Susana Aznar

Prevalence of overweight and obesity in non-institutionalized people aged 65 or over from Spain: the elderly EXERNET multi-centre study

Coupled with the growth of the older population, an increase in the prevalence of overweight and obesity in this age group has occurred in the last decades. The main aims of the present study were (i) to provide an updated prevalence of overweight and obesity in a representative sample of the Spanish elderly population; (ii) to calculate the prevalence of sarcopenic obesity (SO) and (iii) to analyse the relationships between adiposity measurements and lifestyle. A cross‐sectional study was carried out in a sample of 3136 persons representative of the non‐institutionalized population ≥65 years of age. Anthropometric measurements were obtained using standardized techniques and equipment. Overall, 84% of the population can be categorized as overweight and/or obese. The present study indicates that 67% of the Spanish elderly population has an increased percentage of fat mass and more than 56% suffer from central obesity. Moreover, SO is present in 15% of the Spanish elderly population. Finally, a strong relationship between both physically active and sedentary lifestyles and the level of adiposity was found. Prevalence of overweight and obesity among elderly people in Spain is very high and is still increasing. Lifestyle seems to be a determinant factor in the development of obesity among elderly people.

Patterns of physical activity in Spanish children: a descriptive pilot study

BACKGROUND The majority of Spanish adults and children do not engage in enough physical activity to be beneficial for health. There is a need for objective and accurate assessment of the proportion of children meeting the physical activity recommendation for health. Assessing patterns of physical activity both between days (during weekdays and weekend days) and within days is of interest to improve our understanding of the variation in Spanish childrens physical activity and to provide efficient intervention programmes. METHODS A sample of 221 children: 136 9-year-old children (68 boys and 68 girls) and 85 15-year-old children (36 girls and 49 boys) from 12 urban public schools in Madrid, Spain entered the study. The variables measured were anthropometric characteristics (height, weight, body mass index) and physical activity measured during four consecutive days using the GT1M accelerometer. RESULTS Younger children were more active and less sedentary than older ones during week and weekend days. Nine-year-old boys and girls achieved significantly (P < 0.05) more moderate to vigorous physical activity (MVPA) and significantly (P < 0.01) less sedentary time than older 15-year-old children. During weekdays more children achieved physical activity recommendations versus weekend days. Physical activity patterns analyses indicated that boys achieved relatively high values of MVPA from 1100 till 1300 h (school break) and from 1800 till 2000 h in comparison with the rest of the day. Girls were substantially different, with the 9-year-old girls having only two obvious peaks of weekday MVPA at lunch (1300) and after school (1900 h) while the adolescent girls had no clear peak of MVPA. CONCLUSIONS Few children achieved the level of MVPA recommended for health; at particular risk were adolescent girls. More effort needs to be devoted to promoting appropriate opportunities for Spanish girls across the day and to promoting physical activity during weekends for all children.

Sitting time increases the overweight and obesity risk independently of walking time in elderly people from Spain.

INTRODUCTION Obesity, defined as an excess of total body fat, is a matter of concern all over the world, and its prevalence is still increasing among elderly people. OBJECTIVES To examine whether sedentary behaviour (hours sitting per day) is associated with higher risk of central obesity, overweight-obesity and overfat in a representative sample of non-institutionalized Spanish elderly population and if so, whether hours walking per day modified this association. STUDY DESIGN A cross-sectional study in a sample of 3136 people ≥65 years of age. MAIN OUTCOMES MEASURES Anthropometric measurements were obtained using standardized techniques and equipment. Active and sedentary behaviours were recorded by questionnaire. RESULTS For both men and women, the higher prevalence of overweight-obesity, central obesity and overfat was found in those who spent sitting more than 4h per day and walk less than 1h, compared with those who spent sitting less than 4h per day and walk more than 1h (all p<0.001, except for central obesity in women). In men, more than 4h sitting per day was associated with 1.7-fold higher odds of having central obesity compared with those sitting less than 4h per day (p<0.01). In women, this sedentary behaviour increased the risk of overweight-obesity and overfat by 1.5 and 1.4, respectively (p<0.01). Age or time spent walking did not significantly change these results. CONCLUSION Sitting time increases the risk of overweight-obesity and overfat in women and the risk of central obesity in men, independently of walking time.

