RoboticSurgery4all: are discovery courses important for robotic surgery skills acquisition?

Cost, logistics, and availability of robotic simulation opportunities suppose a real challenge for robotic surgery training. We aimed to test a new methodology for introduction to robotic surgery pre-congress courses. Two different "introduction to robotic surgery" pre-congress courses were developed. A new methodology using a sleeve/bypass, a ventral TAPP and an inguinal TAPP silicone models was implemented. After the session, the trainees answered a questionnaire to evaluate the course and the methodology using 1-5 Likert scales. A total of 21 participants participated in the courses and (72.2%) had no experience in robotic surgery. All trainees rated the course as good or excellent. There was a strong agreement between participants regarding the adequacy of the silicone models for this type of simulation/course. Trainees agree that the course gave them more confidence to perform a real robotic procedure, increased their interest in robotic surgery and made them feel ready to start their robotic surgery pathway. Congresses are a frequent way of contact between surgeons and robotic systems, mostly in the form of technical demonstrations or pre-congress courses. Our methodology showed that it is possible to allow for this contact in a low-cost way. This kind of courses is well received by congress delegates and have a positive educational impact. Despite of being "Discovery" courses, they have a positive impact on the congress, on the acquisition of robotic surgery skills and increase the interest in robotic surgery.

RAWS4all project: validation of a new silicone model for robotic TAPP inguinal hernia repair.

BACKGROUND: Trans-abdominal pre-peritoneal (TAPP) hernia repair is a complex procedure that presents several challenges. Even though, due to the high prevalence of inguinal hernia, TAPP technique is increasing in frequency and robotic Abdominal Wall Surgery (rAWS) is emerging as a valuable tool in this regard. Although inguinal TAPP procedure principles have been published and simulation is needed, the availability of validated models remains scarce. METHODS: A new low-cost model was developed to simulate inguinal rTAPP repair. For validity assessment, a new TAPP-specific fidelity questionnaire and assessment scale were developed to compare the performance of novices and experts in the simulated procedure. The models used were assessed at 60 min for execution and quality score. RESULTS: Twenty-five residents and specialists from all over the country participated in this study. Execution, quality, and global performance was higher in the seniors group compared to juniors (8.91 vs 6.36, p = 0.02; 8.09 vs 5.14, p < .001; and 17 vs. 11,5, p < .001, respectively). Overall fidelity was assessed as being very high [4.41 (3.5-5.0), α = .918] as well as face [4.31 (3.0-5.0), α = .867] and content validity [4.44 (3.2-5.0), α = .803]. Participants strongly agreed that the model is adequate to be used with the DaVinci® Robot [4.52 (3.5-5.0), α = .758]. CONCLUSION: This study shows face, content, and construct validity of the model for inguinal TAPP simulation, including for robotic surgery. Therefore, the model can be a valuable tool for learning, understanding, practicing, and mastering the TAPP technique prior to participating in the operating room.

Effects of Aquatic Exercises for Women with Rheumatoid Arthritis: A 12-Week Intervention in a Quasi-Experimental Study with Pain as a Mediator of Depression.

BACKGROUND: Rheumatoid arthritis (RA) is characterized by low physical fitness, pain, and depression. The present study aimed to examine the effects of a supervised aquatic exercise program on physical fitness, depression, and pain in women with RA and determine whether decreases in pain mediate depression. METHODS: Forty-three women with RA, divided into an experimental group (EG; n = 21) and a control group (CG; n = 23), participated in a 12-week exercise program. Treatment effects were calculated via standardized difference or effect size (ES) using ANCOVA adjusted for baseline values (ES, 95% confidence interval (CI)). A simple panel of mediation was executed to determine whether changes in pain mediated improvements in depression after controlling for confounding variables, such as age, physical activity, and body mass index (BMI). RESULTS: The aquatic exercise program had trivial and small effects on physical fitness, large effects on pain, and moderate effects on depression. The mediation model confirmed the indirect effect of pain on the decrease of depression in the participants of the aquatic exercise program. CONCLUSIONS: Participants with RA in the aquatic exercise program experienced improvements in physical fitness, depression, and joint pain. Moreover, the improvements in joint pain mediated improvements in depression.

