Effectiveness of Land- and Water-based Exercise on Fatigue and Sleep Quality in Women With Fibromyalgia: The al-Ándalus Quasi-Experimental Study.

OBJECTIVE: To assess the effectiveness of 24 weeks of land- and water-based exercise on fatigue and sleep quality in women with fibromyalgia, and the persistence of changes 12 weeks after exercise cessation. DESIGN: Quasi-experimental study. SETTING: University facilities and fibromyalgia associations. PARTICIPANTS: Women with fibromyalgia (N=250; 50.8±7.6 years old). INTERVENTIONS: Participants were assigned to land-based exercise (n=83), water-based exercise (n=85), or no exercise control (n=82) groups. The intervention groups engaged in a similar multicomponent exercise program for 24 weeks. MAIN OUTCOME MEASURES: The Multidimensional Fatigue Inventory and Pittsburgh Sleep Quality Index were used. RESULTS: Intention-to-treat analyses revealed that, compared with the control group, at week 24: (i) the land-based exercise group improved physical fatigue (mean difference -0.9 units; 95% confidence interval -1.7 to -0.1; Cohen's d=0.4) and (ii) the water-based exercise group improved general fatigue (-0.8; -1.4 to -0.1, d=0.4), and global sleep quality (-1.6; -2.7 to -0.6, d=0.6). Additionally, compared with the land-based exercise group, the water-based exercise group improved global sleep quality (-1.2; -2.2 to -0.1, d=0.4). Changes were generally not sustained at week 36. CONCLUSION: Land-based multicomponent exercise improved physical fatigue, whereas water-based exercise improved general fatigue and sleep quality. The magnitude of the changes was small-to-medium, and no benefits were maintained after exercise cessation.

Longitudinal association of sedentary time and physical activity with pain and quality of life in fibromyalgia.

OBJECTIVE: To analyze changes over time and the predictive value of baseline and changes of sedentary time (ST) and physical activity (PA) on pain, disease impact, and health-related quality of life (HRQoL) at 2- and 5-year follow-up in women with fibromyalgia. METHODS: This is a longitudinal and exploratory study with three time points. A total of 427 women with fibromyalgia (51.4 ± 7.6 years) were followed after 2 (n = 172) and 5 years (n = 185). ST and PA (light and moderate-to-vigorous [MVPA]) were assessed using triaxial accelerometers. Pain, disease impact, and HRQoL were measured using: pressure pain threshold, the pain subscale of the revised fibromyalgia impact questionnaire (FIQR), the bodily pain subscale of the 36-item short-form health survey (SF-36), a visual analog scale (VAS), the FIQR, and the SF-36 physical and mental components. RESULTS: Over 5 years, pressure pain threshold, ST, light PA, and MVPA variables were worsened, while FIQR and SF-36 variables were improved (Cohen's d < 0.1-0.3). Baseline ST or light PA were not associated with future outcomes, whereas greater MVPA at baseline was associated with better SF-36 bodily pain at 5-year follow-up (ß = 0.13). Reducing ST and increasing light PA were associated with better bodily pain (ß = -0.16 and 0.17, respectively) and SF-36 physical component (ß = -0.20 and 0.17, respectively) at 5-year follow-up. Increasing MVPA was associated with less pain (pressure pain threshold, VAS, and FIQR-pain) and better SF-36 physical component at 2- and 5-year follow-up (ß's from -0.20 to 0.21). CONCLUSIONS: Objectively measured variables slightly worsened over years, while for self-reported outcomes there was a trend for improvement. Reductions in ST and increases in light PA and MVPA were associated with better HRQoL at 5-year follow-up, and increases in MVPA were additionally associated with better pain and HRQoL at 2-year follow-up.

An m-Health telerehabilitation and health education program on physical performance in patients with hip fracture and their family caregivers: Study protocol for the ActiveHip+ randomized controlled trial.