Recommended levels of physical activity to avoid adiposity in Spanish children.

What is already known about this subject There is an association between adiposity levels and physical activity guidelines for adolescents. Achieving physical activity recommendations helps adolescents to prevent obesity status.

Obesity and physical activity patterns in children and adolescents.

The aim of this study is to measure objectively and accurately the physical activity (PA) patterns in Spanish children and adolescents according to their obesity status, gender and age groups.

Heart rate recovery is associated with obesity traits and related cardiometabolic risk factors in children and adolescents

BACKGROUND AND AIMS Increased vagal activity is associated with obesity and metabolic risk in children and adolescents. The aim of the present cross-sectional study was to examine the association of parasympathetic function, as assessed by heart rate recovery (HRR) from a maximal exercise cycle-ergometer test, with obesity traits and related cardiometabolic risk factors in Spanish children and adolescents. METHODS AND RESULTS A sample of 437 Spanish 9-year-old-children and 235 15-year-old-adolescents participated in the study. The variables measured were anthropometric characteristics (height, body mass and waist circumference) and physical activity using the Actigraph accelerometer. Additional measured outcomes included fasting insulin, triglycerides, high-density lipoprotein cholesterol (HDLc) and blood pressure. A metabolic risk score was computed as the mean of the standardised outcomes scores. The HRR was calculated as the difference between peak heart rate and heart rate 1, 3 and 5 min after cessation of the maximal ergometer test. Diastolic blood pressure was associated with all the HRR parameters in 9-year-old-girls. In 9-year-old-boys, the 3-min HRR was inversely associated with systolic blood pressure (p < 0.05) and Homeostasis Model Assessment (HOMA) (p < 0.05). Five minute HRR was inversely associated with waist circumference (p < 0.05), sum of five skinfolds (p < 0.01) and HOMA (p = 0.004). There were no significant associations in adolescents. In 9-year-old-girls, the adjusted 5-min HRR showed significant differences between quartile 2 and 4 of metabolic risk (p = 0.011). In all samples, the adjusted HRR (1-, 3- and 5-min HRR) did not show significant differences across quartiles. CONCLUSION HRR was inversely associated with obesity traits and related cardiometabolic risk factors mainly in healthy boys.

Harmonization process and reliability assessment of anthropometric measurements in the elderly EXERNET multi-centre study.

Background The elderly EXERNET multi-centre study aims to collect normative anthropometric data for old functionally independent adults living in Spain. Purpose To describe the standardization process and reliability of the anthropometric measurements carried out in the pilot study and during the final workshop, examining both intra- and inter-rater errors for measurements. Materials and Methods A total of 98 elderly from five different regions participated in the intra-rater error assessment, and 10 different seniors living in the city of Toledo (Spain) participated in the inter-rater assessment. We examined both intra- and inter-rater errors for heights and circumferences. Results For height, intra-rater technical errors of measurement (TEMs) were smaller than 0.25 cm. For circumferences and knee height, TEMs were smaller than 1 cm, except for waist circumference in the city of Cáceres. Reliability for heights and circumferences was greater than 98% in all cases. Inter-rater TEMs were 0.61 cm for height, 0.75 cm for knee-height and ranged between 2.70 and 3.09 cm for the circumferences measured. Inter-rater reliabilities for anthropometric measurements were always higher than 90%. Conclusion The harmonization process, including the workshop and pilot study, guarantee the quality of the anthropometric measurements in the elderly EXERNET multi-centre study. High reliability and low TEM may be expected when assessing anthropometry in elderly population.