Normative Values and Psychometric Properties of EQ-5D-Y-3L in Chilean Youth Population among Different Weight Statuses.

BACKGROUND: This study aimed to provide population norms among children and adolescents in Chile using the EQ-5D-Y-3L questionnaire and to examine its feasibility and validity among body weight statuses. METHODS: This was a cross-sectional study in which 2204 children and adolescents (aged 8-18 years) from Chile completed a set of questionnaires providing sociodemographic, anthropometric and health-related quality of life (HRQoL) data using the five EQ-5D-Y-3L dimensions and its visual analogue scale (EQ-VAS). Descriptive statistics of the five dimensions and the EQ-VAS were categorized into body weight status groups for the EQ-5D-Y-3L population norms. The ceiling effect, feasibility and discriminant/convergent validity of the EQ-5D-Y-3L were tested. RESULTS: The dimensions of the EQ-5D-Y-3L questionnaire presented more ceiling effects than the EQ-VAS. The validity showed that the EQ-VAS could discriminate among body weight statuses. However, the EQ-5D-Y-3L index (EQ-Index) demonstrated a non-acceptable discriminant validity. Furthermore, both the EQ-Index and the EQ-VAS presented an acceptable concurrent validity among weight statuses. CONCLUSIONS: The normative values of the EQ-5D-Y-3L indicated its potential use as a reference for future studies. However, the validity of the EQ-5D-Y-3L for comparing the HRQoL among weight statuses could be insufficient.

High Fragmented Physical Activity as an Early Risk Indicator of Frailty and Mortality in Adults Aged 50 Years and Over.

INTRODUCTION: This study aimed to explore the associations of activity fragmentation with frailty status and all-cause mortality in a representative US sample of people 50 years and over. METHODS: This prospective study used data from the 2003-2006 waves of the National Health and Nutrition Examination Survey (NHANES). Participants 50 years or over were included in the study (n = 2,586). Frailty status was assessed using a valid modification of the Fried criteria. Linked data from the National Death Index registry were used to ascertain mortality. Physical activity fragmentation was measured by accelerometry. To calculate activity fragmentation, an active-to-sedentary transition probability was calculated as the number of physical activity bouts divided by the total sum of minutes spent in physical activity. Age, gender, ethnicity, education, mobility issues, drinking status, smoking status, BMI, and self-reported chronic diseases were reported in the NHANES study. RESULTS: An increment of 1 SD in activity fragmentation was associated with an increased likelihood of frailty (odds ratio [95% confidence interval] = 1.36 [1.13-1.664]). Compared with participants in the high activity fragmentation/low physical activity category, participants in the low activity fragmentation/low physical activity and low activity fragmentation/high physical activity categories were associated with a lower likelihood of frailty. We found a nonlinear association between activity fragmentation and all-cause mortality. Compared with participants in the high activity fragmentation/low physical activity category, participants in the low activity fragmentation/low physical activity, low activity fragmentation/high physical activity, and high activity fragmentation/high physical activity categories were associated with a lower mortality risk. Participants with a low fragmented activity pattern may also overcome some of the detrimental effects associated with sedentary behavior. CONCLUSIONS: Our results suggest that a high fragmented physical activity pattern is associated with frailty and risk of mortality in adults and older adults. This association was independent of total volume of physical activity and time spent sedentary.

Psychometric Properties of the Spanish Versions of EQ-5D-Y-3L and EQ-5D-Y-5L in Children with Cancer: A Comparative Study.

