School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials.

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

A school-based physical activity promotion intervention in children: rationale and study protocol for the PREVIENE Project.

BACKGROUND: The lack of physical activity and increasing time spent in sedentary behaviours during childhood place importance on developing low cost, easy-toimplement school-based interventions to increase physical activity among children. The PREVIENE Project will evaluate the effectiveness of five innovative, simple, and feasible interventions (active commuting to/from school, active Physical Education lessons, active school recess, sleep health promotion, and an integrated program incorporating all 4 interventions) to improve physical activity, fitness, anthropometry, sleep health, academic achievement, and health-related quality of life in primary school children. METHODS: A total of 300 children (grade 3; 8-9 years of age) from six schools in Granada (Spain) will be enrolled in one of the 8-week interventions (one intervention per school; 50 children per school) or a control group (no intervention school; 50 children). Outcomes will include physical activity (measured by accelerometry), physical fitness (assessed using the ALPHA fitness battery), and anthropometry (height, weight and waist circumference). Furthermore, they will include sleep health (measured by accelerometers, a sleep diary, and sleep health questionnaires), academic achievement (grades from the official school's records), and health-related quality of life (child and parental questionnaires). To assess the effectiveness of the different interventions on objectively measured PA and the other outcomes, the generalized linear model will be used. DISCUSSION: The PREVIENE Project will provide the information about the effectiveness and implementation of different school-based interventions for physical activity promotion in primary school children.

Associations between patterns of active commuting and socioeconomic factors in women with fibromyalgia: the al-Ándalus project.

OBJECTIVES: The aims of this study were to know whether active commuting behaviour differs between fibromyalgia patients and controls, and to test whether active commuting is associated with socioeconomic factors in this population. METHODS: This cross-sectional study included 459 women with fibromyalgia (52.2 years) and 214 female control participants (51.3 years) from Andalusia (southern Spain). Participants reported patterns of active commuting and socioeconomic factors (civil status, accompaniment at home, living with, educational level, and current occupational and professional status). RRESULTS: On the age group <51 years, women with fibromyalgia revealed a significant higher percentage of active commuting for the variable active worker commuters than control group (p<0.05). On the age group ≥51 years, control group displayed a significant higher percentage of active commuting for commuting to local shops, super-market and active commuters variables (all, p<0.05). Women with fibromyalgia who lived alone were more active commuters in comparison to either those living accompanied, or living with both partner and children, only partner and only children (all, p<0.05). CONCLUSIONS: The prevalence of active commuting was similar in women with fibromyalgia and controls aged <51 years. However, fibromyalgia participants aged ≥51 years displayed differences: fibromyalgia women who lived alone were more active commuters than those living accompanied; family demands were inversely associated with commuting patterns. Policies focused on reducing family demands for fibromyalgia patients (i.e. social help on housework, childcare or overprotection) might facilitate the inclusion of daily active behaviours.

Effectiveness of a tai-chi training and detraining on functional capacity, symptomatology and psychological outcomes in women with fibromyalgia.

Background. The purpose was to analyze the effects of Tai-Chi training in women with fibromyalgia (FM). Methods. Thirty-two women with FM (mean age, 51.4 ± 6.8 years) attended to Tai-Chi intervention 3 sessions weekly for 28 weeks. The outcome measures were: tenderness, body composition, functional capacity and psychological outcomes (Fibromyalgia impact questionnaire (FIQ), Short Form Health Survey 36 (SF-36)). Results. Patients showed improvements on pain threshold, total number of tender points and algometer score (all P < 0.001). The intervention was effective on 6-min walk (P = 0.006), back scratch (P = 0.002), handgrip strength (P = 0.006), chair stand, chair sit & reach, 8 feet up & go and blind flamingo tests (all P < 0.001). Tai-Chi group improved the FIQ total score (P < 0.001) and six subscales: stiffness (P = 0.005), pain, fatigue, morning tiredness, anxiety, and depression (all P < 0.001). The intervention was also effective in six SF-36 subscales: bodily pain (P = 0.003), vitality (P = 0.018), physical functioning, physical role, general health, and mental health (all P < 0.001). Conclusions. A 28-week Tai-Chi intervention showed improvements on pain, functional capacity, symptomatology and psychological outcomes in female FM patients.