Biomarkers of physical activity and exercise

Traditionally, biomarkers have been of interest in sports in order to measure performance, progress in training and for identifying overtraining. During the last years, growing interest is set on biomarkers aiming at evaluating health-related aspects which can be modulated by regular physical activity and sport. The value or concentration of a biomarker depends on many factors, as the training status of the subject, the degree of fatigue and the type, intensity and duration of exercise, apart from age and sex. Most of the biomarkers are measured in blood, urine and saliva. One of the main limitations for biochemical biomarkers is that reference values for blood concentration of biomarkers specifically adapted to physically active people and athletes are lacking. Concentrations can differ widely from normal reference ranges. Therefore, it is important to adapt reference values as much as possible and to control each subject regularly, in order to establish his/her own reference scale. Other useful biomarkers are body composition (specifically muscle mass, fat mass, weight), physical fitness (cardiovascular capacity, strength, agility, flexibility), heart rate and blood pressure. Depending on the aim, one or several biomarkers should be measured. It may differ if it is for research purpose, for the follow up of training or to prevent risks. For this review, we will get deeper into the biomarkers used to identify the degree of physical fitness, chronic stress, overtraining, cardiovascular risk, oxidative stress and inflammation.

Validation of a short physical activity recall questionnaire completed by Spanish adolescents

Abstract Self-report recall questionnaires are commonly used to measure physical activity in children and adolescents. However, they have been shown to have low to moderate validity, mainly due to inaccuracies in recall activity. The purpose of the present study was to determine the reliability and validity of an adapted version of the Assessment of Physical Activity Levels Questionnaire (APALQ) among a sample of Spanish adolescents. Test–retest reliability of the APALQ was assessed using a sample of 150 adolescents (72 males, 78 females), aged 13.6±1.1 years, who answered the APALQ twice within 7 days. Criterion validity was assessed using a sample of 77 adolescents (50 males, 27 females), aged 13.6±1.1 years, by comparing the APALQ against the Computer Science and Application (CSA) monitor. All participants were volunteers recruited from local schools in the Aragon region of Spain. Test–retest reliability for all items was high with intra-class coefficients of 0.77 for boys and 0.74 for girls. The APALQ demonstrated modest criterion validity with Pearson correlation coefficients (r) ranging from 0.53 between Physical Activity Index (PAI) and CSA minutes of moderate and vigorous physical activity, and 0.47 between PAI and CSA steps per day. When the data were analysed by gender, girls had higher correlations than boys (P < 0.01). The Spanish APALQ seems to be a valid and reliable short self-report physical activity questionnaire.

Physical activity, hydration and health

Since the beginning of mankind, man has sought ways to promote and preserve health as well as to prevent disease. Hydration, physical activity and exercise are key factors for enhancing human health. However, either a little dose of them or an excess can be harmful for health maintenance at any age. Water is an essential nutrient for human body and a major key to survival has been to prevent dehydration. However, there is still a general controversy regarding the necessary amount to drink water or other beverages to properly get an adequate level of hydration. In addition, up to now the tools used to measure hydration are controversial. To this end, there are several important groups of variables to take into account such as water balance, hydration biomarkers and total body water. A combination of methods will be the most preferred tool to find out any risk or situation of dehydration at any age range. On the other hand, physical activity and exercise are being demonstrated to promote health, avoiding or reducing health problems, vascular and inflammatory disea ses and helping weight management. Therefore, physical activity is also being used as a pill within a therapy to promote health and reduce risk diseases, but as in the case of drugs, dose, intensity, frequency, duration and precautions have to be evaluated and taken into account in order to get the maximum effectiveness and success of a treatment. On the other hand, sedentariness is the opposite concept to physical activity that has been recently recognized as an important factor of lifestyle involved in the obesogenic environment and consequently in the risk of the non-communicable diseases. In view of the literature consulted and taking into account the expertise of the authors, in this review a Decalogue of global recommendations is included to achieve an adequate hydration and physical activity status to avoid overweight/obesity consequences.