(1) Background: The recent published version with five levels of response of EQ-5D-Y needs to be studied in children with chronic illness. For this, the aim of the present study was to assess and compare the psychometric properties of EQ-5D-Y-3L and EQ-5D-Y-5L in terms of feasibility, ceiling effect, redistribution properties, informativity and inconsistence responses in children with cancer. (2) Methods: A core set of self-report tools, including the Spanish version of EQ-5D-Y-3L and EQ-5D-Y-5L, were administered to children drawn from the population with cancer. EQ-5D-Y-3L and EQ-5D-Y-5L were evaluated in terms of feasibility, ceiling effects, redistribution properties and differences in absolute and relative informativity. (3) Results: A total of 73 children (9.7 ± 2.3 years old) from the population with cancer participated in the study. No missing data in the new EQ-5D-Y-5L were visualized, so the feasibility was acceptable. EQ-5D-Y-5L showed a low ceiling effect in all dimensions with relative changes from EQ-5D-Y-3L to EQ-5D-Y-5L of between 15.3% and 42.4% for the dimensions and 44.6% for the overall system. Compared to EQ-5D-Y-3L, EQ-5D-Y-5L provided a better distribution of the severity of the problem in the five levels of response. The absolute informativity (Shannon's index) did not show statistically significant differences between EQ-5D-Y-3L and EQ-5D-Y-5L in all dimensions and the overall system. (4) Conclusions: EQ-5D-Y-5L is feasible, presenting a low ceiling effect and high discriminative power.

Sit to stand muscle power reference values and their association with adverse events in Colombian older adults.

Recently, a valid method to assess lower-body muscle power based on a sit-to-stand field test (STS) has been published. Our study aimed to describe lower-body muscle power in older individuals aged ≥ 60 years and examine the relationship of muscle weakness with adverse events according to gender- and age-specific muscle weakness cut-off points. A total of 3689 Colombian older adults (57.6% women, age 69.1 ± 6.9 years) from the 2015 Survey on Health, Well-Being, and Aging in Latin America and the Caribbean (SABE) participated in this study. Lower-body muscle power normalized to body mass was estimated by the five-repetitions STS test. Anthropometric, physical performance and clinical characteristics were collected. Age-specific percentiles using the LMS method, cut-off points and association with adverse events were calculated. Lower-body muscle power was greater in men than among women (2.2 ± 0.7 vs. 1.6 ± 0.5 W·kg-1, respectively; p < 0.001) at all ages. Muscle power ranked in the 50th percentile between 2.38 and 1.30 W·kg-1 in men, whereas women ranked between 1.79 and 1.21 W·kg-1. According to the cut-off points, lower-limb muscle power < 1 standard deviation  in men was associated with having dynapenia, poor gait speed, cognitive impairment and mental, visual, hearing and memory problems. While, women were associated with having sarcopenia, dynapenia, poor gait speed, cognitive impairment, mental, hearing and memory problems, dementia and hospitalizations of > 24 h in the last year. Overall, participants with poor lower-limb muscle power had a significantly higher risk of adverse events [in men: odds ratio (OR) = 1.51, 95% confidence interval (CI) = 1.19-1.91, p < 0.001; in women: OR = 1.52, 95% CI = 1.27-1.87, p = 0.001] than their stronger counterparts. This study is the first to describe lower-limb muscle power values and cut-off points among a nationally representative sample of Colombian older adults. In men, 7 of the 14 adverse events studied were associated with lower muscle strength, whereas in women, it was 9 of the 14 adverse events.

A Versatile Nanocarrier-Cubosomes, Characterization, and Applications.

The impact of nanotechnology on the exponential growth of several research areas, particularly nanomedicine, is undeniable. The ability to deliver active molecules to the desired site could significantly improve the efficiency of medical treatments. One of the nanocarriers developed which has drawn researchers' attention are cubosomes, which are nanosized dispersions of lipid bicontinuous cubic phases in water, consisting of a lipidic interior and aqueous domains folded in a cubic lattice. They stand out due to their ability to incorporate hydrophobic, hydrophilic, and amphiphilic compounds, their tortuous internal configuration that provides a sustained release, and the capacity to protect and safely deliver molecules. Several approaches can be taken to prepare this structure, as well as different lipids like monoolein or phytantriol. This review paper describes the different methods to prepare nanocarriers. As it is known, the physicochemical properties of nanocarriers are very important, as they influence their pharmacokinetics and their ability to incorporate and deliver active molecules. Therefore, an extensive characterization is essential to obtain the desired effect. As a result, we have extensively described the most common techniques to characterize cubosomes, particularly nanocarriers. The exceptional properties of the cubosomes make them suitable to be used in several applications in the biomedical field, from cancer therapeutics to imaging, which will be described. Taking in consideration the outstanding properties of cubosomes, their application in several research fields is envisaged.