Telerehabilitation interventions administered via a smartphone may provide new feasible and effective rehabilitation options at home for patients with hip fracture. However, to date, no such interventions have been shown to be effective in the recovery key health outcomes of these patients. The present multicentre randomized controlled trial (RCT) aims to test the effect of the ActiveHip+ m-Health system in the recovery of physical performance, functional level, quality of life, and other health-related outcomes in both patients with hip fracture and their family caregivers. A total of 104 patients older than 65 years, with hip fracture, and their family caregivers will be randomized into the ActiveHip+ rehabilitation (N = 52) or the control group (N = 52). ActiveHip+ is a 12-week smartphone-based rehabilitation program conducted in Granada and Cádiz (Spain) that includes: (1) 24 sessions of physical exercise and 12 sessions of occupational therapy; (2) seven educational modules for patients and for caregivers; and (3) general recommendations in activities of daily living. The control group will receive the usual rehabilitation protocol offered by the Andalusian Public Healthcare System. The primary outcome is the patient's physical performance, while the secondary outcomes are the patient's functional level, quality of life, pain, fear of falling, fitness perception, pre-fracture functional level, emotional status, and caregiver burden. The present project will substantially contribute to the existing knowledge by testing for the first time the efficacy and feasibility of a multidisciplinary m-Health system in the rehabilitation of patients with hip fracture.

Objectively measured sedentary time and physical activity levels in Spanish pregnant women. Factors affecting the compliance with physical activity guidelines.

The aims of this cross-sectional study were to describe objectively measured sedentary time (ST) and physical activity (PA) levels in Spanish pregnant women, to analyze the degree of compliance with PA guidelines during the early second trimester of pregnancy and to explore sociodemographic and clinical factors associated with meeting these PA guidelines. One hundred and thirty-four Caucasian pregnant women were recruited between October 2015 and October 2017 to participate in this study. Triaxial accelerometers were used to analyze ST andPA levels for seven consecutive valid days. Womenspent512 ± 92.1 minutes daily in sedentary behaviors, and 85 ± 108.2 minutes in moderate-to-vigorous physical activity (MVPA) in bouts of at least 10 minutes. They walked on average 7436 ± 2410steps per day. Only 22% of the study sample complied with the PA guidelines. Having an University degree was related with threefold higher odds of compliance with the PA guidelines (95% confidence interval: 0.096-0.913, p < .05). Binary logistic regressions showed that being primiparous was associated with fivefold higher odds of compliance with the PA guidelines (95% confidence interval 1.658-18.039, respectively, p < .01). Maternal age, BMI, marital status, working status, and previous miscarriages were not associated with compliance with PA guidelines. Pregnant women spent more than a third of the day in sedentary behaviors and the compliance with PA guidelines was less than desirable. Finally, not having an university degree or having children could be factors related to lower odds of compliance with these guidelines, and therefore require special attention from healthcare professionals.

International Fitness Scale-IFIS: Validity and association with health-related quality of life in pregnant women.

This study aimed (a) to examine the construct validity of the International Fitness Scale (IFIS) to discriminate between different objectively measured physical fitness levels in pregnant women and (b) to assess the extent to which IFIS is able to discriminate between pregnant women with different levels of health-related quality of life (HRQoL). A total of 159 pregnant women were involved in the GESTAtion and FITness project: 106 pregnant women (mean age 32.7, SD 4.4 years) were included. Self-reported physical fitness-that is, cardiorespiratory fitness, muscular strength, flexibility, and overall fitness-was assessed with the IFIS. Physical fitness was objectively measured using the Bruce test, the handgrip strength test and the back-scratch test. The HRQoL was assessed with the 36-item Short Form Health Survey (SF-36). Higher self-reported physical fitness measured with IFIS was associated with higher objectively measured physical fitness (P < .05). There was a linear association so that higher self-reported physical fitness (ie, IFIS; regardless of the fitness component) was related to greater General Health dimension scores (P < .05). Moreover, higher self-reported physical fitness (all components except muscular strength) was associated with better Physical Functioning, lower Bodily Pain and higher Vitality scores (ie, SF-36 components). This linear trend was not seen for objectively measured physical fitness. The results of this study suggest that IFIS might be a useful tool for identifying pregnant women with low or very low physical fitness and with low quality of life health-related. Further research should elucidate whether IFIS can identify women with pregnancy complications before it can be implemented in clinical practice.

