The influence of meaningful activities in the quality of life and functional autonomy of adults with intellectual disability: A prospective study during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic might negatively impact the quality of life and functional autonomy of Spanish adults with intellectual disability, and meaningful activities could prevent this negative progression. METHODS: This is a prospective cohort study in Spanish adults with intellectual disability during the COVID-19 pandemic. Quality of life, functional autonomy and functional independence were measured. The meaningful activities studied were structured-leisure, community self-management, and occupational and physical activities. RESULTS: Seventy-three participants were included in the study. Quality of life and functional autonomy significantly deteriorated during the COVID-19 pandemic (all p > .001). Greater participation in community self-management activities before COVID-19 was associated with less detriment to quality of life (ß = -.312; p = .008), while greater participation in occupational and physical activities was associated with less detriment to the performance of instrumental activities (ß = -.317; p = .016; and ß = -.285; p = .030, respectively). CONCLUSION: People with intellectual disability living in residential homes experienced a decrease in their quality of life and functional autonomy during the COVID-19 pandemic. Their involvement in community self-management activities and physical and occupational activities before the pandemic had preventive effects on the detriment to the quality of life and functional autonomy.

Does sleep-disordered breathing add to impairments in academic performance and brain structure usually observed in children with overweight/obesity?

Approximately 4-11% of children suffer from sleep-disordered breathing (SDB), and children with obesity are at increased risk. Both obesity and SDB have been separately associated with poorer brain health, yet whether SDB severity affects brain health in children with obesity remains unanswered. This study aimed to examine associations of SDB severity with academic performance and brain structure (i.e., total brain and gray and white matter volumes and gray matter volume in the hippocampus) in children with overweight/obesity. One hundred nine children aged 8-12 years with overweight/obesity were included. SDB severity and its subscales (i.e., snoring, daytime sleepiness, and inattention/hyperactivity) were evaluated via the Pediatric Sleep Questionnaire (PSQ), and academic performance was evaluated with the Woodcock-Muñoz standardized test and school grades. Brain structure was assessed by magnetic resonance imaging. SDB severity was not associated with academic performance measured by the standardized test (all |ß|> 0.160, P > 0.076), yet it was associated with the school grade point average (ß = -0.226, P = 0.007) and natural and social science grades (ß = -0.269, P = 0.024). Intention/hyperactivity seemed to drive these associations. No associations were found between SDB severity and the remaining school grades (all ß < -0.188, P > 0.065) or brain volumes (all P > 0.05). CONCLUSION: Our study shows that SDB severity was associated with lower school grades, yet it was not associated with the standardized measurement of academic performance or with brain volumes in children with overweight/obesity. SDB severity may add to academic problems in children beyond the effects contributed by overweight/obesity status alone. WHAT IS KNOWN: • Sleep-disordered breathing (SDB) may affect brain structure and academic performance in children. • Children with overweight/obesity are at higher risk for the development of SDB, yet the comorbid obesity-SDB relationship with brain health has not been investigated thus far. WHAT IS NEW: • To our knowledge, this is the first study examining the associations of comorbid obesity-SDB severity with brain volumes and academic performance in children. • SDB symptoms may adversely affect academic performance at school in children with overweight/obesity, beyond the effects of weight status alone.

Effects of integrative neuromuscular training on the gait biomechanics of children with overweight and obesity.

