Health economic evaluation of exercise interventions in people over 60 years old: A systematic review.

This systematic review was conducted to examine the cost-effectiveness of exercise interventions in community-dwelling older adults. A systematic search for articles published in English or Spanish was carried out in PubMed, Web of Science and Cochrane Library that covered the period from the respective start date of each database to October 2021. Methodological quality was assessed with the Physiotherapy Evidence Database scale and quality of economic evaluation with the Quality of Health Economic Studies and Consolidated Health Economic Evaluation Reporting Standards. A total of 12 out of 15 studies on exercise programmes for older adults reported cost-effective results. The most cost-effective training appears to be a multicomponent training programme, including aerobic exercise, muscle-strengthening of lower extremities, and balance and stretching training. The training methodology should be of progressive moderate or vigorous intensity performed at least twice per week with each session lasting 60 min for ≥6 months. The exercise programme should be delivered as a group-based intervention, doing extra exercise at home to increase the cost-effectiveness. These findings suggest that exercise interventions in non-institutionalized older people are a cost-effective tool. Sex, age, cognitive status, frailty, frequency and training duration could modify the cost-effectiveness of exercise interventions. Systematic review registration. PROSPERO CRD42021231530 (date of registration: 20/02/2021).

Assessment of Active Video Games' Energy Expenditure in Children with Overweight and Obesity and Differences by Gender.

(1) Background: Childhood obesity has become a main global health problem and active video games (AVG) could be used to increase energy expenditure. The aim of this study was to investigate the energy expenditure during an AVG intervention combined with exercise, differentiating by gender. (2) Methods: A total of 45 children with overweight or obesity (19 girls) performed an AVG intervention combined with exercise. The AVG used were the Xbox Kinect, Nintendo Wii, dance mats, BKOOL cycling simulator, and Nintendo Switch. The energy expenditure was estimated from the heart rate recorded during the sessions and the data from the individual maximal tests. (3) Results: The mean energy expenditure was 315.1 kilocalories in a one-hour session. Participants spent the most energy on BKOOL, followed by Ring Fit Adventures, Dance Mats, Xbox Kinect, and the Nintendo Wii, with significant differences between BKOOL and the Nintendo Wii. Significant differences between boys and girls were found, but were partially due to the difference in weight, VO2max, and fat-free mass. (4) Conclusions: The energy expenditure with AVG combined with multi-component exercise was 5.68 kcal/min in boys and 4.66 kcal/min in girls with overweight and obesity. AVG could be an effective strategy to increase energy expenditure in children and adolescents with overweight and obesity.

Higher socioeconomic status is related to healthier levels of fatness and fitness already at 3 to 5 years of age: The PREFIT project.

This study aimed to analyse the association between socioeconomic status (SES) and fatness and fitness in preschoolers. 2,638 preschoolers (3-5 years old; 47.2% girls) participated. SES was estimated from the parental educational and occupational levels, and the marital status. Fatness was assessed by body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Physical fitness components were assessed using the PREFIT battery. Preschoolers whose parents had higher educational levels had lower fatness (P < 0.05). BMI significantly differed across occupational levels of each parent (P < 0.05) and WHtR across paternal levels (P = 0.004). Musculoskeletal fitness was different across any SES factor (P < 0.05), except handgrip across paternal occupational levels (P ≥ 0.05). Preschoolers with high paternal occupation had higher speed/agility (P = 0.005), and those with high or low maternal education had higher VO2max (P = 0.046). Odds of being obese and having low musculoskeletal fitness was lower as SES was higher (P < 0.05). Those with married parents had higher cardiorespiratory fitness than single-parent ones (P = 0.010). School-based interventions should be aware of that children with low SES are at a higher risk of obesity and low fitness already in the first years of life.

Dietary sources and sociodemographic and lifestyle factors affecting vitamin D and calcium intakes in European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study.