Land- and water-based exercise intervention in women with fibromyalgia: the al-Andalus physical activity randomised controlled trial.

BACKGROUND: The al-Andalus physical activity intervention study is a randomised control trial to investigate the effectiveness of a land- and water-based exercise intervention for reducing the overall impact of fibromyalgia (primary outcome), and for improving tenderness and pain-related measures, body composition, functional capacity, physical activity and sedentary behaviour, fatigue, sleep quality, health-related quality of life, and cognitive function (secondary outcomes) in women with fibromyalgia. METHODS/DESIGN: One hundred eighty women with fibromyalgia (age range: 35-65 years) will be recruited from local associations of fibromyalgia patients in Andalucía (Southern Spain). Patients will be randomly assigned to a usual care (control) group (n = 60), a water-based exercise intervention group (n = 60) or a land-based exercise intervention group (n = 60). Participants in the usual care group will receive general physical activity guidelines and participants allocated in the intervention groups will attend three non-consecutive training sessions (60 min each) per week during 24 weeks. Both exercise interventions will consist of aerobic, muscular strength and flexibility exercises. We will also study the effect of a detraining period (i.e., 12 weeks with no exercise intervention) on the studied variables. DISCUSSION: Our study attempts to reduce the impact of fibromyalgia and improve patients' health status by implementing two types of exercise interventions. Results from this study will help to assess the efficacy of exercise interventions for the treatment of fibromyalgia. If the interventions would be effective, this study will provide low-cost and feasible alternatives for health professionals in the management of fibromyalgia. Results from the al-Andalus physical activity intervention will help to better understand the potential of regular physical activity for improving the well-being of women with fibromyalgia. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT01490281.

Physical activity among Spanish adolescents: relationship with their relatives' physical activity - the AVENA study.

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

Relationship between Sedentary Time, Physical Activity, and Health-Related Quality of Life in Spanish Children.

Higher sedentary time and lower physical activity (PA) are associated with a poor health-related quality of life (HRQoL) in children. The aims of this study were: (1) to analyze the sedentary time, objectively measured PA levels (light, moderate, vigorous, and moderate-to-vigorous physical activity (MVPA)), and HRQoL dimensions (physical well-being, emotional well-being, self-esteem, family, friends, school, and total score) in children; and (2) to examine the association between sedentary time, PA levels, and HRQoL in children separately by sex. A total of 459 children (8.4 ± 0.4 years old, 50.54% males) from 15 schools in Granada (Spain) participated in the study. A tri-axial accelerometer was used to measure PA levels in the children for 7 consecutive days. The Revidierter KINDer Lebensqualitätsfragebogen (KINDL-R) questionnaire was used to determine the children's HRQoL dimensions. The results showed that males presented more minutes engaged in MVPA than females. Both sedentary time and PA levels were associated with self-esteem and total score (all p < 0.05). In males, moderate and vigorous PA levels were associated with higher HRQoL, whereas light PA was associated with higher HRQoL in females. Future studies should take into account the use of activities with difference intensities in order to increase HRQoL in males and females.

Physical activity, fitness, weight status, and cognitive performance in adolescents.

OBJECTIVE: To examine the association of participation in physical sports activity during leisure time, sedentary behaviors, cardiorespiratory and muscular fitness, and weight status with cognitive performance in Spanish adolescents. STUDY DESIGN: This cross-sectional study comprised a total of 1820 adolescents (958 female) aged 13.0 to 18.5 years. Cognitive performance (verbal, numeric and reasoning abilities, and an overall score) was measured with the "SRA-Test of Educational Ability." Participation in physical sports activity during leisure time (yes/no) and time devoted to study, television viewing, and playing video games were self-reported and categorized as ≤ 3 hours/day and >3 hours/day. We assessed cardiorespiratory and muscular fitness with field-based tests. Adolescents were classified as underweight, normal weight, overweight, and obese. RESULTS: Participation in physical sports activities during leisure time was associated with better cognitive performance study variables (all P < .001), independent of potential confounders including cardiorespiratory fitness and body mass index. We did not observe an association of time devoted to study, television viewing, or playing video-games with cognitive performance. Likewise, cognitive performance was similar across cardiorespiratory and muscular fitness levels and body weight categories. CONCLUSION: Participation in physical sports activity during leisure time may positively influence cognitive performance in adolescents.