Effects of respiratory muscle training on respiratory efficiency and health-related quality of life in sedentary women with fibromyalgia: a randomised controlled trial.

OBJECTIVES: Fibromyalgia syndrome (FM) is a complex disease that is mainly characterised by chronic pain, fatigue, and sleep disturbances and may be precipitated or worsened by many stressors. The aim of this study was to examine the effects of respiratory muscle training (RMT) on respiratory efficiency and health-related quality of life (HRQoL) in women with FM. METHODS: A total of 30 women with FM were included in the intention to treat analyses: 15 were assigned to the RMT group and 15 to the control group. The intervention consisted of 12 weeks of RMT. The primary outcome was the change in pulmonary function assessed by global body plethysmography at 12 weeks compared with baseline. Secondary outcomes included changes of scores in HRQoL assessed by the Short Form 36 Health Survey-Portuguese version. RESULTS: The maximal inspiratory pressure (MIP) improved by 17.5% (p-value = .033), maximal expiratory pressure (MEP) improved 21.6% (p-value = 0.045) and maximum occlusion pressure (P0.1 max) increased 27.7% (p-value = 0.007). HRQoL improved in the dimensions of physical function, physical role, bodily pain and vitality (p-value <0.05). CONCLUSIONS: RMT results in a significant improvement of respiratory efficiency and HRQoL after 12 weeks. RMT could be an effective therapy to enhance respiratory function and quality of life in women with FM.

Magnitude and Shape of the Forces Applied on the Foot Rest and Paddle by Elite Kayakers.

The study aimed to investigate the magnitude and shape of the forces applied on the foot rest, foot strap, and paddle. Thirteen elite male kayakers participated in this study and performed a 2-min test simulating 500 m race pace in a kayak ergometer. Forces applied by the kayakers on the paddle, foot rest, and foot strap were measured with load cells and recorded by an electronic measuring system. The magnitude of the peak forces applied on the foot rest (left: 543.27 ± 85.93; right: 524.39 ± 88.36) approximately doubled the ones applied on the paddle (left: 236.37 ± 19.32; right: 243.92 ± 28.89). The forces on the foot strap were similar in magnitude to the paddle forces (left: 240.09 ± 74.92; right: 231.05 ± 52.01). A positive correlation was found between the peak forces applied on the foot rest and paddle on the same side (p < 0.001). When comparing the best and worst kayakers' performance, the best showed greater forces magnitudes and synchronization of the peak forces. Analyses of the force-time curves, including not only the forces applied by the kayaker on the paddle but also the ones applied on the foot rest and strap, should be considered relevant in terms of technique analyses.

Genome-wide clonal variability in European pear "Rocha" using high-throughput sequencing.

Pears (Pyrus) are one of the most economically important fruits worldwide. The Pyrus genus is characterized by a high degree of genetic variability between species and interspecific hybrids, and several studies have been performed to assess this variability for both cultivated and wild accessions. These studies have mostly been limited by the resolving power of traditional molecular markers, although in the recent past the availability of reference genome sequences or SNP arrays for pear have enhanced the capability of high-resolution genomics studies. These tools can also be applied to better understand the intra-varietal (or clonal) variability in pear. Here we report the first high resolution genomics analysis of a pear clonal population using whole genome sequencing (WGS). Results showed unique signatures for the accumulation of mutations and transposable element insertions in each clone, which are likely related to their history of propagation and cultivation. The nucleotide diversity remained low in the clonal collection with the exception of few genomic windows, suggesting that balancing selection may be occurring. These windows included mainly genes related to plant fertility. Regions with higher mutational load were partially associated with transcription factors, probably reflecting the distinctive phenotypes in the collection. The annotation of variants also revealed the theoretical disruption of relevant genes in pear. Taken together, the results from this study show that pear clones accumulate mutations differently, and that those mutations can play a role on pear phenotypes, meaning that the study of pear clonal populations can be relevant in genetic studies, mainly when comparing with traditional association studies.

