nonobese. Compared with no changes in PA, the multivariable hazard ratio (95% CI) of overall obesity was 0.95 (0.90-1.00) for a PA increase of 0.01 to 3.74 metabolic equivalent hours (MET-h) per week and 0.86 (0.80-0.91) for a PA increase of ≥ 3.75 MET-h per week. Corresponding values for remission of obesity were 1.00 (0.91-1.09) and 1.16 (1.05-1.28). Similar results were observed for the development and remission of abdominal obesity. Any decrease in PA was not associated with the risk of obesity outcomes when compared with a stable pattern (0 MET-h/week)., Conclusions: Increasing PA was consistently associated with a progressively lower incidence and higher remission of overall and abdominal obesity., (© 2020 The Obesity Society.)

Objectives: We examined the dose-response relationship between physical activity (PA) and incidence of cardiovascular disease (CVD) risk factors in adults in Taiwan., Methods: This study included 1 98 919 participants, aged 18-97 years, free of CVD, cancer and diabetes at baseline (1997-2013), who were followed until 2016. At baseline, participants were classified into five PA levels: inactive' (0 metabolic equivalent of task (MET)-h/week), 'lower insufficiently active' (0.1-3.75 MET-h/week), 'upper insufficiently active' (3.75-7.49 MET-h/week), 'active' (7.5-14.99 MET-h/week) and 'highly active' (≥15 MET-h/week]. CVD risk factors were assessed at baseline and at follow-up by physical examination and laboratory tests. Analyses were performed with Cox regression and adjusted for the main confounders., Results: During a mean follow-up of 6.0±4.5 years (range 0.5-19 years), 20 447 individuals developed obesity, 19 619 hypertension, 21 592 hypercholesterolaemia, 14 164 atherogenic dyslipidaemia, 24 275 metabolic syndrome and 8548 type 2 diabetes. Compared with inactive participants, those in the upper insufficiently active (but not active) category had a lower risk of obesity (HR 0.92; 95% CI 0.88 to 0.95), atherogenic dyslipidaemia (0.96; 0.90 to 0.99), metabolic syndrome (0.95; 0.92 to 0.99) and type 2 diabetes (0.91; 0.86 to 0.97). Only highly active individuals showed a lower incidence of CVD risk factors than their upper insufficiently active counterparts., Conclusion: Compared with being inactive, doing half the recommended amount of PA is associated with a lower incidence of several common biological CVD risk factors. Given these benefits, half the recommended amount of PA is an evidence based target for inactive adults., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To assess the validity of the single question to determine sedentary behavior (SB) by using the Global Physical Activity Questionnaire (GPAQ) in older adults., Methods: The sample included 163 participants (96 women) aged 65-92 years. Self-reported SB was obtained from the GPAQ. Objectively measured SB was assessed using the Intelligent Device for Energy Expenditure and Activity. Participants wore the Intelligent Device for Energy Expenditure and Activity continuously during 2 consecutive days while following their daily routine. The relative validity was assessed using the Spearman rank correlation coefficient (ρ), and the agreement was examined using mean bias and 95% limit of agreement with the Intelligent Device for Energy Expenditure and Activity as reference., Results: The results showed small correlations (ρ = .291, P < .001) between the SB from the GPAQ and the objective measures, and ranged from ρ = .217 to ρ = .491 depending on the potential moderator. Similarly, the GPAQ underestimates the SB for approximately 2 hours per day in older adults (limit of agreement = -7.3 to 3.4 h/d)., Conclusion: The GPAQ may not be the most suitable questionnaire for measuring SB in this population and should be used with caution because those studies that use this questionnaire in older adults may have an inaccurate measurement of SB levels.

Objectives: The aims of the present study were: (i) to analyze the associations of the time spent in daily activities (i.e., lie, recline, passive sit, active sit, stand, walk at slow pace, walk at average pace, walk at brisk pace, and other activities) with body mass index (BMI) and waist circumference (WC); and (ii) to examine how theoretically reallocating time between these daily activities is associated with BMI and WC., Methods: The sample included 437 older adults (288 women), aged 65 to 92 years, participating in the IMPACT65+ study. The time in daily activities was assessed by the Intelligent Device for Energy Expenditure and Activity (IDEEA). BMI and WC were measured following standardized procedures. Associations of daily activities with BMI and WC were examined using linear regression models adjusting for potential confounders. Isotemporal substitution models were performed to estimate the theoretical effect of replacing one activity with another activity while holding total time constant., Results: The time spent lying and reclining was associated with increased BMI and WC, while the time spent standing, walking at average pace, and walking at brisk pace was associated with decreased BMI and WC. Isotemporal substitution analyses revealed significant hypothetical reductions in BMI and WC when reallocating 15 min from lying or reclining to standing or walking at average pace. Moreover, replacing 15 min from any sedentary activity or light physical activity (except for walking at average pace) with an equal amount of time in walking at brisk pace was associated with lower BMI and WC., Conclusions: This is the first study examining the activity specific and isotemporal associations of daily behaviors (considering body postures and movements) with overall and abdominal obesity in older people. The results could be used in the development of specific recommendations encouraging an active lifestyle in older people.