Bidirectional Associations between Objective Physical Activity and Sleep Patterns in Spanish School Children.

Physical activity (PA) and sleep contribute to better children's health. Nonetheless, the bidirectional relationship between both of these health-related factors is unclear when using objective measures. The aims of this study were (1) to describe the PA (light PA and moderate-to-vigorous PA (MVPA) and sleep (duration, latency, and efficiency) patterns of children and compare them with recommendations, and (2) to analyze the bidirectional association between PA levels and sleep patterns in 470 Spanish children according to sex (average age of 8.4 (0.4) years, 51.9% boys). A tri-axial accelerometer and sleep logs were used to measure PA (light PA and MVPA) and sleep patterns (duration, latency, and efficiency) in the children for seven consecutive days. Linear mixed models were conducted to analyze the bidirectional association (PA ⇒ sleep and sleep ⇒ PA) adjusted for the child, the sex, the school, and the day of observation. The results showed that, overall, the children did not meet the sleep duration recommendations per day. Regarding the bidirectional association, increased light PA and MVPA during the day was related to decreased sleep duration but an improvement in sleep efficiency that night. However, sleep duration and sleep efficiency were only related negatively and positively to light PA the following day, respectively. Regarding sex, light PA was associated with decreased sleep duration in both sexes, although the average value was lower in boys. In addition, light PA was also related only to an improvement in sleep efficiency the same night in both sexes, with girls generally having more efficient sleep. More studies in a representative sample of children that use objective measures to corroborate these results are needed.

Socio-economic factors and active commuting to school in urban Spanish adolescents: the AVENA study.

BACKGROUND: This study aimed: (i) to describe the patterns of commuting to school in urban Spanish adolescents; and (ii) to examine the associations between active commuting to school (ACS) and socio-economic factors. METHODS: From the AVENA Study, 2183 adolescents (1142 females) aged 13-18.5 years were gathered. Mode and time of transportation to school were self-reported by the adolescents. Parental education level (primary, secondary or university degree), parental professional level (managerial, skilled worker or unskilled worker/unemployed) and the type of school (public or private) were self-reported by the parents. The relationships between ACS and socio-economic factors were analysed by binary logistic regression. RESULTS: Nearly <65% of the adolescents reported ACS and 83% of them spent <15 min travelling to school. In male adolescents, maternal primary education level showed an odds ratio (OR) of 1.55 (95% confidence interval, 1.12-2.15), with respect to mothers with a university degree. In female adolescents, mothers with a primary education level showed an OR of 0.68 (0.50-0.92), with respect to mothers with a university degree. Low maternal professional level showed an OR of 1.70 (1.29-2.24), with respect to high maternal professional levels. Students attending public schools showed an OR of 3.47 (2.46-4.90), with respect to students from private schools. CONCLUSION: Most of the adolescents actively commuted to school, yet the time spent commuting was low. Socio-economic level seems to be inversely related to the ACS in adolescents. Type of school and maternal educational level were the main predictors of ACS.

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.

Are there gender differences in quality of life and symptomatology between fibromyalgia patients?

The purpose of this study is to examine gender differences in quality of life (QoL) and symptomatology in fibromyalgia (FM) patients. A total of 20 men (48.0 ± 8.0 years) and 78 women (49.8 ± 7.2 years) with FM participated in the study (age range 31-63 years). Health-related QoL and FM impact were assessed by means of the Spanish versions of the Short-Form-36 Health Survey (SF36) and the Fibromyalgia Impact Questionnaire (FIQ), respectively. Comparisons in QoL were performed using one-way analysis of covariance adjusted by age and body mass index (BMI), and comparisons in FIQ dimensions were performed using Mann-Whitney test. Overall FM impact, as measured by FIQ-total score (p = .01) and FIQ-physical impairment (p = .02) was higher in men, whereas women presented higher values of FIQ-fatigue and FIQ-morning tiredness (p = .04) and less SF36-vitality (p = .02). Therefore, women appear to feel more fatigue, whereas men present higher FM overall impact. Due to the small number of men included in this study and the consequent small statistical power, these results should be taken as preliminary. Higher powered studies are warranted to further address gender differences in FM in order to design more successful treatments.

Preliminary findings of a 4-month Tai Chi intervention on tenderness, functional capacity, symptomatology, and quality of life in men with fibromyalgia.