OBJECTIVE: To investigate dietary sources of Ca and vitamin D (VitD) intakes, and the associated sociodemographic and lifestyle factors, among European adolescents. DESIGN: Linear regression mixed models were used to examine sex-specific associations of Ca and VitD intakes with parental education, family affluence (FAS), physical activity and television (TV) watching while controlling for age, Tanner stage, energy intake and diet quality. SETTING: The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA)Cross-Sectional Study. SUBJECTS: Adolescents aged 12·5-17·5 years (n 1804). RESULTS: Milk and cheese were the main sources of Ca (23 and 19 % contribution to overall Ca intake, respectively). Fish products were the main VitD source (30 % contribution to overall VitD intake). Ca intake was positively associated with maternal education (ß=56·41; 95 % CI 1·98, 110·82) and negatively associated with TV viewing in boys (ß=-0·43; 95 % CI -0·79, -0·07); however, the significance of these associations disappeared when adjusting for diet quality. In girls, Ca intake was positively associated with mother's (ß=73·08; 95 % CI 34·41, 111·74) and father's education (ß=43·29; 95 % CI 5·44, 81·14) and FAS (ß=37·45; 95 % CI 2·25, 72·65). This association between Ca intake and mother's education remained significant after further adjustment for diet quality (ß=41·66; 95 % CI 0·94, 82·38). Girls with high-educated mothers had higher Ca intake. CONCLUSIONS: Low-educated families with poor diet quality may be targeted when strategizing health promotion programmes to enhance dietary Ca.

Health inequalities in urban adolescents: role of physical activity, diet, and genetics.

OBJECTIVE: Coordinated European projects relying on standardized methods are needed to identify health inequalities across Europe. This study aimed to compare fitness, fatness, and cardiometabolic risk between urban adolescents from the south and center-north of Europe and to explore whether physical activity (PA) and other factors might explain these differences. METHODS: The Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional project comprised 3528 adolescents from the south (4 cities) and central-north (6 cities) of Europe, 1089 of whom provided blood samples for analysis. Fitness (strength, speed-agility, and cardiorespiratory fitness), total and abdominal fatness (anthropometry and bioelectrical impedance), and cardiometabolic risk (z scores including fitness, fatness, blood lipids, insulin resistance, and blood pressure) were assessed. The analyses were adjusted for socioeconomic factors, objectively measured PA (accelerometry), total energy intake and diet quality, and genetic variants of the FTO rs9939609 polymorphism. RESULTS: Adolescents from southern Europe were less fit and fatter according to all markers (P < .001). Differences in cardiometabolic risk scores were not consistent. Adolescents from the south were less active and this would largely explain the differences observed in speed-agility and cardiorespiratory fitness. Differences in total and abdominal fatness could not be explained by PA, energy intake, diet quality, or FTO rs9939609 polymorphism. CONCLUSIONS: Fitness and fatness levels indicate that urban adolescents from the south are less healthy than those from central-northern Europe. Our data suggest that differences in PA might explain differences in important health-related fitness components, yet factors explaining the differences in fatness encountered remain unknown.

Inter-methods agreement for the assessment of percentage of body fat between two laboratory methods in male adolescent cyclists.

OBJECTIVE: To examine inter-methods agreement between dual energy X-ray absorptiometry (DXA) and air displacement plethysmography (ADP) in male adolescent cyclists for assessing percentage of body fat (PBF). METHODS: PBF of 24 male adolescent cyclists was assessed by DXA and ADP. Agreement between ADP and DXA was determined according to a Bland-Altman plot; validity and lack of agreement was assessed by calculating inter-methods difference. The limits of agreement and differences between methods were also calculated by paired t-tests. Heteroscedasticity was also examined. RESULTS: The values obtained by DXA were higher than those obtained by ADP, and the graph presented heteroscedasticity (both p < 0.05; r = 0.74). CONCLUSION: DXA and ADP methods were not comparable in terms of PBF assessment in our sample of male adolescent cyclists; it needs to be taken into account when evaluating longitudinal changes in this determined population.