Comparison of the Psychometric Properties of the EQ-5D-3L-Y and EQ-5D-5L-Y Instruments in Spanish Children and Adolescents.

OBJECTIVES: The study aimed to assess the reliability and validity of EQ-5D-5L-Y and to compare the performance of EQ-5D-5L-Y with EQ-5D-3L-Y in children and adolescents. METHODS: The Spanish versions of the 3L and 5L of EQ-5D for youths, were administered to children and adolescents from the general population. Feasibility and reliability were determined for the EQ-5D-5L-Y. The EQ-5D-5L-Y and EQ-5D-3L-Y were evaluated in terms of ceiling effects, informativity, and correlations with other generic measurements of health-related quality of life. RESULTS: A total of 714 healthy children and adolescents (10.7 ± 2.1 years old) from the general population participated in the study. Most of the sample reported full health status. The feasibility and reliability for the EQ-5D-5L-Y were acceptable, but the questionnaire showed a low convergent validity. Absolute informativity (Shannon index) showed a slight increase in all dimensions of the 5L compared with the 3L; nevertheless, there were only statistically significant differences between 5L and 3L in the dimension "feeling worried, sad, or unhappy" and also on the overall system. Relative informativity (Shannon evenness index) showed a decrease in the 5L compared with 3L for all dimensions, except for "looking after myself." Correlations with other health measurements, in both 3L and 5L, showed similar results to those observed in the international EQ-5D-3L-Y validation study. CONCLUSION: The results show that EQ-5D-5L-Y is feasible, consistent, and reliable, but there are minor differences in the ceiling effect and informativity between the EQ-5D-5L-Y and EQ-5D-3L-Y versions in the general population.

Role for Physical Fitness in the Association between Age and Cognitive Function in Older Adults: A Mediation Analysis of the SABE Colombia Study.

Objectives. We investigated the association between physical fitness and cognitive status. Further, we examined whether physical fitness mediates the association between cognitive functioning and aging. Design. Cross-sectional study. Setting. Urban and rural Colombian older adults. Methods. 4416 participants from the SABE study were included in the current analysis. Physical fitness was assessed with the handgrip test and the usual gait speed test. Cognitive status was evaluated through the Folstein Mini-Mental State Examination. A parallel mediation path was used to test the possible mediator role of physical fitness between aging and cognitive functioning. Results. Older adults with lower handgrip strength (HGS) were more likely to have mild-cognitive status than older adults with healthy HGS (OR = 1.53, 95% CI = 1.15; 2.02). In addition, older adults with a slower gait speed were more likely to have mild cognitive impairment (OR = 2.05, 95% CI = 1.54; 2.78). Age had an inverse relationship with cognitive function (ß = -0.110, 95% CI = -0.130; -0.100) and it was also inversely associated with HGS (ß = -0.003, 95% CI = -0.005; -0.002) and gait speed (ß = -0.010, 95% CI = -0.011; -0.009). The indirect effects, which indicate that the effect of age on cognitive function is transmitted through mediators, showed that both gait speed (ß = -0.028, 95% CI = -0.036; -0.020) and HGS (ß = -0.014, 95% CI = -0.024; -0.005) were independent mediators of the detrimental effect of aging on cognitive function. Conclusions. Physical fitness mediates the effects of aging on cognitive functioning. Our findings suggest that physical activity can be a key factor to prevent cognitive deterioration during aging process.

High Prevalence of Probable Sarcopenia in a Representative Sample From Colombia: Implications for Geriatrics in Latin America.