Association of Patterns of Moderate-to-Vigorous Physical Activity Bouts With Pain, Physical Fatigue, and Disease Severity in Women With Fibromyalgia: the al-Ándalus Project.

OBJECTIVES: To examine the associations of non-bouted moderate-to-vigorous physical activity (MVPA) and patterns of MVPA in bouts ≥10 minutes with pain, physical fatigue, and disease severity in women with fibromyalgia, and test whether these associations are independent of sedentary time (ST) and physical fitness (PF). DESIGN: Cross-sectional study carried out from November 2011 to January 2013. SETTING: University facilities and fibromyalgia associations. PARTICIPANTS: Women with fibromyalgia (N=439; 51.3±7.6y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: ST and MVPA were measured with triaxial accelerometry, and PF with the Senior Fitness test battery. We assessed pain, physical fatigue and disease severity with diverse questionnaires. RESULTS: Total time in non-bouted MVPA only was independently associated with lower physical fatigue (B=-0.012; P=.010) and disease severity (B=-0.068; P=.007) in women with fibromyalgia, regardless of PF but not of ST. Patterns of bouted MVPA were overall associated with symptoms independently of ST or PF. The strongest regressor was the maximum time in MVPA bout (min/bout), which was consistently and independently associated with pain, physical fatigue and disease severity after controlling for ST or PF (all, P≤.002). Patients meeting bouted physical activity guidelines displayed lower disease severity than those not meeting guidelines (bouted or non-bouted) and those meeting non-bouted physical activity guidelines (all, P≤.008). CONCLUSIONS: Patterns of MVPA performed in bouts ≥10 minutes were overall consistently and independently associated with core symptoms (pain and fatigue) in fibromyalgia and the overall disease severity, regardless of ST or PF. The results suggest that longer bouts of continuous MVPA are associated with better symptoms profile in this population, which needs to be corroborated in longitudinal research.

Association of self-reported physical fitness with pain during pregnancy: The GESTAFIT Project.

AIMS: To explore the association of self-reported physical fitness with bodily, lumbar and sciatic pain, and pain disability during pregnancy. METHODS: The present study sample comprised 159 pregnant women (32.9 ± 4.7 years old). Self-reported physical fitness was assessed with the International Fitness Scale (IFIS), where higher scores indicate greater physical fitness. Bodily pain was assessed with the 36-Item Short Form Health Survey (SF-36), where higher scores indicate lower pain. Lumbar and sciatic pain were measured with a visual analogue scale (VAS). The Oswestry Disability Index (ODI) questionnaire was employed to assess the disability resulting from pain. Measures were assessed at 16th and 34th gestational weeks (g. w.). RESULTS: Pregnant women showed low-moderate pain during pregnancy course. Most of them showed medium self-reported overall physical fitness. At 16th g. w., greater self-reported overall physical fitness and cardiorespiratory fitness were associated with less bodily and lumbar pain, and pain disability (all, P < 0.05). Greater muscular strength was associated with less bodily pain and pain disability (both, P < 0.05). Greater speed-agility was associated with less bodily pain (P < 0.01) and less pain disability (P < 0.05). Self-reported flexibility was not associated with any outcome (P > 0.05). At 34th g. w., greater overall physical fitness and its components were associated with less bodily and sciatic pain (all, P < 0.05). CONCLUSION: Greater self-reported overall physical fitness and its components are associated with less bodily, lumbar and sciatic pain, and reduced pain disability during pregnancy. Future studies are needed to explore whether increasing physical fitness before and during pregnancy could decrease pain in this relevant stage.

Sedentary time, physical activity, and sleep quality in fibromyalgia: The al-Ándalus project.