Purpose: Whether physical activity (PA) might have certain benefits for cardiovascular disease (CVD) primordial prevention even in the absence of clinically significant weight loss is of public health interest. In this study, we examined the independent and combined associations of simultaneous changes in PA and body weight with the subsequent development of major CVD risk factors in adults., Methods: This prospective analysis included 116,134 healthy men and women, aged ≥18 years, with at least 3 medical examinations from the Taiwan MJ Cohort. Two-year changes in PA and body weight between the first and second examination were linked to subsequent development of hypertension, hypercholesterolemia, atherogenic dyslipidemia, metabolic syndrome, type 2 diabetes mellitus (T2DM), and chronic inflammation, which were assessed by physical examinations and laboratory tests., Results: During an average follow-up of 5.7 ± 4.1 years after the second examination, 10,840 individuals developed hypertension, 10,888 hypercholesterolemia, 6078 atherogenic dyslipidemia, 13,223 metabolic syndrome, 4816 T2DM, and 2027 inflammation. Weight gain was associated with a subsequent higher risk of all CVD risk factors, with HR (95%CI) ranging from 1.11 (1.00-1.23) for inflammation to 1.74 (1.67-1.82) for metabolic syndrome, compared with participants who lost weight. A stable weight was also associated with a higher risk of all CVD risk factors except with inflammation. In combined analyses, participants who simultaneously gained weight and decreased PA levels had the highest risk compared with those who lost weight and increased PA. Increasing or maintaining PA reduced the increased subsequent risk of some CVD risk factors among participants who maintained a stable weight or gained weight. Among participants who lost weight, decreased PA was not associated with an increased risk., Conclusions: Although weight loss is crucial for the prevention of CVD risk factors, increasing or maintaining PA is also important to prevent them among adults who gain or maintain their weight., Competing Interests: Declaration of competing interest There are no conflicts of interest relating to this manuscript., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To examine the association between physical activity (PA) and the risk for metabolically unhealthy obesity (MUO) or metabolically healthy obesity (MHO) in Asian adults., Patients and Methods: Data were obtained from 205,745 healthy individuals 18 years or older. Individuals were classified as inactive, lower or upper insufficiently active, active, and high active. Metabolically unhealthy was defined as having 1 or more of the metabolic syndrome criteria, excluding the abdominal obesity criterion., Results: The percentages of metabolically healthy normal-weight (MHNW), metabolically healthy overweight (MHOW), MHO, and MUO in our cohort were 30.8% (63,408 of 205,745), 5.8% (12,002 of 205,745), 4.1% (8329 of 205,745), and 20.7% (42,564 of 205,745), respectively. During a mean follow-up of 6 (range, 0.5-19) years, among 63,408 MHNW participants, 1890 (3.0%) and 1174 (1.9%) developed MUO and MHO, respectively. Among 12,002 MHOW participants, 3404 (28.4%) developed MUO and 2734 (22.8%) developed MHO. A total of 5506 of 8329 (66.1%) participants moved from MHO to MUO, and 5675 of 42,564 (13.3%) moved from MUO to MHO. Compared with being inactive, MHNW individuals who were active or high active showed lower risk for MUO. Among those with MHOW, being high active was associated with reduced risk for MUO and MHO. Although among MHO participants, PA was not associated with incident MUO, being active or high active was linked to a greater likelihood of moving from MUO to MHO., Conclusion: PA may prevent the development of both MHO and MUO. PA also helps increase the transition from MUO to MHO, which may contribute to reduce the subsequent development of type 2 diabetes mellitus and major cardiovascular disease complications., (Copyright © 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the association between cognitive frailty and long-term all-cause mortality and the stratified and combined associations of physical activity and cognitive frailty with long-term all-cause mortality in a population-based cohort of older adults from Spain., Patients and Methods: A representative cohort of 3677 noninstitutionalized individuals from Spain aged 60 years or older was recruited between April 17, 2000, and April 28, 2001, with follow-up through December 28, 2014. Information on self-reported physical activity and cognitive frailty status were collected at baseline. Analyses were performed with Cox regression after adjustment for confounders., Results: The median follow-up was 14 years (range, 0.03-14.25 years), corresponding to 40,447 person-years, with a total of 1634 deaths. The hazard ratio (HR) for all-cause mortality among participants with cognitive frailty compared with robust participants was 1.69 (95% CI, 1.43-2.01). Being active was associated with a mortality reduction of 36% (95% CI, 21%-47%) in cognitively frail individuals. Compared with those who were robust and active, participants with cognitive frailty who were inactive had the highest mortality risk (HR, 2.13; 95% CI, 1.73-2.61), which was equivalent to being 6.8 (95% CI, 5.33-7.99) years older., Conclusion: Cognitive frailty was more markedly associated with increased mortality in inactive older adults, and being active reduced the mortality risk among cognitively frail individuals by 36%. These novel results highlight that engaging in physical activity could improve survival among cognitively frail older adults., (Copyright © 2018 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

The interday reliability of the Intelligent Device for Energy Expenditure and Activity (IDEEA) has not been studied to date. The study purpose was to examine the interday variability and reliability on two consecutive days collected with the IDEEA, as well as to predict the number of days needed to provide a reliable estimate of several movement (walking and climbing stairs) and nonmovement (lying, reclining, and sitting) behaviors and standing in older adults. The sample included 126 older adults (74 women) who wore the IDEEA for 48 hr. Results showed low variability between the 2 days, and the reliability was from moderate (intraclass coefficient correlation = .34) to high (.80) in most of movement and nonmovement behaviors analyzed. The Bland-Altman plots showed high-moderate agreement between days, and the Spearman-Brown formula estimated that 1.2 and 9.1 days of monitoring with the IDEEA are needed to achieve intraclass coefficient correlations ≥ .70 in older adults for sitting and climbing stairs, respectively.

Purpose: To examine the separate and joint associations of physical activity and levels of physical, mental, and social health with long-term all-cause and cardiovascular disease (CVD) mortality in older adults., Methods: A cohort of 4008 individuals representative of the non-institutionalized population of Spain aged 60 years and older was analyzed. Information on physical activity was self-reported. Physical and mental health were assessed with the SF-36 questionnaire, and social health with a 4-item score on network structure and social engagement. Participants were categorized as being in a good, intermediate, or poor health according to tertiles of the score in each health dimension. Analyses were performed with Cox regression and adjusted for main confounders, including levels in the other two health dimensions., Results: Over a median follow-up of 14 years, a total of 1811 deaths occurred, 674 due to CVD. Hazard ratios (95% confidence interval) for all-cause mortality were 1.35 (1.18-1.55), 1.18 (1.02-1.36), and 1.37 (1.18-1.58) for poor vs. good physical, mental, and social health, respectively (all p trend < 0.001). Being physically active was associated with a 28% (15-39%), 31% (19-42%), and 19% (5-31%) lower all-cause mortality in participants with poor physical, mental, and social health, respectively. In each health dimension, physically active individuals with poor health showed a similar or lower all-cause mortality than those who had intermediate or good health but were physically inactive. Results for CVD mortality were similar to those for all-cause death., Conclusions: Physical activity might attenuate the excess all-cause and CVD mortality associated with poor physical, mental, and social health.