OBJECTIVES: The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) recently defined the new concept of probable sarcopenia to help improve screening and prevent future sarcopenia. We investigated the prevalence of probable sarcopenia, defined as weak grip strength, in community-dwelling older Colombian adults, and examined the long-term associated conditions. DESIGN: Cross-sectional study. SETTING: Urban and rural Colombian older adults from the "Estudio Nacional de Salud, Bienestar y Envejecimiento (SABE) study". PARTICIPANTS: 5237 Colombian older adults aged ≥60 years. MEASUREMENTS: Probable sarcopenia was assessed following the cut-off points for weak grip strength recommended by EWGSOP2 guidelines. Odds ratios (ORs) of the relationship between long-term conditions and probable sarcopenia were determined using logistic regression. RESULTS: The prevalence of probable sarcopenia defined as weak grip strength was 46.5% [95% confidence interval (CI), 45.1-47.8]. Physical inactivity "proxy" (OR 1.35, 95% CI 1.14-1.59); diabetes (OR 1.32, 95% CI 1.11-1.56); and arthritis, osteoarthritis, and rheumatism (OR 1.44, 95% CI 1.25-1.67) were independently associated with probable sarcopenia. CONCLUSIONS AND IMPLICATIONS: We found that almost half of all the Colombian older adults in our sample had probable sarcopenia. Individuals with physical inactivity, diabetes, arthritis, or osteoarthritis and rheumatism had a higher prevalence of probable sarcopenia. Probable sarcopenia is clinically highly relevant, and several of the factors associated with this condition are potentially preventable, treatable, and reversible.

Validation of the ICU Mobility Scale for Nursing Use: Portuguese Multicentric Observational Study.

BACKGROUND AND PURPOSE: Mobilization of critical patients should be precocious and the inclusion of nursing in this task can be decisive in paradigm shift. The purpose of this study was to validate the Portuguese version of the intensive care unit Mobility Scale for nursing use. METHODS: Prospective multicenter observational study. Patients' mobility was evaluated by rehabilitation nurses in order to determine interobserver agreement. The validation criteria was tested by determining the correlation between the evaluation results of mobility, strength, and functionality levels at discharge. RESULTS: Good interobserver agreement (R = 0.98; K = 0.76). Positive correlation with muscle strength (R = 0.77) and functionality (R = 0.85) levels at discharge. CONCLUSIONS: Based on the correlations observed the scale is a valid instrument for nurses and could be a useful tool for routine use. More research is recommended to make the results more robust.

Glucose Levels as a Mediator of the Detrimental Effect of Abdominal Obesity on Relative Handgrip Strength in Older Adults.

Excess central adiposity accelerates the decline of muscle strength in older people. Additionally, hyperglycemia, independent of associated comorbidities, is related to the loss of muscle mass and strength, and contributes to functional impairment in older adults. We studied the mediation effect of glucose levels, in the relationship between abdominal obesity and relative handgrip strength (HGS). A total of 1571 participants (60.0% women, mean age 69.1 ± 7.0 years) from 86 municipalities were selected following a multistage area probability sampling design. Measurements included demographic and anthropometric/adiposity markers (weight, height, body mass index, and waist circumference). HGS was measured using a digital dynamometer for three sets and the mean value was recorded. The values were normalized to body weight (relative HGS). Fasting glucose was analyzed by enzymatic colorimetric methods. Mediation analyses were performed to identify associations between the independent variable (abdominal obesity) and outcomes (relative HGS), as well as to determine whether fasting glucose levels mediated the relationship between excess adiposity and relative HGS. A total of 1239 (78.8%) had abdominal obesity. Abdominal obesity had a negative effect on fasting glucose (ß = 9.04, 95%CI = 5.87 to 12.21); while fasting glucose to relative HGS was inversely related (ß = -0.003, 95%CI = -0.005 to -0.001), p < 0.001. The direct effect of abdominal obesity on relative HGS was statistically significant (ß = -0.069, 95%CI = -0.082 to -0.057), p < 0.001. Lastly, fasting glucose levels mediates the detrimental effect of abdominal obesity on relative HGS (indirect effect ß = -0.002, 95%CI = -0.004 to -0.001), p < 0.001. Our results suggest that the glucose level could worsen the association between abdominal obesity status and lower HGS. Thus, it is plausible to consider fasting glucose levels when assessing older adults with excess adiposity and/or suspected loss of muscle mass.