OBJECTIVE: To analyze whether 13 weeks of integrative neuromuscular training can benefit spatiotemporal and kinematic parameters of gait in children with overweight/obesity. METHODS: This is a non-randomized controlled trial. Fifty children (10.77 ± 1.24 years, 31 girls) with overweight/obesity were allocated to an exercise group (EG) (n = 25) that carried out a 13-week exercise program based on fundamental movement skills, strength activities and aerobic training, and a control group (CG) (n = 25) that followed their normal lifestyle. Spatiotemporal (i.e., cadence, stance and support times, step length, and stride width) and kinematic (i.e., hip, pelvis, knee, and ankle angles) parameters were evaluated under laboratory conditions through a 3D analysis. ANCOVA was used to test raw and z-score differences between the EG and CG at post-exercise, adjusting for pre-exercise values. RESULTS: The EG maintained their baseline stance and single-limb support times while the CG increased them during walking (groups' difference: 3.1 and 1.9 centiseconds). The EG maintained baseline maximum foot abduction angle during the stance phase whereas the CG showed an increase (groups' difference: 3.9º). Additional analyses on kinematic profiles demonstrated that the EG walked with similar pelvic tilt and ankle abduction angles at post-exercise, while the CG increased the pelvic anterior tilt in the whole stance phase (mean groups' difference: 7.7º) and the ankle abduction angles in early- and mid-stance phases (mean groups' difference: 4.6º). No changes were observed in the rest of spatiotemporal and kinematic parameters. CONCLUSIONS: The integrative neuromuscular training stopped the progression of some biomechanical alterations during walking in children with overweight/obesity. These findings could contribute to preventing common movement-derived musculoskeletal disorders in this population, as well as preserving an optimal mechanical efficiency during walking.

Leptin levels were negatively associated with lumbar spine bone mineral content in children with overweight or obesity.

AIM: Adipokines seem to play a role in bone morphogenesis, although this also depends on the mechanical forces applied to the skeleton. The aim was to assess the relationships of resting leptin and adiponectin with bone parameters and whether high muscular fitness levels affect these relationships in children with overweight or obesity. METHODS: This cross-sectional study took part from 2014 to 2016 in Granada, Spain. Participants were recruited from University Hospitals, and we also used advertisements in local media and school contacts in the city. Adipokines were analysed in plasma. Muscular fitness was assessed by one repetition maximum in bench and leg press tests. Dual-energy X-ray absorptiometry was used to measure bone parameters. RESULTS: We included 84 children (10.0 ± 1.2y; 63% boys) in this analysis. Leptin was negatively associated with lumbar spine bone mineral content (ß = -0.162, p = 0.053). No significant interaction was found for muscular fitness. Simple slope estimates suggested that children performing more than 133.3 kg in leg press test ameliorated the negative association between leptin and lumbar spine bone mineral content. CONCLUSION: Leptin levels were negatively associated with lumbar spine bone mineral content in children with overweight or obesity. A high muscular fitness at the lower body could counteract this association.

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.

Effects of post-tetanic potentiation induced by whole-body electrostimulation and post-activation potentiation on maximum isometric strength.

It is currently unknown the most effective potentiation protocol to increase maximum strength. Hence, we investigated the separated and combined effects of post-tetanic potentiation (PTP) induced by whole-body electrostimulation (WB-EMS) and post-activation potentiation (PAP) induced by voluntary maximum isometric contractions on maximum isometric strength. Ten trained males were randomly evaluated on four occasions. In session A, maximum isometric strength (split squat) was measured in minutes 1, 4, and 8. In session B, the measurements were taken in minutes 2, 6, and 10. In session C, a WB-EMS protocol was applied to elicit PTP and the measurements were performed in minutes 1, 4, and 8. In session D, the same WB-EMS protocol was applied and the measurements were taken in minutes 2, 6, and 10. No significant differences in maximum isometric strength were observed between: (i) the control and WB-EMS in minutes 1 vs. 1 and 2 vs. 2; (ii) the control and PAP in minutes 1 vs. 4, 1 vs. 8, 2 vs. 6, and 2 vs. 10; and (iii) the PAP and WB-EMS plus PAP in minutes 4 vs. 4, 8 vs. 8, 6 vs. 6, and 10 vs. 10. In contrast, the WB-EMS plus PAP revealed a significant increase of 54% (~450 N) compared to the WB-EMS in minutes 4 and 8 compared to the minute 1 (p < 0.001), but not between minutes 2 vs. 6 and 2 vs. 10. The present results showed that PTP induced by WB-EMS in isolation or combined with PAP induced by voluntary maximum isometric contractions did not produce a significant increase in maximum isometric strength compared to the control and PAP alone, respectively.