PURPOSE: To get insight into the potential significance of objectively measured sedentary time (ST), and physical activity (PA) intensity levels on sleep quality (SQ) in women with fibromyalgia; and to assess whether those who meet moderate-to-vigorous PA (MVPA) recommendations have better SQ than their counterparts. METHODS: Four-hundred and nine women with fibromyalgia (age range 30-65 years old) from Andalusia (southern Spain) were included in this cross-sectional study. Sedentary time, PA intensity levels (light, moderate, and MVPA), and total PA were assessed with accelerometers during seven consecutive days. Sleep quality was measured with the Pittsburgh Sleep Quality Index self-report questionnaire. RESULTS: Higher ST was associated with worse subjective SQ, sleep duration, sleep disturbances, daytime dysfunction, and SQ global score (all, P < 0.05). All PA levels were associated with better subjective SQ and sleep latency and with less sleep medication and daytime dysfunction (all, P < 0.05). In addition, light and total PA were associated with better sleep efficiency, SQ global score, and less sleep disturbances (all, P < 0.05). Finally, women meeting bouted PA recommendations displayed better SQ than patients not meeting the recommendations (bouted or non-bouted). CONCLUSION: Lower ST and greater PA levels are associated with better SQ in women with fibromyalgia. This result demonstrates that those patients with fibromyalgia who reduce periods of inactivity and perform PA could be better sleepers, which might contribute to a lower severity of the disease. It is noteworthy that meeting bouted PA recommendations is associated with better SQ.

Association of sedentary time and physical activity during pregnancy with maternal and neonatal birth outcomes. The GESTAFIT Project.

AIM: (a) To analyse the association of objectively measured sedentary time (ST) and physical activity (PA) during early second trimester of pregnancy with maternal and neonatal birth outcomes; (b) to explore if ST and PA differ between women with vaginal or caesarean section deliveries. METHODS: Ninety-four Caucasian pregnant women (32.9 ± 4.6 years old) participated in this prospective longitudinal study. Triaxial accelerometers were used to assess ST and PA intensity levels for seven consecutive days during second trimester of pregnancy. Birth data were collected from the obstetric medical records. Umbilical cord arterial and venous blood gas (pH, partial pressure of carbon dioxide and oxygen, and oxygen saturation) were analysed after birth. RESULTS: After adjusting for potential confounders, greater ST was associated with higher arterial and venous cord blood partial pressure of carbon dioxide and more acidic arterial and venous pH (all, P < 0.01). Moderate PA, moderate-to-vigorous PA (MVPA), total PA and steps per day were positively associated with arterial cord blood oxygen saturation (all P < 0.05). Steps per day were inversely associated with gestational age at birth (P < 0.01), and duration of first stage of labor (P < 0.05). Total and light PA were associated with a more alkaline pH in umbilical vein (all, P < 0.01). Vigorous PA was inversely associated with the Apgar score (P < 0.01). No significant differences were observed in ST and PA levels between women with vaginal and women with caesarean section deliveries (all, P > 0.10). CONCLUSION: Increasing PA and decreasing ST during pregnancy might promote better maternal and neonatal birth markers.

Identification of candidate genes associated with fibromyalgia susceptibility in southern Spanish women: the al-Ándalus project.

BACKGROUND: Candidate-gene studies on fibromyalgia susceptibility often include a small number of single nucleotide polymorphisms (SNPs), which is a limitation. Moreover, there is a paucity of evidence in Europe. Therefore, we compared genotype frequencies of candidate SNPs in a well-characterised sample of Spanish women with fibromyalgia and healthy non-fibromyalgia women. METHODS: A total of 314 women with a diagnosis of fibromyalgia (cases) and 112 non-fibromyalgia healthy (controls) women participated in this candidate-gene study. Buccal swabs were collected for DNA extraction. Using TaqMan™ OpenArray™, we analysed 61 SNPs of 33 genes related to fibromyalgia susceptibility, symptoms, or potential mechanisms. RESULTS: We observed that the rs841 and rs1799971 GG genotype was more frequently observed in fibromyalgia than in controls (p = 0.04 and p = 0.02, respectively). The rs2097903 AT/TT genotypes were also more often present in the fibromyalgia participants than in their control peers (p = 0.04). There were no differences for the remaining SNPs. CONCLUSIONS: We identified, for the first time, associations of the rs841 (guanosine triphosphate cyclohydrolase 1 gene) and rs2097903 (catechol-O-methyltransferase gene) SNPs with higher risk of fibromyalgia susceptibility. We also confirmed that the rs1799971 SNP (opioid receptor µ1 gene) might confer genetic risk of fibromyalgia. We did not adjust for multiple comparisons, which would be too stringent and yield to non-significant differences in the genotype frequencies between cases and controls. Our findings may be biologically meaningful and informative, and should be further investigated in other populations. Of particular interest is to replicate the present study in a larger independent sample to confirm or refute our findings. On the other hand, by including 61 SNPs of 33 candidate-genes with a strong rationale (they were previously investigated in relation to fibromyalgia susceptibility, symptoms or potential mechanisms), the present research is the most comprehensive candidate-gene study on fibromyalgia susceptibility to date.