Introduction: Physical activity and physical inactivity patterns can affect health status. In the elderly people, their study is relevant given the importance that they have on the morbidity and mortality., Objective: To present preliminary data on activity and inactivity patterns of a sub-sample of older adults from the IMPACT65+ Study., Material and Methods: The sample included the first 84 participants (57% women) over 65 years (age 70.7±4.7). Time spent in activity and inactivity patterns was obtained from an Intelligent Device for Energy Expenditure and Activity monitor over a continuous period of 24hours. The patterns analysed were: standing, lying down, sitting or reclining, and the transition between them. The physical activity patterns analysed were; walking, step up or step down, running, and jumping., Results: Time spent in inactivity patterns like reclining, lying down, and sitting was 16.1±1.9hours (67% day), while the amount of time spent in activity patterns was 2.4±1.9hours (10% day). Differences were observed between men and women in the amount of hours sitting (9.7±3 men vs. 7.5±2.7 women) and standing (4.5±1.4 men vs. 5.6±2.7 women). These differences were greater in the older participants., Conclusions: Preliminary results show that older adults spend a great part of day in inactivity patterns like sitting, and that gender is the only factor analysed that affects the time spent in the activity patterns analysed., (Copyright © 2018 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To examine the separate and joint association between physical activity and frailty and long-term all-cause and cardiovascular disease (CVD) mortality in older adults., Design: Population-based prospective cohort study., Setting: Cohort representative of the noninstitutionalized Spanish population., Participants: Individuals aged 60 and older (N=3,896) in 2000-01., Measurements: Participants reported their physical activity using a validated instrument, and frailty was ascertained using the Fatigue, low Resistance, limitation in Ambulation, Illness and weight Loss (FRAIL) scale. Those with 0 frailty criteria were considered to be robust, with 1 or 2 criteria to be prefrail, and with 3 of more criteria to be frail. Participants were followed until 2014 to identify all-cause and CVD deaths. Associations were summarized using hazard ratios (HRs) and Cox regression after adjustment for main covariates., Results: During a median 14 years of follow-up, 1,801 total deaths occurred, 672 from CVD. Compared with being robust, the multivariate hazard ratio (95% confidence interval) for all-cause mortality was 1.29 (1.14-1.45) in prefrail individuals, and 2.16 (1.82-2.58) in frail individuals (p-trend <.001). Compared with being physically inactive, being physically active was associated with a statistically significant 18% (1-32%), 28% (16-39%) and 39% (17-55%) lower all-cause mortality among robust, prefrail, and frail individuals, respectively (all p <.001). Compared with participants who were robust and physically active, those who were frail and inactive showed the highest all-cause mortality 2.45 (95%CI: 1.95-3.06); however, the hazard ratio (95% confidence interval) for all-cause mortality in frail individuals who were physically active was comparable to that in pre-frail and inactive participants: 1.70 (1.32-2.19) and 1.56 (1.34-1.82), respectively. Mortality of prefrail active participants was similar to that of robust inactive participants. Results were similar for CVD mortality., Conclusion: Physical activity might partly compensate for the greater mortality risk associated with frailty in old age. J Am Geriatr Soc 66:2097-2103, 2018., (© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.)

This work examines whether the increased all-cause and cardiovascular disease (CVD) mortality associated with polypharmacy could be offset by a healthy lifestyle. We included a prospective cohort of 3,925 individuals representative of the Spanish population aged ≥60 years, who were recruited in 2000-2001 and followed up through 2014. Polypharmacy was defined as treatment with ≥5 medications. The following lifestyle behaviors were considered healthy: not smoking, eating a healthy diet, being physically active, moderate alcohol consumption, low sitting time, and adequate sleep duration. Individuals were classified into three lifestyle categories s: unfavorable (0-2), intermediate (3-4) favorable (5-6). Over a median 13.8-y follow-up, 1,822 all-cause and 675 CVD deaths occurred. Among individuals with polypharmacy, intermediate and favorable lifestyles were associated with an all-cause mortality reduction (95% confidence interval [CI]) of 47% (34-58%) and 54% (37-66%), respectively; 37% (9-56%) and 60% (33-76%) for CVD death, respectively. The theoretical adjusted hazard ratio (95%CI) associated with replacing 1 medication with 1 healthy lifestyle behavior was 0.73 (0.66-0.81) for all-cause death and 0.69 (0.59-0.82) for CVD death. The theoretical adjusted hazard ratio (95%CI) for all-cause and CVD mortality associated with simply reducing 1 medication was 0.88 (0.83-0.94) and 0.83 (0.76-0.91), respectively. Hence, adherence to a healthy lifestyle behavior can reduce mortality risk associated with polypharmacy in older adults.

Objective: The aim of this study was to examine the independent and combined associations of physical activity (PA) and sitting time (ST) with long-term mortality attributed to inflammatory causes other than cardiovascular disease (CVD) and cancer in a national cohort of older adults in Spain. Design: Prospective study. Setting and Participants: A cohort of 3,677 individuals (1,626 men) aged ≥60 years was followed-up during 14.3 years. Measures: At baseline, individuals reported PA and ST. The study outcome was death from inflammatory diseases when CVD or cancer mortality was excluded. This outcome was classified into infectious and non-infectious conditions. Analyses were performed with Cox regression and adjusted for PA, ST, and other main confounders (age, sex, educational level, smoking, alcohol consumption, body mass index, and chronic conditions). Results: During follow-up, 286 deaths from inflammatory diseases (77 from infectious diseases) were identified. Compared to individuals who defined themselves as inactive/less active, mortality from inflammatory diseases was lower in those who were moderately active (hazard ratio [HR] = 0.67, 95% confidence interval [CI] = 0.50-0.90) or very active (HR = 0.48, 95%CI = 0.33-0.68), independently of ST. Also, being seated ≥7 h/d vs. <7 h/d was linked to higher mortality (HR = 1.38, 95%CI = 1.02-1.87). The largest risk of mortality was observed in inactive/less active individuals with ST≥7 h/d (HR = 2.29, 95%CI = 1.59-3.29) compared to those with moderate/very PA and ST <7 h/d. Low PA and high ST were consistently associated with a higher risk of mortality from non-infectious inflammatory causes. Associations of PA and ST with mortality from infectious inflammatory causes showed a similar trend, but most of them did not reach statistical significance. Conclusions: Low PA and high ST were independently associated with higher mortality from inflammatory diseases other than CVD or cancer in older adults. Interventions addressing simultaneously both behaviors could have greater benefits than those focusing on only one of them.

Objectives: The aims of the present study were (i) to develop automated algorithms to identify the sleep period time in 24 h data from the Intelligent Device for Energy Expenditure and Activity (IDEEA) in older adults, and (ii) to analyze the agreement between these algorithms to identify the sleep period time as compared to self-reported data and expert visual analysis of accelerometer raw data., Approach: This study comprised 50 participants, aged 65-85 years. Fourteen automated algorithms were developed. Participants reported their bedtime and waking time on the days on which they wore the device. A well-trained expert reviewed each IDEEA file in order to visually identify bedtime and waking time on each day. To explore the agreement between methods, Pearson correlations, mean differences, mean percentage errors, accuracy, sensitivity and specificity, and the Bland-Altman method were calculated., Main Results: With 87 d of valid data, algorithms 6, 7, 11 and 12 achieved higher levels of agreement in determining sleep period time when compared to self-reported data (mean difference  =  -0.34 to 0.01 h d -1 ; mean absolute error  =  10.66%-11.44%; r  =  0.515-0.686; accuracy  =  95.0%-95.6%; sensitivity  =  93.0%-95.8%; specificity  =  95.7%-96.4%) and expert visual analysis (mean difference  =  -0.04 to 0.31 h d -1 ; mean absolute error  =  5.0%-6.97%; r  =  0.620-0.766; accuracy  =  97.2%-98.0%; sensitivity  =  94.5%-97.6%; specificity  =  98.4%-98.8%). Bland-Altman plots showed no systematic biases in these comparisons (all p  >  0.05). Differences between methods did not vary significantly by gender, age, obesity, self-rated health, or the presence of chronic conditions., Significance: These four algorithms can be used to identify easily and with adequate accuracy the sleep period time using the IDEEA activity monitor from 24 h free-living data in older adults.