Physical fitness and brain source localization during a working memory task in children with overweight/obesity: The ActiveBrains project.

The present study aims (i) to examine the association of physical fitness components (i.e., cardiorespiratory fitness, speed-agility, and muscular fitness) with brain current source density during working memory; and (ii) to examine whether fitness-related current density was associated to working memory performance and academic achievement. Eighty-five children with overweight/obesity aged 8-11 years participated in this cross-sectional study. Physical fitness components were assessed using the ALPHA test battery. Electroencephalography recordings were performed during a Delayed Non-Match-to-Sample task that assessed working memory. Brain source analysis was carried out using sLORETA to estimate regional current source density differences between high and low (H-L) working memory loads. Academic achievement was measured by the Spanish version of the Woodcock-Johnson III test battery. The main results showed that higher cardiorespiratory fitness was associated with higher H-L current density differences in frontal, limbic, and occipital regions during encoding and maintenance task's phases (ß≥0.412, p ≤ 0.019). A limbic area was further related to better working memory performance (ß=0.267, p = 0.005). During retrieval, higher cardiorespiratory fitness was also associated with higher current density in temporal regions (ß=0.265, p = 0.013), whereas lower muscular fitness was associated with higher current density in frontal regions (ß=-0.261, p = 0.016). Our results suggest that cardiorespiratory fitness, but not speed-agility nor muscular fitness, is positively associated with brain current source density during working memory processes in children with overweight/obesity. Fitness-related current density differences in limbic regions were associated with better working memory.

Recommendations for determining the validity of consumer wearable heart rate devices: expert statement and checklist of the INTERLIVE Network.

Assessing vital signs such as heart rate (HR) by wearable devices in a lifestyle-related environment provides widespread opportunities for public health related research and applications. Commonly, consumer wearable devices assessing HR are based on photoplethysmography (PPG), where HR is determined by absorption and reflection of emitted light by the blood. However, methodological differences and shortcomings in the validation process hamper the comparability of the validity of various wearable devices assessing HR. Towards Intelligent Health and Well-Being: Network of Physical Activity Assessment (INTERLIVE) is a joint European initiative of six universities and one industrial partner. The consortium was founded in 2019 and strives towards developing best-practice recommendations for evaluating the validity of consumer wearables and smartphones. This expert statement presents a best-practice validation protocol for consumer wearables assessing HR by PPG. The recommendations were developed through the following multi-stage process: (1) a systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, (2) an unstructured review of the wider literature pertaining to factors that may introduce bias during the validation of these devices and (3) evidence-informed expert opinions of the INTERLIVE Network. A total of 44 articles were deemed eligible and retrieved through our systematic literature review. Based on these studies, a wider literature review and our evidence-informed expert opinions, we propose a validation framework with standardised recommendations using six domains: considerations for the target population, criterion measure, index measure, testing conditions, data processing and the statistical analysis. As such, this paper presents recommendations to standardise the validity testing and reporting of PPG-based HR wearables used by consumers. Moreover, checklists are provided to guide the validation protocol development and reporting. This will ensure that manufacturers, consumers, healthcare providers and researchers use wearables safely and to its full potential.

Recommendations for determining the validity of consumer wearable and smartphone step count: expert statement and checklist of the INTERLIVE network.