Objetivo: Examinar la validez inter-métodos entre la absorciometría rayos X (DXA) y la pletismografía por desplazamiento de aire (PDA) en ciclistas varones adolescentes, para la evaluación del porcentaje de grasa corporal. Métodos: Se evaluó el porcentaje de grasa corporal de 24 ciclistas varones adolescentes mediante DXA y PDA. La validez inter-métodos se determinó mediante un gráfico de Bland-Altman; se calculó la diferencia intermétodo y los límites de concordancia mediante test t de Student. Se examinó también la heteroscedasticidad ente ambos métodos. Resultados: Los valores de porcentaje de grasa corporal obtenidos por el DXA fueron más elevados que los obtenidos por PDA, y el gráfico presentó heteroscedasticidad (ambos p < 0,05; r = 0,74). Conclusión: El DXA y la PDA no son métodos comparables para la evaluación del porcentaje de grasa en nuestra muestra de ciclistas varones adolescentes; esto debería ser tenido en cuenta a la hora de evaluar cambios longitudinales en esta determinada población.

Validity of hip-mounted uniaxial accelerometry with heart-rate monitoring vs. triaxial accelerometry in the assessment of free-living energy expenditure in young children: the IDEFICS Validation Study.

One of the aims of Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants (IDEFICS) validation study is to validate field measures of physical activity (PA) and energy expenditure (EE) in young children. This study compared the validity of uniaxial accelerometry with heart-rate (HR) monitoring vs. triaxial accelerometry against doubly labeled water (DLW) criterion method for assessment of free-living EE in young children. Forty-nine European children (25 female, 24 male) aged 4-10 yr (mean age: 6.9 ± 1.5 yr) were assessed by uniaxial ActiTrainer with HR, uniaxial 3DNX, and triaxial 3DNX accelerometry. Total energy expenditure (TEE) was estimated using DLW over a 1-wk period. The longitudinal axis of both devices and triaxial 3DNX counts per minute (CPM) were significantly (P < 0.05) associated with physical activity level (PAL; r = 0.51 ActiTrainer, r = 0.49 uniaxial-3DNX, and r = 0.42 triaxial Σ3DNX). Eight-six percent of the variance in TEE could be predicted by a model combining body mass (partial r(2) = 71%; P < 0.05), CPM-ActiTrainer (partial r(2) = 11%; P < 0.05), and difference between HR at moderate and sedentary activities (ModHR - SedHR) (partial r(2) = 4%; P < 0.05). The SE of TEE estimate for ActiTrainer and 3DNX models ranged from 0.44 to 0.74 MJ/days or ∼7-11% of the average TEE. The SE of activity-induced energy expenditure (AEE) model estimates ranged from 0.38 to 0.57 MJ/day or 24-26% of the average AEE. It is concluded that the comparative validity of hip-mounted uniaxial and triaxial accelerometers for assessing PA and EE is similar.

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.

Socioeconomic status and bone mass in Spanish adolescents. The HELENA Study.

PURPOSE: Socioeconomic status (SES) has been frequently associated with body composition, particularly fat mass and obesity. However, the SES-bone mass association is not clear. We aimed to evaluate the associations between different SES indicators (Family Affluence Scale, parental education, and occupation) and bone mineral content in Spanish adolescents. METHODS: Participants were 322 adolescents (164 boys and 158 girls, 12.5-17.5 years) from the Healthy Lifestyle in Europe by Nutrition in Adolescence study. The social background of the adolescents was self-reported using an SES questionnaire, and the bone variables were measured using dual-energy x-ray absorptiometry. Physical activity was measured using accelerometers. Calcium intake was estimated from two nonconsecutive 24 hours recalls. One-way analysis of covariance was performed to examine the relationships between SES indicators and bone mass using different sets of confounders: basic model (sex + sexual maturation), model 1 (basic model + height), model 2 (basic model + lean mass), and model 3 (basic model + calcium intake + average physical activity). RESULTS: Adjusted results showed no association between SES indicators and whole-body or total hip bone mineral content. Additional analyses were performed in lumbar spine, pelvis, and hip subregions (femoral neck, trochanter, and intertrochanter), and no significant associations were observed at these sites either. CONCLUSIONS: Our data do not support a link between different SES indicators (Family Affluence Scale, parental education, and occupation) and bone mass in adolescents.

Reliability and intermethod agreement for body fat assessment among two field and two laboratory methods in adolescents.