We examined the associations of maintaining or increasing physical activity (PA) for a 3-yr follow-up with subsequent incident inability to complete the 400-m walk test (i.e., mobility disability) for 6 yrs of follow-up in older adults. This study included 421 participants 65 yrs and older. The 400-m walk test was assessed at baseline and at 3-, 6-, and 9-yr follow-up. Physical activity was self-reported through a 6-point rating scale at baseline and 3-yr follow-up. Three-year cumulative PA (i.e., average at baseline and at 3-yr follow-up) and its changes (i.e., from baseline to 3-yr follow-up) were linked to subsequent incidence of mobility disability for 6 yrs of follow-up (i.e., from 3- to 9-yr follow-up), after adjustment for potential covariates. After the 3-yr period, incidence of mobility disability for the subsequent 6 yrs of follow-up occurred in 129 participants. The odds ratio (95% confidence interval) of incident mobility disability associated with 1-category increase in cumulative PA was 0.63 (0.41-0.97, P = 0.036). The odds ratio (95% confidence interval) of incident mobility disability associated with 1-category increase in changes in PA was 0.56 (0.38-0.84, P = 0.005). Hence, maintaining or increasing PA levels is associated with a reduced risk of mobility disability among older adults.

Introduction: Stair climbing is an activity of daily living that might contribute to increase levels of physical activity (PA). To date, there is no study examining the validity of climbing stairs assessed by self-report. The aim of this study was, therefore, to examine the validity of estimated stair climbing from one question included in a common questionnaire compared to a pattern-recognition activity monitor in older adults., Methods: A total of 138 older adults (94 women), aged 65-86 years (70.9 ± 4.7 years), from the IMPACT65 + study participated in this validity study. Estimates of stair climbing were obtained from the European Prospective Investigation into Cancer and Nutrition (EPIC) PA questionnaire. An objective assessment of stair climbing was obtained with the Intelligent Device for Energy Expenditure and Activity (IDEEA) monitor., Results: The correlation between both methods to assess stair climbing was fair (ρ = 0.22, p = 0.008 for PA energy expenditure and ρ = 0.26, p = 0.002 for duration). Mean differences between self-report and the IDEEA were 7.96 ± 10.52 vs. 9.88 ± 3.32 METs-min/day for PA energy expenditure, and 0.99 ± 1.32 vs. 1.79 ± 2.02 min/day for duration (both Wilcoxon test p < 0.001). Results from the Bland-Altman analysis indicate that bias between both instruments were -1.91 ± 10.30 METs-min/day and -0.80 ± 1.99 min/day, and corresponding limits of agreement for the two instruments were from 18.27 to -22.10 METs-min/day and from 3.09 to -4.70 min/day, respectively., Conclusion: Our results indicate that self-reported stair climbing has modest validity to accurately rank old age participants, and underestimates both PAEE and its duration, as compared with an objectively measured method.

Background: Regular physical activity (PA) has been shown to protect against disability onset but, once the disability is present, it is unclear if PA might attenuate its harmful health consequences. Thus, we examined if mortality risk associated with physical disability can be offset by PA among older adults., Methods: We used data from a cohort of 3,752 individuals representative of the noninstitutionalized population aged 60 years and older in Spain. In 2000-2001, participants self-reported both PA levels (inactive, occasionally, monthly, weekly) and five physical disabilities (agility, mobility, global daily activities, instrumental activities of daily living, and self-care). Individuals were prospectively followed through 2014 to assess incident deaths., Results: The mean follow-up was 10.8 years, with a total of 1,727 deaths, 638 of them due to cardiovascular disease (CVD). All disability types were associated with higher total and CVD mortality. Being physically active (ie, doing any PA) was associated with a statistically significant 26%-37% and 35%-50% lower risk of total and CVD death, respectively, across types of disability. As compared with those being physically active and without disability, those who were inactive and had a disability showed the highest mortality risk from total (hazard ratios from 1.52 to 1.90 across disabilities, all p < .05) and from CVD (hazard ratios from 1.99 to 2.24 across disabilities, all p < .05). Total and CVD mortality risk was similar in physically active participants with disabilities and in inactive individuals without disability., Conclusions: In older adults, PA could attenuate the increased risk of mortality associated with physical disability., (© The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To examine the associations between cumulative physical activity (PA) and its changes over 3 years and changes over 9 years of follow-up in physical performance in older adults., Design: Longitudinal., Setting: Community-based., Participants: Men and women aged 65 and older from the Invecchiare in Chianti study (N = 782)., Measurements: Physical performance was assessed at baseline and at 3-, 6-, and 9-year follow-up using the Short Physical Performance Battery (SPPB). PA was assessed through an interviewer-administered questionnaire at baseline and 3-year follow-up. Analyses were adjusted for education, body mass index, smoking, alcohol intake, coronary heart disease, stroke, peripheral arterial disease, cancer, lung disease, lower extremity osteoarthritis, depression, and Mini-Mental State Examination., Results: Over 3 years of follow-up, 27.8% of participants were inactive, 52.2% were minimally active, and 20.0% were active, and the PA of 37.2% decreased, there was no change in PA of 50.1% and the PA of 12.7% increased. After adjustment for potential covariates, being mostly active (-1.08, 95% confidence interval (CI) = -1.43 to -0.73) and minimally active (-1.33, 95% CI = -1.53 to -1.12) over 3 years of follow-up was associated with less decline in SPPB score than being mostly inactive (-2.60, 95% CI = -2.92 to -2.27). When analyzing changes, increasing PA (-0.57, 95% CI = -1.01 to -0.12) was associated with less decline in SPPB score over 9 years than decreasing PA (-2.16, 95% CI = -2.42 to -1.89)., Conclusion: Maintaining or increasing PA levels may attenuate age-associated physical performance decline., (© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)

Background: This study examined the associations of objectively measured physical activity in Physical Education and recess with academic performance in youth., Methods: This cross-sectional study was conducted with 1,780 participants aged 6 to 18 years (863 girls). Physical activity was objectively measured by accelerometry and was also classified according to sex- and agespecific quartiles of physical activity intensities. Academic performance was assessed through school records., Results: Physical activity in physical education (PE) and recess was not associated with academic performance (β ranging from -0.038 to -0.003; all P > .05). Youth in the lowest quartile of physical activity in PE engaged in an average of 1.40 min of moderate-to-vigorous physical activity and those in the highest quartile engaged in 21.60 min (for recess: lowest quartile, 2.20 min; highest quartile, 11.15 min). There were no differences in academic performance between quartiles of physical activity in Physical Education and recess., Conclusions: Time spent at different physical activity intensities during PE and recess does not impair academic performance in youth.