Consumer wearable and smartphone devices provide an accessible means to objectively measure physical activity (PA) through step counts. With the increasing proliferation of this technology, consumers, practitioners and researchers are interested in leveraging these devices as a means to track and facilitate PA behavioural change. However, while the acceptance of these devices is increasing, the validity of many consumer devices have not been rigorously and transparently evaluated. The Towards Intelligent Health and Well-Being Network of Physical Activity Assessment (INTERLIVE) is a joint European initiative of six universities and one industrial partner. The consortium was founded in 2019 and strives to develop best-practice recommendations for evaluating the validity of consumer wearables and smartphones. This expert statement presents a best-practice consumer wearable and smartphone step counter validation protocol. A two-step process was used to aggregate data and form a scientific foundation for the development of an optimal and feasible validation protocol: (1) a systematic literature review and (2) additional searches of the wider literature pertaining to factors that may introduce bias during the validation of these devices. The systematic literature review process identified 2897 potential articles, with 85 articles deemed eligible for the final dataset. From the synthesised data, we identified a set of six key domains to be considered during design and reporting of validation studies: target population, criterion measure, index measure, validation conditions, data processing and statistical analysis. Based on these six domains, a set of key variables of interest were identified and a 'basic' and 'advanced' multistage protocol for the validation of consumer wearable and smartphone step counters was developed. The INTERLIVE consortium recommends that the proposed protocol is used when considering the validation of any consumer wearable or smartphone step counter. Checklists have been provided to guide validation protocol development and reporting. The network also provide guidance for future research activities, highlighting the imminent need for the development of feasible alternative 'gold-standard' criterion measures for free-living validation. Adherence to these validation and reporting standards will help ensure methodological and reporting consistency, facilitating comparison between consumer devices. Ultimately, this will ensure that as these devices are integrated into standard medical care, consumers, practitioners, industry and researchers can use this technology safely and to its full potential.

Associations of novel 24-h accelerometer-derived metrics with adiposity in children and adolescents.

BACKGROUND: Further research is required to explore the associations between 24-h movement behaviours and health outcomes in the paediatric population. Therefore, this study aimed to examine the associations between novel data-driven 24-h activity metrics and adiposity among children and adolescents. METHODS: The sample included 382 children (8-13 years) and 338 adolescents (14-18 years). The average acceleration (AvAcc) of activity, intensity gradient (IG), and metrics representing the initial acceleration for the most active time periods of the 24-h cycle were calculated from raw acceleration data. Adiposity measures included body mass index z-score, fat mass percentage (FM%), and visceral adipose tissue (VAT). Data analysis was performed using multiple linear regression adjusted for wear time, sex, maternal education level, and maternal overweight and obesity. RESULTS: Children demonstrated higher values in all 24-h activity metrics than did adolescents (p < 0.001 for all). For children, the initial acceleration for the most active 2, 5, 15, and 30 min of the 24-h cycle were negatively associated with FM% (p ≤ 0.043 for all) and VAT (p <0.001 for all), respectively. For adolescents, the IG was negatively associated with FM% (p = 0.002) and VAT (p = 0.007). Moreover, initial acceleration for the most active 2, 5, 15, 30, 60, and 120 min were associated with FM% (p ≤ 0.007 for all) and with VAT (p ≤ 0.023 for all). CONCLUSIONS: The intensity distribution of activity and initial acceleration for the most active 2, 5, 15, 30, 60, and 120 min within the 24-h cycle are beneficial for the prevention of excess adiposity in the paediatric population.

Fitness, physical activity and academic achievement in overweight/obese children.

The aim of this study was to examine the associations of fitness and physical activity with academic achievement in children with overweight/obesity. A total of 106 (10.0 ± 1.1y, 61 boys) children participated. The fitness components were assessed by field and laboratory-based tests. Physical activity was measured via accelerometry. The academic achievement was assessed by a standardised test and school-grades. Field-based cardiorespiratory fitness was associated with language skills (ß-standardised- ranging from 0.281 to 0.365, p < 0.01). The field-based muscular strength was associated with grade point average, natural and social sciences, and foreign language (ß = 0.280-0.326, all p ≤ 0.01). Speed-agility was associated with some language-related skills (ß = 0.325-0.393, all p ≤ 0.01). The laboratory-based muscular strength also showed an association with mathematics skills (ß = 0.251-0.306, all p ≤ 0.01). Physical activity did not show significant association with academic achievement (p > 0.01). Overall, the significant associations observed for muscular strength and speed/agility were attenuated and disappeared in many cases after additional adjustments for body mass index and cardiorespiratory fitness, indicating that these associations are inter-dependent. Our study contributes by indicating that other fitness components apart from cardiorespiratory fitness, such as muscular strength and speed-agility, are positively associated with academic achievement. However, these associations appear to be dependent on body mass index and cardiorespiratory fitness.