Adaptation profiles comprising objective and subjective measures in fibromyalgia: the al-Ándalus project.

Objectives: The aim of this study was to identify subgroups in terms of adaptation to FM and to test differences in FM severity between these subgroups. Methods: The al-Ándalus project made it possible to perform a comprehensive population-based cross-sectional study in 486 FM patients including multiple assessments of modifiable (could be targeted in therapy) resilience and vulnerability factors, measured by objective and subjective assessments, related to psychological and physical function. FM severity was assessed by means of FM impact (total score of the Revised Fibromyalgia Impact Questionnaire) and distress (Polysymptomatic Distress Scale of the modified 2011 preliminary criteria for FM). Exploratory factor analysis, cluster analysis and analysis of variance were conducted. Results: Factor analysis yielded eight factors: three included objective measures (declarative memory, active lifestyle and objective physical fitness) and five included subjective measures (fatigue, psychological distress, catastrophizing, resilience and subjective physical fitness). Cluster analysis based on these eight factors identified five profiles: Adapted (16%), Fit (18%), Poor performer (20%), Positive (20%) and Maladapted (26%). Most profile comparisons revealed different levels of FM severity varying from Adapted (the most favourable profile) to Maladapted (the most unfavourable profile) with Fit, Poor performer and Positive obtaining intermediate positions. Conclusions: Heterogeneity of FM was shown by five clinically meaningful profiles of modifiable factors that were associated with FM severity. It is of clinical interest to examine whether these profiles are associated with FM prognosis and the effectiveness of interventions, which would enhance the development of customized interventions based on adaptation profiles in FM.

Do women with fibromyalgia present higher cardiovascular disease risk profile than healthy women? The al-Ándalus project.

OBJECTIVES: To analyse the cardiovascular disease risk profile of women with fibromyalgia and compare it with control women; and to test whether physical activity is associated with the cardiovascular disease risk profile in this population. METHODS: This cross-sectional study comprised 436 women with fibromyalgia (51.4±7.5 years old) and 217 controls (48.4±9.6 years old) from Andalusia, Spain. Clinical data, waist circumference, body fat percentage, resting heart rate, blood pressure and cardiorespiratory fitness were assessed. Moderate-to-vigorous physical activity was objectively assessed with accelerometry. A clustering of individual cardiovascular disease risk factors was represented by the number of cigarettes/day, adiposity, mean arterial pressure, resting heart rate and cardiorespiratory fitness. RESULTS: Women with fibromyalgia presented higher waist circumference and body fat percentage, greater number of cigarettes/day consumption and lower levels of cardiorespiratory fitness after controlling for age, marital status, educational level, occupational status, medication for cholesterol and monthly regular menstruation (all, p<.05). Women with fibromyalgia showed higher clustered cardiovascular disease risk than control women after controlling for the potential confounders described above (p<.001). Women with fibromyalgia who did not meet moderate-to-vigorous physical activity recommendations showed increased clustered cardiovascular disease risk after adjusting for the potential confounders described above (p<.001). CONCLUSIONS: Women with fibromyalgia may present higher risk of cardiovascular disease than controls. Inadequate levels of moderate-to-vigorous physical activity may play a significant role as an additional predisposing factor for cardiovascular disease risk in this population.

The Potential of Established Fitness Cut-off Points for Monitoring Women with Fibromyalgia: The al-Ándalus Project.