Objective: To examine the stratified and joint associations of physical activity (PA) and the number of chronic conditions on long-term all-cause mortality., Patients and Methods: We used data from a cohort of 3967 individuals representative of the noninstitutionalized population 60 years and older in Spain (2000/2001). Information on self-reported PA (inactive, occasionally, monthly, weekly) and 11 chronic conditions diagnosed by a physician and reported by the study participants were recorded. Associations are summarized using hazard ratios (HRs) and Cox regression, after adjustment for covariates., Results: At baseline, 43.2%, 37.5%, 14.4%, and 4.9% of participants had 0, 1, 2, and 3 or more chronic conditions, respectively. Mean follow-up was 8.9 years (median, 10.8 years; range, 0.02-11.28 years), with 1483 deaths. The HRs (95% CIs) for all-cause mortality in participants with 1, 2, and 3 or more chronic conditions compared with those with none were 1.26 (1.05-1.39), 1.78 (1.51-2.09), and 2.27 (1.79-2.86), respectively. Being physically active (ie, doing any PA) was associated with a mortality reduction (95% CI) of 30% (14%-43%), 33% (18%-45%), 35% (16%-50%), and 47% (18%-66%) in participants with 0, 1, 2, and 3 or more chronic conditions, respectively. Compared with those with 0 chronic conditions who were physically active, participants with 2 (HR=2.63; 95% CI, 2.09-3.31) and 3 or more (HR=3.26; 95% CI, 2.42-4.38) chronic conditions who were physically inactive had the highest mortality risk., Conclusion: Physical activity is associated with a reduction in increased risk of death associated with multimorbidity (ie, coexistence of ≥2 chronic conditions) in older individuals., (Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Background: The progressive aging of the population has increased the number of older adults with disabilities. Regular physical activity has shown to improve health among these individuals, but the effects of sedentary behavior are mostly unknown. Thus, this study examined the association between sitting time and mortality in older adults with disability., Methods: Prospective cohort of 2470 people aged ≥60 years. In 2000-2011, the study participants reported their sitting time and physical activity levels and were subsequently followed up through 2011 to ascertain mortality., Results: During an average follow-up of 8.7 years, 982 deaths occurred. Compared with people who spent seated <4 hours/d, the hazard ratio (95% confidence interval) of mortality was 1.27 (1.07-1.51) in those seated during 4-6 hours/d and 1.55 (1.29-1.87) in those seated for >6 hours/d. Each increment of 1 hour/day in sitting time was linked to a 7% increase in mortality. Compared with active individuals who spent seated <4 hours/day, those who were inactive and spent seated >6 hours/d showed the highest mortality (hazard ratio 1.82, 95% confidence interval 1.37-2.42)., Conclusions: Sitting time is associated with higher mortality in older people with disability. Interventions combining the reduction of sedentary behavior with increased physical activity should be developed and evaluated in this group of population., (Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Marjolin's ulcer is defined as the appearance of a neoplasm within a chronic wound. The most common histological type is squamous. A total of 2 cases treated in our hospital are presented., Clinical Case: Case 1. A 71 year old man who presented with redness and suppuration from the wounds he had in his right foot after an electric shock 40 years earlier. The radiology showed involvement of the 4° and 5° metatarsal. Supracondylar amputation was performed, showing a well-differentiated invasive squamous cell carcinoma., Case 2: A 56 year old male, paraplegic for 20 years. He was treated due to an infected right heel ulcer, with partial improvement, but the ulcers persisted. Biopsy was performed, reporting as epidermoid carcinoma. Infracondylar amputation was performed. The diagnosis was a well-differentiated squamous cell carcinoma infiltrating the dermis., Conclusion: The prevalence of Marjolin's ulcer is 1.3-2.2% of all ulcers. Diagnosis is difficult, so biopsy is recommended on any suspicious lesion or ulcer that has received conservative treatment for one month without improvement, although this time limit is not clear. The treatment is the surgery. Local excision with a margin of an inch is enough. If the ulcer is extensive, amputation is required. Survival is estimated between 66 and 80% at 2 years, with recurrence rates of 23%. Unfavourable factors are poor tumour differentiation and metástasis, appearing in 20% of cases., (Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.)

Inflammation influences cognitive development in infants and older adults, however, how inflammation may affect academic development during childhood and adolescence remains to be elucidated. This study aimed to examine the association between inflammatory biomarkers and academic performance in children and adolescents. A total of 494 youth (238 girls) aged 10.6 ± 3.4 years participated in the study. Four inflammatory biomarkers were selected: C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and white blood cell (WBC) count. An inflammatory index was created using the above mentioned biomarkers. Academic performance was assessed through schools records. Results showed that three of the four inflammatory biomarkers (CRP, IL-6 and WBC) and the inflammatory index were negatively associated with all academic indicators (β values ranging from -0.094 to -0.217, all P<0.05) independent of confounders including body fat percentage. Indeed, youth in the highest tertile of the inflammatory index had significantly lower scores in all academic indicators compared with youth in the middle tertile (scores ranging from -0.578 to -0.344) and in the lowest tertile (scores ranging from -0.678 to -0.381). In conclusion, inflammation may impair academic performance independently of body fat levels in youth. Our results are of importance because the consequences of childhood and adolescence inflammation tend to continue into adulthood. Lifestyle interventions in youth may be promising in reducing levels of inflammation beyond the reduction in body fat in order to achieve cognitive benefits., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To examine the association of maternal physical activity before and during pregnancy with academic performance in youth., Methods: This study included 1868 youth (6-18 years) and their mothers. Mothers recalled their physical activity before and during pregnancy. Mothers were categorized into four groups: "remained active", "became inactive", "became active" and "remained inactive". Academic performance was assessed through school records., Results: Boys whose mothers practiced physical activity before or during pregnancy had significantly higher scores in academic performance indicators independently of physical activity, fitness, current body mass index (BMI) and birthweight than those whose mothers did not practice physical activity before or during pregnancy (all p < 0.05). In addition, boys whose mothers remained active had higher scores in all academic indicators (ranging from +0.358 to +0.543) than boys whose mothers remained inactive. Boys whose mothers remained active had higher scores in Language (score +0.546; 95% CI, 0.150-0.940), average of Math and Language (score +0.468; 95% CI, 0.100-0.836) and grade point average (GPA) (score +0.368; 95% CI, 0.092-0.644) than boys whose mothers became active., Conclusions: Maternal physical activity before and during pregnancy may positively influence youth's academic performance. Continuing maternal physical activity practice during pregnancy may have greater benefits for youth's academic performance.