Effects of Exercise on Body Posture, Functional Movement, and Physical Fitness in Children With Overweight/Obesity.

Molina-Garcia, P, Mora-Gonzalez, J, Migueles, JH, Rodriguez-Ayllon, M, Esteban-Cornejo, I, Cadenas-Sanchez, C, Plaza-Florido, A, Gil-Cosano, JJ, Pelaez-Perez, MA, Garcia-Delgado, G, Vanrenterghem, J, and Ortega, FB. Effects of exercise on body posture, functional movement, and physical fitness in children with overweight/obesity. J Strength Cond Res 34(8): 2146-2155, 2020-This study aims to analyze whether a 13-week exercise program based on "movement quality" and "multi-games" can lead to simultaneous benefits to body posture, fundamental movements, and physical fitness of children with overweight/obesity. A total of 64 children (10.9 ± 1.3 years, 25.9 ± 3.8 kg·m, 38 girls and 26 boys) with overweight/obesity were assigned either to a 13-week exercise-based intervention group (IG) (n = 33) or to a control group (CG) (n = 31). Subjects underwent assessments of basic anthropometry (body mass and height), body posture (2-dimensional photogrammetry), fundamental movements (Functional Movement Screen), and physical fitness (1 repetition maximum [1RM] arm and leg press, and ALPHA test battery). After the exercise program, the IG reduced lower limb angle (high effect size: -0.82 SDs; p = 0.001) and plumb-tragus distance (low effect: -0.43 SDs; p = 0.002) in the sagittal plane and increased lower limb angle in the frontal plane (high effect: 0.82 SDs; p = 0.003) compared with the CG. The IG improved their performance in deep squat (p = 0.004), active straight leg raise (p < 0.001), 1RM arm (low effect: 0.46 SDs; p = 0.002), handgrip strength (medium effect: 0.53 SDs; p < 0.001), and standing long jump (medium effect: 0.59 SDs; p = 0.003), all compared with the CG. In conclusion, children with overweight/obesity who participated in our 13-week exercise program developed a better alignment of the head and lower limb, improved their performance in fundamental movements, and experienced global muscular strength gains compared with the peers who continued with their usual lives. Among other potential implications, these improvements could contribute to the prevention of musculoskeletal disorders associated with childhood obesity and could increase adherence by positioning these children in a better physical status to keep practicing exercise.

Fitness, cortical thickness and surface area in overweight/obese children: The mediating role of body composition and relationship with intelligence.