The aim of the present study was to determinate whether fitness cut-off points discriminate the severity of major fibromyalgia symptoms and health-related quality of life. Additionally, we investigated which American Colleague of Rheumatology (ACR) fibromyalgia criteria (1990 vs. modified 2010) better discriminate fibromyalgia symptomatology. A total of 488 women with fibromyalgia and 200 non-fibromyalgia (control) women participated. All participants underwent both the 1990 and the modified 2010 ACR preliminary criteria (hereinafter 1990c and m-2010c, respectively). We used fitness cut-off points (Senior Fitness Tests Battery plus handgrip strength test) to discriminate between presence and absence of fibromyalgia. Additionally, we employed several instruments to assess fibromyalgia symptoms. Fitness cut-off points discriminated between high and low levels of the main symptoms the disease in all age groups (P from <0.001 to 0.01). Overall, the arm-curl and the 30-s chair stand tests presented the highest effect sizes in all symptoms, reinforcing the inclusion of fitness testing as a complementary tool for fibromyalgia diagnosis and monitoring. Moreover, the effect size of the differences in symptoms between women with fibromyalgia and controls were overall larger using the m-2010c compared with the 1990c, except for the tender points count, reflecting better the polysymptomatic distress condition of fibromyalgia.

Association of physical fitness, body composition, cardiometabolic markers and adherence to the Mediterranean diet with bone mineral density in perimenopausal women. The FLAMENCO project.

This study aimed to analyse the association of different components of physical fitness, body composition, cardiometabolic markers and the Mediterranean diet with bone mineral density (BMD) in perimenopausal women, and to test which of these components are independently associated with BMD. The sample comprised 197 perimenopausal women (52.6 ± 4.5 years). Physical fitness was assessed with the "Senior Fitness Test" battery and the handgrip strength and Bruce tests. Fat and lean mass and BMD were measured using dual-energy X-ray absorptiometry. We analysed the markers of metabolic syndrome, C-reactive protein, and components of the Mediterranean diet. Handgrip muscle strength (ß = 0.212, P = 0.005), body weight (ß = 0.244, P = 0.001), BMI (ß = 0.180, P = 0.011) and lean mass (ß = 0.379, P < 0.001) were positively associated with BMD. No associations were observed between cardiometabolic markers or the Mediterranean diet with BMD (all P > 0.05). When all relevant indicators of BMD were simultaneously considered, lean mass was the only 1 showing an independent association with BMD (ß = 0.392, P < 0.001), explaining 14% of the BMD variability. In conclusion, muscle strength might be a marker of BMD in perimenopausal women. However, lean mass was the only factor independently associated with BMD. Future research to determine whether increasing lean mass through specific exercise-based interventions contributes to increasing BMD is warranted.

Effects of supervised aerobic and strength training in overweight and grade I obese pregnant women on maternal and foetal health markers: the GESTAFIT randomized controlled trial.

BACKGROUND: During pregnancy, a sedentary lifestyle may have negative consequences on maternal and foetal health status. The main objective of this project is to assess the effects of an exercise intervention in overweight and grade I obese pregnant on maternal and foetal health markers. METHODS/DESIGN: The present study aims to recruit 60 overweight and grade I obese women interested in participating in an exercise intervention program from the 17th gestational week until delivery. Women will be randomized to either an exercise (three 60-min sessions/week of combined aerobic and strength training and pelvic floor exercises), or usual care (control) group (30 women per group). The primary outcome measures are maternal weight gain, and maternal and neonatal glycaemic profile. Secondary outcome measures are: i) perinatal obstetric records; i) body composition; iii) dietary patterns; iv) physical fitness; v) low-back pain; vi) objectively measured physical activity and sedentary behaviour; vii) haematology and biochemical analyses; viii) oxidative stress; ix) pro- and anti-inflammatory markers; x) bone health biomarkers; xi) sleep quality; xii) mental health, quality of life and positive health. DISCUSSION: The findings of this project will help to identify strategies for primary prevention and health promotion based on this exercise-based intervention program among overweight and grade I obese pregnant women. TRIAL REGISTRATION: NCT02582567 ; Date of registration: 20/10/2015.