Background: Repair of complete brachial plexus avulsion injuries may require contralateral C7 nerve root transfer. The available techniques might allow direct neuroraphy in about 50 % of cases but the others require interposing nerve grafts or humeral shaft shortening. We aimed to see if transdiscal C6-C7 contralateral C7 nerve root transfer is technically feasible and if it allows direct coaptation with the contralateral nerve roots in 100 % of cases., Methods: In ten fresh-frozen adult cadavers, the C7 nerve root was sectioned just before it connects with other brachial plexus branches and re-routed though the C6-C7 disc space to the contralateral side. A complete C6-C7 discectomy was performed and the disc space kept open with the aid of an autologous iliac crest bone graft., Results: Transdiscal C6-C7 contralateral C7 nerve root transfer is technically feasible. In our cadavers, it provided 5.3 ± 1.2 SDcm of extra length that allowed direct coaptation with the contralateral nerve roots, mainly C8 and T1., Conclusions: Transdiscal C6-C7 contralateral C7 nerve root transfer is technically feasible. In our dissections it lengthens the available C7 nerve root stump by 5.3 ± 1.2SDcm. The increase was 4 cm versus the retropharyngeal route making direct coaptation with the contralateral C8 and T1 nerve roots possible.

Objective: To examine the associations of (i) objectively measured and self-reported sedentary behavior during leisure time with academic performance and (ii) patterns of sedentary behavior with academic performance., Methods: This study was conducted with 1146 youth aged 12.5±2.5years in Spain during 2011-2012. Leisure-time sedentary behavior during out-of-school hours was assessed by accelerometry and self-report. Academic performance was assessed through school grades., Results: Objectively measured sedentary leisure-time was not significantly associated with academic performance. Time spent in Internet surfing, listening to music, and sitting without doing anything were negatively associated with all academic performance indicators (β ranging from -0.066 to -0.144; all p<0.05). However, time spent in doing homework/study without computer and reading for fun were positively associated (β ranging from 0.058 to 0.154; all p<0.05). Five major sedentary patterns were identified. The "high social-low TV/video" and the "low studying-high TV/video" patterns were negatively associated with all academic indicators (β ranging from -0.085 to -0.148; all p<0.05). The "educational" pattern was positively associated with all academic indicators (β ranging from 0.063 to 0.105; all p<0.05)., Conclusions: Specific domains of self-reported sedentary behavior during leisure-time, but not objectively measured sedentary leisure time, may influence academic performance., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: to examine if those adolescents who dislike physical education classes get better results on academic and cognitive performance than their peers., Methods: participants included 4 226 adolescents from the AVENA, AFINOS and UP&DOWN studies. Physical education enjoyment was assessed with a 7-point Likert scale. Cognitive performance in the AVENA study was assessed using the Spanish version of the SRA Test of Educational Ability. Academic performance in the AFINOS and UP&DOWN studies was assessed through Mathematics and Language grades and the average of both subjects., Results: in the AVENA study we found differences in verbal ability among girls who dislike physical education and their peers (P = 0.033). In the AFINOS study, boys who dislike physical education had higher scores in Language than their peers (P = 0.024). In the UP&DOWN study girls who disliked physical education had higher scores in Language and in the average of Language and Mathematics than their peers (P < 0.001)., Conclusion: in the AVENA and AFINOS studies adolescents who disliked physical education had similar results in cognitive and academic performance than their peers, but in the UP&DOWN study girls who disliked physical education showed higher results in academic performance than their peers., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: High cardiorespiratory fitness (CRF) is strongly associated with longer life among older adults. CRF can be assessed by exercise-based methods, which are not feasible in most clinical settings. Thus, nonexercise algorithms to estimate CRF have been developed, but whether they predict mortality in older adults is uncertain., Methods: A cohort of 1470 men and 1460 women, representative of the Spanish population age ≥60 yr, was established in 2000/2001 and followed up prospectively through 2011. At baseline, nonexercise CRF was estimated with the sex-specific algorithms developed by Jackson et al. Analyses were performed with Cox regression and adjusted for the main confounders., Results: During an average follow-up of 9.4 yr, 570 (38.8%) deaths occurred in men and 295 (20.2%) in women. Among men, no association was observed between nonexercise CRF and all-cause mortality. Compared with women in the lowest quartile of CRF, the hazard ratio (95% confidence interval) for all-cause death was 0.81 (0.62-1.06) in the second quartile, 0.68 (0.48-0.95) in the third quartile, and 0.56 (0.36-0.87) in the highest quartile (P for trend = 0.004). Results held regardless of age, body mass index, waist circumference, HR, subjective health, functional limitations, and disease status., Conclusions: Higher nonexercise CRF was related to lower risk of death in older women but not in men. Because previous research does not support clear sex-specific association, further research is required to assess whether nonexercise CRF predicts mortality in older adults or new algorithms should be developed for this population, with special attention to older men.