Cortical thickness and surface area are thought to be genetically unrelated and shaped by independent neurobiological events suggesting that they should be considered separately in morphometric analyses. Although the developmental trajectories of cortical thickness and surface area may differ across brain regions and ages, there is no consensus regarding the relationships of physical fitness with cortical thickness and surface area as well as for its subsequent influence on intelligence. Thus, this study examines: (i) the associations of physical fitness components (i.e., cardiorespiratory fitness, speed-agility and muscular fitness) with overall and regional cortical thickness and surface area; (ii) whether body composition indicators (i.e., body mass index, fat-free mass index and fat mass index) mediate these associations; and (iii) the association of physical fitness and cortical thickness with intelligence in overweight/obese children. A total of 101 overweight/obese children aged 8-11 years were recruited in Granada, Spain. The physical fitness components were assessed following the ALPHA health-related fitness test battery. T1-weighted images were acquired with a 3.0 Tesla Siemens Magnetom Tim Trio system. We used FreeSurfer software version 5.3.0 to assess cortical thickness (mm) and surface area (mm2). The main results showed that cardiorespiratory fitness and speed-agility were related to overall cortical thickness (ß = 0.321 and ß = 0.302, respectively; both P < 0.05), and in turn, cortical thickness was associated with higher intelligence (ß = 0.198, P < 0.05). Muscular fitness was not related to overall cortical thickness. None of the three physical fitness components were related to surface area (p > 0.05). The associations of cardiorespiratory fitness and speed-agility with overall cortical thickness were mediated by fat mass index (56.86% & 62.28%, respectively). In conclusion, cardiorespiratory fitness and speed-agility, but not muscular fitness, are associated with overall cortical thickness, and in turn, thicker brain cortex is associated with higher intelligence in overweight/obese children. Yet, none of the three physical fitness components were related to surface area. Importantly, adiposity may hinder the benefits of cardiorespiratory fitness and speed-agility on cortical thickness. Understanding individual differences in brain morphology may have important implications for educators and policy makers who aim to determine policies and interventions to maximize academic learning and occupational success later in life.

Physical Fitness, Physical Activity, and the Executive Function in Children with Overweight and Obesity.

OBJECTIVE: To examine the associations of physical fitness and physical activity with executive function in children with overweight and obesity. STUDY DESIGN: A cross-sectional study involving 100 children with overweight and obesity (10.1 ± 1.1 years old; 58.0% boys). We assessed physical fitness components (ie, muscular strength, speed-agility, and cardiorespiratory fitness) using the ALPHA battery, and physical activity and sedentary time by accelerometry. Cognitive flexibility was measured by the Design Fluency Test and Trail Making Test, inhibition by the Stroop test, and planning ability by the Zoo Map Test. RESULTS: Handgrip strength was positively associated with planning ability (P = .025). Speed-agility was positively related to cognitive flexibility and inhibition (P < .05). Cardiorespiratory fitness and an overall fitness Z-score were positively associated with indicators of cognitive flexibility (P < .05). No associations were found for physical activity and sedentary time with executive function (P ≥ .05). CONCLUSIONS: Muscular strength, speed agility, and cardiorespiratory fitness are associated with executive function in children with overweight and obesity. Cognitive flexibility seems to be more robustly associated with all fitness components, whereas planning ability and inhibition might depend on the component analyzed. The positive associations found in the present study in children with overweight and obesity call for more exercise-based randomized controlled trials in this population.

Fitness, physical activity, working memory, and neuroelectric activity in children with overweight/obesity.

The aim of the present study was to examine the associations of physical fitness, sedentary time, and physical activity (PA) with working memory and neuroelectric activity in children with overweight/obesity. Seventy-nine children with overweight/obesity (10.2 ± 1.1 years old) participated in this cross-sectional study. We assessed physical fitness components (ie, muscular strength, speed agility, and cardiorespiratory fitness) using the ALPHA battery. Sedentary time and PA were assessed by GT3X+accelerometers (ActiGraph). Working memory was assessed using the delayed non-matched-to-sample task; mean reaction time (RT) and response accuracy were registered. Neuroelectric activity (ie, P3 amplitude and latency) was registered using the ActiveTwo System of BioSemi electroencephalogram. Higher upper-limb absolute strength was associated with lower response accuracy (P = 0.023), while higher lower-limb relative-to-weight strength was associated with larger P3 amplitude (P < 0.05). Higher speed agility and cardiorespiratory fitness levels were associated with shorter mean RT and larger P3 amplitude, and speed agility was also associated with shorter P3 latency (all P < 0.05). Vigorous PA was associated with larger P3 amplitude (P < 0.05). No associations were found for sedentary time or the rest of PA intensities (P ≥ 0.05). In addition to cardiorespiratory fitness, muscular strength and speed agility are also associated with working memory and neuroelectric activity in children with overweight/obesity. The association between PA and working memory is intensity-dependent, as significant findings were only observed for vigorous PA. Randomized controlled trials in this population would help to better understand whether improvements in different components of fitness and PA lead to better working memory and underlying brain function.