To increase knowledge about reliability and intermethods agreement for body fat (BF) is of interest for assessment, interpretation, and comparison purposes. It was aimed to examine intra- and inter-rater reliability, interday variability, and degree of agreement for BF using air-displacement plethysmography (Bod-Pod), dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and skinfold measurements in European adolescents. Fifty-four adolescents (25 females) from Zaragoza and 30 (14 females) from Stockholm, aged 13-17 years participated in this study. Two trained raters in each center assessed BF with Bod-Pod, DXA, BIA, and anthropometry (DXA only in Zaragoza). Intermethod agreement and reliability were studied using a 4-way ANOVA for the same rater on the first day and two additional measurements on a second day, one each rater. Technical error of measurement (TEM) and percentage coefficient of reliability (%R) were also reported. No significant intrarater, inter-rater, or interday effect was observed for %BF for any method in either of the cities. In Zaragoza, %BF was significantly different when measured by Bod-Pod and BIA in comparison with anthropometry and DXA (all P < 0.001). The same result was observed in Stockholm (P < 0.001), except that DXA was not measured. Bod-Pod, DXA, BIA, and anthropometry are reliable for %BF repeated assessment within the same day by the same or different raters or in consecutive days by the same rater. Bod-Pod showed close agreement with BIA as did DXA with anthropometry; however, Bod-Pod and BIA presented higher values of %BF than anthropometry and DXA.

Food and drink intake during television viewing in adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study.

OBJECTIVE: To compare food consumption during television (TV) viewing among adolescents who watched >2 h/d v. ≤2 h/d; and to examine the association between sociodemographic variables (age, gender and socio-economic status (SES)) and the consumption of energy-dense foods and drinks during TV viewing. DESIGN: The data are part of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional survey. Data on time watching TV, types of foods and drinks consuming during TV viewing and parental SES (parental education, parental occupation and family affluence) were measured by questionnaires completed by adolescents. Binary logistic regression tested the association between energy-dense foods and drinks and (i) sociodemographic variables and (ii) TV time. SETTING: Ghent (Belgium), Heraklion (Greece), Pecs (Hungary) and Zaragoza (Spain). SUBJECTS: Girls (n 699) and boys (n 637) aged 12·5-17·5 years. RESULTS: Boys reported more frequent consumption of beer and soft drinks whereas girls selected more fruit juice, water, herbal infusions and sweets (all P ≤ 0·05). Watching TV for >2 h/d was associated with the consumption of energy-dense foods and drinks. Girls whose mothers achieved the lowest education level had an adjusted OR of 3·22 (95 % CI 1·81, 5·72) for the consumption of energy-dense drinks during TV viewing v. those whose mothers had the highest educational level. CONCLUSIONS: Excessive TV watching may favour concurrent consumption of energy-dense snacks and beverages. Adolescents from low-SES families are more likely to consume unhealthy drinks while watching TV.

Sedentary behaviours and socio-economic status in Spanish adolescents: the AVENA study.

BACKGROUND: This study aimed to describe the influence of socio-economic status (SES) on the prevalence sedentary behaviours among Spanish adolescents. METHODS: Cross-sectional data from Spanish adolescents from the Alimentación y Valoración del Estado Nutricional de los Adolescentes (AVENA) Study (2002). A national representative sample of 1776 adolescents aged 13-18.5 years provided information about time spent watching television (TV), playing with computer or videogames and studying. Parental education and occupation were assessed as SES. Participants were categorized by gender, age, parental education and occupation. Logistic regression models were used. RESULTS: No gender differences were found for TV viewing. For computer and videogames use (weekdays), more boys played >3 h/day (P < 0.001), whereas a higher percentage of girls reported studying >3 h/day (P < 0.001). Among boys, parental education and occupation were inversely associated with TV viewing, parental occupation directly associated with study and maternal education inversely with computer and videogames use during weekdays (all P < 0.05). For girls, parental occupation was inversely associated with TV viewing. CONCLUSION: Spanish adolescents presented different sedentary patterns according to age, gender and SES. Boys reported more time engaged in electronic games, whereas girls reported more time studying. Parental occupation had more influence than parental education on the time spent in sedentary behaviours.

Extra-curricular participation in sports and socio-demographic factors in Spanish adolescents: the AVENA study.