Introduction: In the physical education context a well- known myth suggest that obese and unfit youth dislike physical education., Objective: To examine if adolescents who dislike physical education have higher levels of fatness and lower of fitness than their peers., Methods: Participants included 2606 (49.3% girls) adolescents from AVENA and UP&DOWN studies. physical education enjoyment was assessed with a 7-point Likert scale. Fatness was assessed with BMI, skinfolds and waist circumference. Physical fitness was assessed with cardiorespiratory, motor and muscular fitness tests., Results: Boys who dislike physical education had similar levels of fatness and fitness than their peers (all P>0.05). Adolescent girls who dislike physical education had higher levels in body fat (P=0.035), and lower levels in muscular (P=0.007) and motor (P=0.007) fitness than their peers., Conclusion: Since only girls who dislike physical education seem to have, albeit weak, higher levels of fatness and lower of fitness than their peers, it partially confirms the myth in adolescent girls., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: Previous studies suggest that the physical environment is associated with youth physical activity levels., Objective: The present study aimed at assessing the reliability and validity of an adapted version of the ALPHA environmental questionnaire (short version) to adults for application with Spanish youth., Methods: The reliability was evaluated in a sample (n = 190, 80 girls, 14.08 ± 1.38 years) using the Intraclass Correlation Coefficient (ICC) and Weighted kappa. In other sample (n = 140, 61 girls, 13.03 ± 1.40 years) the validity was assessed using the Spearman correlation (rho) for its association with self-reported and objective (accelerometers) physical activity (PA)., Results: The test-retest reliability showed ICC = 0.69 for the total questionnaire score, ranging from k = 0.42 to 0.77 for individual items. The total score showed significant correlations with PA reported by PACE questionnaire (rho = 0.18, p = 0.040), the Finnish Physical Activity Index (rho = 0.26, p = 0.002) and active commuting for girls (rho = 0.34, p = 0.010), as well as vigorous PA measured by accelerometry (rho = 0.18, p = 0.038)., Discussion: The adapted version of the ALPHA environmental questionnaire has moderate to good reliability and acceptable validity to assess environmental factors that may influence PA in youth., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Aim: There is an emerging body of evidence on the potential effects of regular physical activity on academic performance. The aim of this study was to add to the debate, by examining the association between objectively measured physical activity and academic performance in a relatively large sample of children and adolescents., Methods: The Spanish UP & DOWN study is a 3-year longitudinal study designed to assess the impact, overtime, of physical activity and sedentary behaviours on health indicators. This present analysis was conducted with 1778 children and adolescents aged 6-18 years. Physical activity was objectively measured by accelerometry. Academic performance was assessed using school grades., Results: Physical activity was inversely associated with all academic performance indicators after adjustment for potential confounders, including neonatal variables, fatness and fitness (all p < 0.05). This association became nonsignificant among quartiles of physical activity. There were only slight differences in academic performance between the lowest and the second quartile of physical activity, compared to the highest quartile, with very small effect size (d < 0.20)., Conclusion: Objectively measured physical activity may influence academic performance during both childhood and adolescence, but this association was negative and very weak. Longitudinal and intervention studies are necessary to further our understanding., (©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Objective: To examine the independent and combined associations of the components of physical fitness with academic performance among youths., Study Design: This cross-sectional study included a total of 2038 youths (989 girls) aged 6-18 years. Cardiorespiratory capacity was measured using the 20-m shuttle run test. Motor ability was assessed with the 4×10-m shuttle run test of speed of movement, agility, and coordination. A muscular strength z-score was computed based on handgrip strength and standing long jump distance. Academic performance was assessed through school records using 4 indicators: Mathematics, Language, an average of Mathematics and Language, and grade point average score., Results: Cardiorespiratory capacity and motor ability were independently associated with all academic variables in youth, even after adjustment for fitness and fatness indicators (all P≤.001), whereas muscular strength was not associated with academic performance independent of the other 2 physical fitness components. In addition, the combined adverse effects of low cardiorespiratory capacity and motor ability on academic performance were observed across the risk groups (P for trend<.001)., Conclusion: Cardiorespiratory capacity and motor ability, both independently and combined, may have a beneficial influence on academic performance in youth., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Active commuting is a good opportunity to accumulate physical activity (PA) across the lifespan that potentially might influence central body fat. We aimed to examine the prospective associations of active commuting at 11, 15 and 18 years of age with central body fat at 18 years., Methods: Participants were part of a large birth cohort study in Pelotas, Brazil (n = 3,649 participants). Active commuting, leisure-time PA and income were self-reported at 11, 15 and 18 years. Waist circumference and trunk fat mass were collected at 18 years with the use of a 3-dimensional photonic scanner and dual-energy X-ray absorptiometry, respectively., Results: Active commuting at 11 years was not prospectively associated with central body fat. However, we found that active commuting at 15 and 18 years were prospectively and cross-sectionally associated with central body fat variables, respectively, in boys but not in girls. Also, boys in the highest tertile of accumulated active commuting (i.e., average of active commuting at 11, 13 and 18 years) were associated with -2.09 cm (95%CI: -3.24; -0.94) of waist circumference and -1.11 kg (95%CI: -1.74; -0.48) of trunk fat mass compared to boys in the lowest tertile. Analyses on changes in tertiles of active commuting from 11 and 15 years to 18 years with central body fat variables at 18 years showed that boys who remained consistently in the highest tertile or moved to a higher tertile had lower levels of central body fat compared to those consistently in the lowest tertile., Conclusions: Active commuting throughout adolescence in boys, especially during middle and late adolescence, is associated with lower levels in central fatness before adulthood.

Background: An objective diagnosis of sedentary behaviour as well as of the physical activity and fitness levels in youth and to better understand how lifestyle is associated with cardiovascular disease risk factors and other phenotypes is of clinical and public health interest, and might be informative for developing intervention studies focused on the promotion of physical activity in these population. The aim of this methodological paper is to describe the design and assessment in the UP&DOWN study., Methods/design: The UP&DOWN study is a multi-center follow-up design where 2225 Spanish primary and secondary schoolchildren from Cadiz and Madrid, respectively, as well as 110 Spanish adolescents with Down syndrome from Madrid and Toledo were recruited to be assessed. Nine main measurement categories are assessed: i) socio-demographic and early determinants; ii) environmental determinants; iii) physical activity and sedentary behaviour; iv) health-related fitness; v) blood pressure and resting heart rate; vi) mental health; vii) dietary patterns; viii) blood samples; and ix) genetic analysis. During the 3-yr follow-up study, socio-demographic and early determinants, and genetic analysis are only assessed in the first year. Blood sampling is assessed in the first year and the third year (2nd follow-up), and all the other measurements are assessed every year., Discussion: The findings of the UP&DOWN study may help the Health Information Systems and policy makers to identify the target population for primary prevention and health promotion policies, and to develop and test preventive strategies. Moreover, these data will allow following the trends at population level, as well as to modify/adapt/create new evidence-based physical activity guidelines at national level. The findings will also serve as a scientific platform for interventional studies.

The aim of this report was to examine the associations between some characteristics (i.e., structure and number) of extracurricular physical activity (EPA) and cognitive performance in adolescents. A total of 1662 adolescents (880 girls; 13.0-18.5 years) from 5 Spanish cities (Granada, Madrid, Murcia, Santander and Zaragoza) were included in this study. Structure (organised and non-organised) and number of EPAs, and participation at vigorous intensity during EPA were self-reported. Cognitive performance (verbal, numeric and reasoning abilities, and an overall score) was measured with the "SRA-Test of Educational Ability". Results showed that vigorous EPA was positively associated with all cognitive variables. Adolescents who practiced an organised EPA had higher scores in 3 of the 4 cognitive variables than those who practiced a non-organised EPA (all P < 0.05). Likewise, the group who participated in more than one EPA had higher cognitive performance in all variables than the group who participated in only one EPA (all P < 0.05). Regardless of potential confounder variables, including vigorous EPA, both structure and number of EPAs were each other independently associated with cognitive performance. Therefore, structure and number of EPAs may positively influence cognitive performance in adolescents. Participating in multiple, organised EPA may have benefits for cognitive performance.