Comparability of published cut-points for the assessment of physical activity: Implications for data harmonization.

This study aimed to compare estimations of sedentary time (SED) and time spent in physical activity (PA) intensities in children with overweight/obesity across different age-appropriate cut-points based on different body-worn attachment sites and acceleration metrics. A total of 104 overweight/obese children (10.1 ± 1.1 years old, 43 girls) concurrently wore ActiGraph GT3X+ accelerometers on their right hip and non-dominant wrist for 7 days (24 hours). Euclidean norm -1 g (ENMO) and activity counts from both vertical axis (VACounts) and vector magnitude (VMCounts) were derived. We calculated estimates of SED and light, moderate, vigorous, and moderate-to-vigorous (MVPA) intensity PA using different published cut-points for children. The prevalence of children meeting the recommended 60 min/d of MVPA was calculated. The time spent in SED and the different PA intensities largely differed across cut-points based on different attachment sites and acceleration metrics (ie, SED = 11-252 min/d; light PA = 10-217 min/d; moderate PA = 1-48 min/d; vigorous PA = 1-35 min/d; MVPA = 4-66 min/d). Consequently, the prevalence of children meeting the recommended 60 min/d of MVPA varied from 8% to 96% of the study sample. The present study provides a comprehensive comparison between available cut-points for different attachment and acceleration metrics in children. Furthermore, our data clearly show that it is not possible (and probably will never be) to know the prevalence of meeting the PA guidelines based on accelerometer data since apparent differences range from almost zero to nearly everyone meeting the guidelines.

Fatness and fitness in relation to functional movement quality in overweight and obese children.

This study aimed to investigate the independent and combined associations between several fatness indicators and fitness components with functional movement quality in overweight/obese children. A total of 56 children (33 girls, aged 8-12) classified as overweight/obese according to the World Obesity Federation standard cut points, participated in this study. Participants underwent assessments of fatness [body mass index (BMI), waist circumference, and bioelectrical impedance measures], fitness [1 repetition maximum bench and leg press, and ALPHA test battery], and functional movement quality [4 tests from Functional Movement Screen TM (FMS)]. All fatness outcomes, except waist circumference, were negatively associated with total FMS score, after controlling for cardiorespiratory fitness. Cardiorespiratory fitness, lower limbs muscle strength, and speed-agility were positively associated with the total FMS score, regardless of BMI. Our results suggest that children with greater fatness indicators demonstrate lower functional movement quality independently of their fitness level, whereas children with better fitness level (i.e. cardiorespiratory fitness, lower limbs muscular strength, and speed-agility) demonstrate greater functional movement quality independently of their fatness level. However, children´s weight status seems to be more determinant than their fitness level in terms of functional movement quality, whereas being fit seems to moderately attenuate the negative influence of fatness.

Effectiveness and cost-effectiveness of telerehabilitation for musculoskeletal disorders: A systematic review and meta-analysis.