The aims of this study were to identify differences between the sexes in extra-curricular participation in sports and to determine its association with body fat and socio-demographic factors in Spanish adolescents. A total of 2165 adolescents (1124 males and 1041 females) aged 13.0-18.5 years from the AVENA Study participated. Participants filled in an ad hoc questionnaire for extra-curricular participation in sports, which was the dependent variable. Independent variables were: age, percent body fat, and father's and mother's educational level and occupation. Chi-square tests and logistic regression were applied. Bivariate analysis showed for male adolescents that age and father's occupation were related to extra-curricular participation in sports. In addition, body fat and mother's education and occupation (all P < 0.05) were related to extra-curricular participation of in sports for female adolescents. Logistic regression analysis showed that the likelihood of involvement in extra-curricular participation in sports was 5.3-fold (3.86-7.38) higher for males than females. Age and father's education in both males and females were independently associated with extra-curricular participation in sports. In summary, Spanish male adolescents were shown to engage in more extra-curricular sports than females. In addition, age and father's education (in both sexes) were associated with the participation of their offspring in extra-curricular sports during adolescence.

Influence of socioeconomic factors on fitness and fatness in Spanish adolescents: the AVENA study.

OBJECTIVE: This study was to examine the influence of socioeconomic status on fitness and fatness in Spanish adolescents. SUBJECTS AND METHODS: A total of 1 795 adolescents (833 boys) aged 12.5-18.5 years from the AVENA study participated in this study. The following physical fitness components were assessed: muscular strength (standing long jump), speed-agility (4 × 10 m shuttle run) and cardiorespiratory fitness (20 m shuttle run). Total and central body fat was assessed using skinfold thickness and waist circumference, respectively. Both parents reported their educational and professional level. RESULTS: Girls with higher paternal educational level and boys with higher either maternal or paternal professional level had higher muscular strength levels (all P<0.05). Speed-agility and cardiorespiratory fitness were not associated with parental educational or professional levels in boys. In contrast, girls with higher paternal educational level or higher parental professional level had higher levels in both fitness components (all P<0.05). A higher maternal educational level was associated with lower total and central body fat in boys (all P<0.05), but not in girls. We observed a small effect size (Cohen's d∼0.2) in most of these associations. CONCLUSIONS: Our results suggest modest associations of high socioeconomic status with better fitness and fatness levels in Spanish adolescents. These associations greatly depend on the socioeconomic status and fitness parameters studied.

Television watching, videogames, and excess of body fat in Spanish adolescents: the AVENA study.

OBJECTIVE: We assessed the individual association of sedentary behaviors with the risk of overweight and excess body fat (overfat) in adolescents. METHODS: A representative sample (1960 subjects, 1012 males, age 13-18.5 y) of Spanish adolescents was studied within the framework of the Alimentación y Valoración del Estado Nutricional de los Adolescentes (AVENA) study. Television (TV) watching, videogame and computer usage, doing homework, and the way students got to school, physical activity, and socioeconomic status were analyzed. Anthropometrics were measured to describe overweight (International Obesity Task Force cutoffs for body mass index) and overfat (body fat percentage >85th percentile). RESULTS: When all subjects were considered as an entire group, the overweight risk increased by 15.8% (P < 0.05) per increasing hour of TV watching. The overweight risks decreased by 32.5% in females, 22% per increasing year of age, and 12.5% by increasing socioeconomic status by 1 U (all Ps < 0.05). The obesity risks decreased with age by 17.8% per year in males and 27.1% in females (both Ps < 0.05). The overfat risks increased by 26.8% and 9.4% per increasing hour of TV and weekend videogame usage, respectively (both Ps < 0.05). In males, the overfat risk increased by 21.5% per increasing hour in weekend videogame usage (P < 0.05). Each hour of TV use increased the overfat risks by 22% in males and 28.3% in females (both Ps < 0.05). CONCLUSIONS: Time spent watching TV increased the risk of overweight and obesity in Spanish adolescents, but the effect was influenced by age, sex, and socioeconomic status. Moreover, an excess of body fat was more directly explained by the time spent watching TV and playing videogames during the weekend.