The Assessing Levels of Physical Activity (ALPHA) health-related fitness test battery is a set of reliable, valid, and feasible tests to assess health-related physical fitness in children and in adolescents. The aim of this study was to examine the reliability of this battery in adolescents with Down syndrome (DS). The extended ALPHA health-related fitness test battery was performed twice within 1 month in 17 apparently healthy adolescents, aged 12-18 years, with DS who had an intelligence quotient ≥ 35. Intraclass correlation coefficient (ICC) was used to determinate test-retest reliability, and nonparametric Wilcoxon signed rank test was used to compare mean differences between measurements. With the exception of subscapular skinfold test, which obtained a moderate agreement (ICC = 0.64), all tests had a very high reliability: the 20-m shuttle-run test (ICC = 0.86), the right handgrip strength test (ICC = 0.86), the left handgrip strength test (ICC = 0.86), the standing broad jump test (ICC = 0.85), body mass index (ICC = 0.95), waist circumference (ICC = 0.98), triceps skinfold (ICC = 0.85), and the 4 × 10-m shuttle-run test (ICC = 0.92). There were no significant differences (all p > 0.05) in any of the tests. The ALPHA health-related fitness battery is reliable for measuring health-related components of fitness in adolescents with DS.

Objective: Atherogenesis involves an inflammatory process that occurs early in life even though clinical symptoms are not observed until adulthood. Two important protective factors for low-grade inflammation may be physical activity (PA) and fitness. We examined the independent associations of objective and subjective measurements of PA and fitness with low-grade inflammation in European adolescents., Methods: A total of 1045 adolescents, aged from 12.5 to 17.5 years old from 10 European cities, were selected from the HELENA-Cross-Sectional Study. Objectively-measured and self-reported PA variables were obtained by accelerometry and the International PA Questionnaire for Adolescents, respectively. Overall, cardiorespiratory, muscular and motor fitness variables were assessed by standardized field-based fitness tests and the International Fitness Scale. C-reactive protein (CRP), complement factors 3 (C3) and 4 (C4), interleukin-6 and TNF-α inflammatory markers were measured., Results: Objectively-measured vigorous PA was inversely associated with C3 (β=-0.094, P=0.021) but it did not remain significant after any objective fitness indicator was included in the model. Other objectively measured or self-reported assessments of PA were not significantly associated with inflammatory markers. All objective measures of fitness were inversely associated with CRP, C3 and C4, whereas only self-reported motor fitness remained significantly associated with C3, C4 and TNF-α. All these observations were independent of age, sex, city and body mass index or waist circumference., Conclusion: High PA in adolescence may play an indirect role on lessening low-grade inflammation through improvements in fitness., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objective: To examine the associations between sleep duration and emerging inflammatory and endothelial function risk factors in adolescents., Methods: This study included a total of 183 (88 girls) adolescents, aged 13-17 years, without diagnosed sleep-related disorders. White blood cell counts, C-reactive protein (CRP), complement factors 3 and 4, interleukin-6, adiponectin, leptin, inter-cellular adhesion molecule 1, vascular cell adhesion molecule-1, E-selectin, l-selectin, and plasminogen activator inhibitor-1 were measured. Sleep duration and sleep-related disorders were obtained by self-report and moderate-to-vigorous physical activity (MVPA) was objectively measured by accelerometer. Body mass index (BMI) was calculated from measured height and weight., Results: A significant inverse association between sleep duration and CRP (β=-0.17, P=0.024) existed only after controlling for sex, age, and pubertal status. The results did not change when MVPA was included into the model. However, the association of sleep duration with CRP was slightly attenuated when BMI was included in the model, though it remained significant (β=-0.15, P=0.044)., Conclusion: Short sleep duration during adolescence might play an important and independent role in cardiovascular and metabolic diseases through CRP., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objective: We investigated the effects of the EVASYON program on body fatness, cardiometabolic risk factors, gut appetite-controlling hormones and serum levels of cytokines in adolescents with overweight or obesity (OW/OB)., Methods: This study comprised 13 boys (10 obese) and 12 girls (8 obese), aged 13-16 years, from a Madrid Hospital. The EVASYON program was based on a calorie-restricted diet (10-40%), increased physical activity (at least 60 min/day 5 days a week), psychological therapy and nutritional education for 13 months. Anthropometric and blood pressure measurements were measured before and after intervention. Serum glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, leptin, total peptide YY and insulin levels were determined before and after intervention. Serum levels of cytokines IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, and TNF-α were also assessed before and after intervention., Results: A decrease in body mass index (BMI), BMI z-score, skinfolds (triceps, biceps, subscapular, thigh, and calf), sum of six skinfolds and body circumferences (arm relaxed and flexed, waist, hip, and proximal thigh) values were observed after the intervention program (all p < 0.05). In addition, diastolic blood pressure also decreased (p < 0.05). A decrease in serum leptin levels (-48.4%, p < 0.001) was observed after intervention without changes in total peptide YY and insulin levels. Levels of IL-8, IL-10, and TNF-α also decreased (all p < 0.05) after the intervention program., Conclusions: These preliminary results evidence that the EVASYON program may improve body fat, leptin, and some pro-inflammatory cytokines in adolescents with OW/OB., (© 2011 John Wiley & Sons A/S.)

Objective: To examine the combined influence of four lifestyle risk factors related to physical activity, television viewing, sleep duration, and meal frequency on body fat (BF) in adolescents., Method: This cross-sectional study comprised 1,310 Spanish adolescents (age 13-18.5 years). Lifestyle variables were self-reported and BF indicators (weight, height, six skinfold thicknesses, waist circumference) measured during the years 2000-2002. Lifestyle risk factors were: physically inactive, ≥ 3 h/day watching television, <8 h/day sleep duration, and <5 meals a day. The number of lifestyle risk factors was calculated for each participant, ranging from 0 to 4., Results: The number of lifestyle risk factors was positively associated with sum of six skinfolds, %BF, waist circumference, and waist-height ratio (all p < 0.001). The odds ratios (95% confidence interval) of overweight (including obesity) for groups with 1, 2, and 3-4 lifestyle risk factors compared with those with 0 were 2.86 (1.77-4.62), 3.61 (2.16-6.04), and 5.81 (3.07-10.99), respectively (p for trend <0.001). All the observations were independent of age, gender, race, socioeconomic status, and fat free mass., Conclusion: The combined influence of four lifestyle risk factors is positively associated with BF and an approximately sixfold risk of overweight in adolescents., (Copyright © 2011 S. Karger AG, Basel.)