Cost-effectiveness of an exercise intervention program in perimenopausal women: the Fitness League Against MENopause COst (FLAMENCO) randomized controlled trial.

BACKGROUND: The high prevalence of women that do not reach the recommended level of physical activity is worrisome. A sedentary lifestyle has negative consequences on health status and increases health care costs. The main objective of this project is to assess the cost-effectiveness of a primary care-based exercise intervention in perimenopausal women. METHODS/DESIGN: The present study is a Randomized Controlled Trial. A total of 150 eligible women will be recruited and randomly assigned to either a 16-week exercise intervention (3 sessions/week), or to usual care (control) group. The primary outcome measure is the incremental cost-effectiveness ratio. The secondary outcome measures are: i) socio-demographic and clinical information; ii) body composition; iii) dietary patterns; iv) glycaemic and lipid profile; v) physical fitness; vi) physical activity and sedentary behaviour; vii) sleep quality; viii) quality of life, mental health and positive health; ix) menopause symptoms. All outcomes will be assessed at baseline and post intervention. The data will be analysed on an intention-to-treat basis and per protocol. In addition, we will conduct a cost effectiveness analysis from a health system perspective. DISCUSSION: The intervention designed is feasible and if it proves to be clinically and cost effective, it can be easily transferred to other similar contexts. Consequently, the findings of this project might help the Health Systems to identify strategies for primary prevention and health promotion as well as to reduce health care requirements and costs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02358109. Date of registration: 05/02/2015.

Association of Moderate-to-Vigorous Physical Activity, Sedentary Time, Fat Percentage, and Physical Fitness with Gait Parameters in Women with Fibromyalgia: The Al-Ándalus Project.

Gait impairments have been found in women with fibromyalgia, reducing the physical activity possibilities in this population and leading to a negative correlation with fibromyalgia impact. The aim of this study was to analyze the individual and independent associations of moderate-to-vigorous physical activity (MVPA), sedentary time, fat percentage, and physical fitness with gait parameters in women with fibromyalgia. A total of 84 women with fibromyalgia were included. MVPA and sedentary time were assessed with accelerometry, fat percentage with bioimpedance analysis, and physical fitness with field-based fitness tests. Gait was assessed during a "6 min walk test" and categorized in velocity, cadence, step length, step cycle duration, unipedal stance phase, and bipedal stance phase. Individual relationships were analyzed by partial correlations and independent relationships by linear regressions, adjusting by age and height. MVPA, sedentary time, fat percentage, and physical fitness were correlated with most gait parameters (rpartial between |0.842| and |0.219|; p ≤ 0.05). Physical fitness was independently associated with all gait parameters (ß between |0.346| and |0.761|; p ≤ 0.002). In addition, MVPA was independently associated with velocity and step length (ß = 0.241 and 0.292; both p = 0.004), and fat percentage was associated with bipedal stance phase (ß = 0.242; p = 0.049). Good levels of MVPA, physical fitness, and adequate weight balance are associated with improved gait parameters in women with fibromyalgia.

Sedentary time is associated with depressive symptoms and state anxiety in women with fibromyalgia. Could physical activity and fitness modify this association? The al-Ándalus project.