The study aimed to determine the effects of a 4-month Tai Chi intervention on tenderness, functional capacity, symptomatology, and quality of life in men with fibromyalgia. The effect of a 3-month detraining period was also analyzed. Six men with fibromyalgia (age 52.3 ± 9.3 years) followed a 4-month Tai Chi intervention. The outcome variables were tenderness, functional capacity (30-second chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8 feet up and go, and 6-minute walk tests), and self-administered questionnaires. A significant improvement (p = .028) after the intervention period for the chair sit and reach test was found, such improvement was maintained after the detraining phase. Tenderness, symptomatology, and quality of life did not significantly change after the intervention period or the detraining phase. In summary, a 4-month Tai Chi intervention improved lower body flexibility in men with fibromyalgia. This improvement persisted after the detraining period.

Efficacy of Biodanza for treating women with fibromyalgia.

OBJECTIVE: The objective of this study was to determine the effects of a 3-month Biodanza intervention in women with fibromyalgia (FM). DESIGN: This was a controlled trial. SETTING/LOCATION: The study was conducted at a university research laboratory and social center. SUBJECTS: The study comprised 59 women with FM recruited from a local association of patients with FM. Participants were allocated to the Biodanza intervention group (n = 27) or usual-care group (n = 32). INTERVENTION: The Biodanza intervention was carried out once a week for 3 months. OUTCOME MEASURES: The outcome measures included the following: Pain threshold, body composition (body-mass index and estimated body fat percentage), physical fitness (30-second chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8 feet up and go, and 6-minute walk test) and psychologic outcomes (Fibromyalgia Impact Questionnaire [FIQ], Short-Form Health Survey 36, Vanderbilt Pain Management Inventory, Hospital Anxiety and Depression Scale, General Self-Efficacy Scale, and Rosenberg Self-Esteem Scale). RESULTS: We observed a significant interaction effect (group*time) for pain threshold of several tender points (left [L] and right [R] side of the anterior cervical and supraspinatus, trapezius L and lateral epicondyle R, algometer score, tender points count), body fat percentage, and FIQ total score. In the intervention group, post hoc analysis revealed a significant improvement in pain threshold of the anterior cervical R and L and supraspinatus R and L tender points (all p < 0.05), algometer score (p = 0.008), tender point count (p = 0.002), body fat percentage (p = 0.001), and FIQ total score (p = 0.003). CONCLUSIONS: A 3-month (one session per week) Biodanza intervention shows improvements on pain, body composition, and FM impact in female patients.

Cardiorespiratory fitness and sedentary activities are associated with adiposity in adolescents.

OBJECTIVE: To determine whether physical activity, sedentary activities, and/or cardiorespiratory fitness are related to waist circumference in adolescents, as previously reported in adults. RESEARCH METHODS AND PROCEDURES: The study subjects were a representative sample of Spanish adolescents (N = 2859; 1357 boys, 1502 girls; age, 13 to 18.5 years), all of whom were involved in the AVENA (Food and Assessment of the Nutritional Status of Adolescents) study. BMI, waist circumference, pubertal maturation status, and cardiorespiratory fitness were measured in all. Leisure-time physical activity, sedentary activities, active commuting to school, and socioeconomic status were assessed by self-reported questionnaires. RESULTS: No relationship was found between leisure-time physical activity and BMI or waist circumference. In contrast, and in both boys and girls and after adjustment for confounding variables, cardiorespiratory fitness was found to be inversely associated with waist circumference and BMI, independent of sedentary activities or physical activity (p < or = 0.001). The maximum oxygen consumption explained 13% of the variance in waist circumference in boys and 16% in girls. Sedentary activities were independently and directly related to waist circumference in both boys and girls (p < or = 0.05) and to BMI in boys (p < or = 0.05). Sedentary activities explained 10% of the variance in waist circumference in boys and 18% in girls. The BMI-adjusted waist circumference was inversely correlated with cardiorespiratory fitness in overweight-obese boys (p < or = 0.05) and showed a trend toward significance in girls (p < or = 0.1). DISCUSSION: Both moderate to high levels of cardiorespiratory fitness and sedentary activities, but not physical activity, are associated with lower abdominal adiposity, as measured by waist circumference.