BACKGROUND: Internet-based telerehabilitation could be a valuable option for the treatment of musculoskeletal disorders, with the advantage of providing rehabilitation from anywhere. However, there is no solid and updated evidence demonstrating its effectiveness on relevant clinical and cost outcomes. OBJECTIVE: This systematic review aims to determine the clinical and cost-effectiveness of internet-based telerehabilitation during the recovery of musculoskeletal disorders. METHODS: Medline, Web of Science, Scopus and Cochrane databases were systematically searched from inception to June 2023. Trials investigating the effects of internet-based telerehabilitation in any musculoskeletal disorder were selected. Nonoriginal articles and grey literature were excluded. Two independent reviewers conducted the study selection and data extraction. Random effect meta-analyses (standardized mean difference) and further sensitivity analyses were performed. RESULTS: We selected 37 clinical trials (33 randomized and 4 non-randomized) and 5 health economics studies, which included a total of 4,288 participants. Telerehabilitation was more favourable than control treatments in improving all studied clinical outcomes, although the effectiveness varied depending on the type of musculoskeletal disorder. The standard mean differences (SMD) ranged from 0.24 to 0.91. For physical function, the primary outcome, superior effectiveness was found only in people with hip fractures (SMD, 0.87; 95 % CI, 0.34 to 1.41). The effects for joint replacement, osteoarthritis, and spine pain were similar to those of control treatments. However, the favourable outcomes for telerehabilitation became insignificant when compared specifically to face-to-face rehabilitation. Some results displayed publication bias and a lack of robustness, necessitating cautious interpretation. In terms of health economics studies, telerehabilitation was 89.55$ (95 % CI 4.6 to 174.5) cheaper per individual than conventional treatments. CONCLUSIONS: Telerehabilitation should be considered in the recovery process of musculoskeletal disorders when optimal face-to-face rehabilitation is not feasible. Moreover, telerehabilitation reduces costs and time. PROSPERO NUMBER: CRD42022322425.

Association of the @ctivehip tele-rehabilitation with the fear of falling of older adults with hip fracture and their family caregivers: Secondary analysis of a non-randomised controlled trial.

INTRODUCTION: Osteoporotic hip fracture is a major health problem. Falls, the primary cause, might lead to a persistent fear of falling (FoF) among older adults, affecting their daily activities and rehabilitation. While in-person interventions exist, limited research is available on the effects of tele-rehabilitation on the FoF after a hip fracture. Thus, this study aims to test the association of the @ctivehip tele-rehabilitation programme on reducing the levels of FoF experienced by both older adults with hip fracture and their family caregivers. METHODS: A non-randomised controlled trial (ClinicalTrials.gov; Identifier: NCT02968589) that compared a webpage-based tele-rehabilitation (@ctivehip) against usual care. Fear of falling was assessed using the Short Falls Efficacy Scale-International. Patients' functional status was evaluated using the Functional Independence Measure. Physical performance was assessed by the Timed Up and Go test and Short Physical Performance Battery. We conducted a per-protocol analysis as the primary outcome, and an intention-to-treat approach as secondary analysis. RESULTS: A total of 71 patients with hip fracture (78.75 ± 6.12 years, 75% women) and their family caregivers participated. Participants in the intervention showed a higher decrease in FoF in comparison to those in the usual care (0.5 Cohen's d; p = 0.042). The reduction in FoF resulting from participation in the tele-rehabilitation programme was mediated by improvements in functional status by 79%. The @ctivehip programme did not decrease FoF of family caregivers. DISCUSSION: @ctivehip is associated with a reduction of the FoF in older adults with hip fractures, but not in their family caregivers, with the reduction being mostly explained by improvements in the patients' functional status. Although the intervention seems promising, it should not be applied in clinical settings until confirmed by appropriate-designed randomised clinical trials.

Assessing cardiorespiratory fitness in clinical and community settings: Lessons and advancements in the 100th year anniversary of VO2max.

Cardiorespiratory fitness (CRF) is a well-established biomarker that has applications to all adults across the health and disease spectrum. Despite overwhelming evidence supporting the prognostic utility of CRF, it remains vastly underutilized. CRF is optimally measured via cardiopulmonary exercise testing which may not be feasible to implement on a large scale. Therefore, it is prudent to develop ways to accurately estimate CRF that can be applied in clinical and community settings. As such, several prediction equations incorporating non-exercise information that is readily available from routine clinical encounters have been developed that provide an adequate reflection of CRF that could be implemented to raise awareness of the importance of CRF. Further, technological advances in smartphone apps and consumer-grade wearables have demonstrated promise to provide reasonable estimates of CRF that are widely available, which could enhance the utilization of CRF in both clinical and community settings.