PURPOSE: To analyze the associations of total and prolonged sedentary time (ST) with depressive symptoms and state anxiety in women with fibromyalgia and whether these associations are modified by moderate-to-vigorous physical activity (MVPA) and physical fitness. METHODS: This cross-sectional exploratory study included 386 women with fibromyalgia aged 51.2 ± 7.6 years. Total ST, time in prolonged bouts of ST (≥30- and ≥60-min) and MVPA were measured with triaxial accelerometry. Depressive symptoms were assessed with the "Beck Depression Inventory-second edition," state anxiety with the "State-Trait Anxiety Inventory," and physical fitness with the "Senior Fitness Test Battery." RESULTS: Total and prolonged ST were directly associated with depressive symptoms (total: ß = 0.19, ≥30-min bout: ß = 0.15, and ≥60-min bout: ß = 0.12) and odds of severe depressive symptoms (all, p < 0.001). These associations generally remained significant after adjustments for MVPA and physical fitness (all, p < 0.05). Total and prolonged ST were directly associated with state anxiety (total: ß = 0.11, ≥30-min bout: ß = 0.12, and ≥60-min bout: ß = 0.07; all, p < 0.001). These associations were generally independent of MVPA (p < 0.05) but vanished when considering physical fitness (p > 0.05). CONCLUSIONS: Higher levels of total and prolonged ST are associated with greater depressive symptoms and state anxiety in women with fibromyalgia. MVPA did not modify these associations, although physical fitness could play a protective role specially for state anxiety.IMPLICATIONS FOR REHABILITATIONReducing sedentary time and avoiding its accumulation in prolonged periods could potentially reduce depressive symptoms and state anxiety in fibromyalgia.Higher sedentary time is associated with more severe depressive symptoms even in patients who engage in moderate-to-vigorous physical activity.Higher levels of physical fitness could attenuate the negative associations of sedentary time with depressive symptoms and, specially, state anxiety."Sit less, move more and exercise to increase your fitness" could be a positive message for people with fibromyalgia in clinical settings.

The influence of an exercise program in middle-aged women on dietary habits. The FLAMENCO project.

OBJECTIVE: To determine the extent to which following an exercise training program can modify dietary habits and adherence to the Mediterranean diet (MD) compared with a counseling group. METHODS: These are secondary analyses from the FLAMENCO (Fitness League Against MENopause COst) project. The present randomized controlled trial included 150 perimenopausal women who were randomized into counseling (n = 75) or exercise (n = 75) groups. The counseling group attended conferences on a healthy lifestyle. The exercise group followed concurrently a 4-month (60 min/session, 3 d/wk) training and did not take part in the conferences. A validated food frequency questionnaire and the Mediterranean diet score were used to assess dietary habits and adherence to the MD, respectively. RESULTS: The fish/shellfish intake was reduced in the counseling group and increased in the exercise group, with a difference between groups of 1.16 servings/wk ( P < 0.01). The counseling group reduced their beer intake, and the exercise group increased it, with a difference between groups of 1.07 servings/wk ( P < 0.01). CONCLUSION: The exercise intervention did not have a significant impact on dietary habits or MD adherence scores in perimenopausal women. Notwithstanding, women in the exercise group increased their beer consumption, which might have been promoted by the social meetings after the exercise training.

Associations of physical activity, sedentary time, and physical fitness with mental health during pregnancy: The GESTAFIT project.

PURPOSE: This study was aimed to analyze the associations of objectively measured physical activity (PA), sedentary time, and physical fitness with mental health in the early second trimester (16 ± 2 gestational weeks) of pregnancy. METHODS: From 229 women initially contacted, 124 pregnant women participated in the present cross-sectional study. Data were collected between November 2015 and March 2017. The participants wore Actigraph GT3X+ Triaxial accelerometers for 9 consecutive days to objectively measure their PA levels and sedentary time. A performance-based test battery was used to measure physical fitness. Self-report questionnaires assessed psychological ill-being (i.e., negative affect, anxiety, and depression), and psychological well-being (i.e., emotional intelligence, resilience, and positive affect). Linear regression analyses were adjusted for age, educational level, accelerometer wear time, miscarriages, and low back pain. RESULTS: Moderate-to-vigorous PA was negatively associated with depression (ß = -0.222, adjusted R2 = 0.050, p = 0.041). Higher levels of sedentary time were negatively associated with positive affect (ß = -0.260, adjusted R2 = 0.085, p = 0.017). Greater upper-body flexibility was positively associated with better emotional regulation (ß = 0.195, adjusted R2= 0.030, p = 0.047). The remaining associations were not significant (all p > 0.05). CONCLUSION: An active lifestyle characterized by higher levels of moderate-to-vigorous PA and lower levels of sedentary time during pregnancy might modestly improve the mental health of pregnant women. Although previous research has focused on the benefits of cardiorespiratory exercise, the present study shows that only upper-body flexibility is related to emotional regulation in early pregnant women. If the present findings are corroborated in further experimental research, physical exercise programs should focus on enhancing flexibility to promote improvements in emotional regulation during early second-trimester of pregnancy.