Analysis of the Force-Velocity Profile in Female Ballet Dancers.

Jumping ability has been identified as one of the best predictors of dance performance. The latest findings in strength and conditioning research suggest that the relationship between force and velocity mechanical capabilities, known as the force-velocity profile, is a relevant parameter for the assessment of jumping ability. In addition, previous investigations have suggested the existence of an optimal force-velocity profile for each individual that maximizes jump performance. Given the abundance of ballistic actions in ballet (e.g., jumps and changes of direction), quantification of the mechanical variables of the force-velocity profile could be beneficial for dancers as a guide to specific training regimens that can result in improvement of either maximal force or velocity capabilities. The aim of this study was to compare the mechanical variables of the force-velocity profile during jumping in different company ranks of ballet dancers. Eighty-seven female professional ballet dancers (age: 18.94 ± 1.32 years; height: 164.41 ± 8.20 cm; weight: 56.3 ± 5.86 kg) showed high force deficits (> 40%) or low force deficits (10% to 40%) regardless of their company rank. Our results suggest that dance training mainly develops velocity capabilities, and due to the high number of dramatic elevations that dance performance requires, supplemental individualized force training may be beneficial for dancers. The individualization of training programs addressed to the direction of each individual's imbalance (high force or low force) could help dancers and their teachers to improve jump height and therefore dance performance.

Relative Handgrip Strength Diminishes the Negative Effects of Excess Adiposity on Dependence in Older Adults: A Moderation Analysis.

The adverse effects of fat mass on functional dependence might be attenuated or worsened, depending on the level of muscular strength. The aim of this study was to determine (i) the detrimental effect of excess adiposity on dependence in activities of daily living (ADL), and (ii) whether relative handgrip strength (HGS) moderates the adverse effect of excess adiposity on dependence, and to provide the threshold of relative HGS from which the adverse effect could be improved or worsened. A total of 4169 participants (69.3 ± 7.0 years old) from 244 municipalities were selected following a multistage area probability sampling design. Measurements included anthropometric/adiposity markers (weight, height, body mass index, waist circumference, and waist-to-height ratio (WHtR)), HGS, sarcopenia "proxy" (calf circumference), and ADL (Barthel Index scale). Moderation analyses were performed to identify associations between the independent variable (relative HGS) and outcomes (dependence), as well as to determine whether relative HGS moderates the relationship between excess adiposity and dependence. The present study demonstrated that (i) the adverse effect of having a higher WHtR level on dependence in ADL was moderated by relative HGS, and (ii) two moderation thresholds of relative HGS were estimated: 0.35, below which the adverse effect of WHtR levels on dependency is aggravated, and 0.62, above which the adverse effect of fat on dependency could be improved. Because muscular strength represents a critically important and modifiable predictor of ADL, and the increase in adiposity is inherent in aging, our results underscore the importance of an optimal level of relative HGS in the older adult population.

Association of Physical Education With Improvement of Health-Related Physical Fitness Outcomes and Fundamental Motor Skills Among Youths: A Systematic Review and Meta-analysis.

Importance: Whether quality- or quantity-based physical education (PE) interventions are associated with improvement of health-related physical fitness outcomes and fundamental motor skills (FMSs) in children and adolescents is unknown. Objective: To examine the association of interventions aimed at optimizing PE in terms of quality (teaching strategies or fitness infusion) or quantity (lessons per week) with health-related physical fitness and FMSs in children and adolescents. Data Sources: For this systematic review and meta-analysis, studies were identified through a systematic search of Ovid MEDLINE, Embase, Cochrane Controlled Trials Registry, and SPORTDiscus databases (from inception to October 10, 2019) with the keywords physical education OR PE OR P.E. AND fitness AND motor ability OR skills. Manual examination of references in selected articles was also performed. Study Selection: Studies that assessed the association of quality- or quantity-based PE interventions with improvement in physical fitness and/or FMSs in youths (aged 3-18 years) were included. Data Extraction and Synthesis: Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Random-effects models were used to estimate the pooled effect size (Hedges g). Main Outcomes and Measures: Health-related physical fitness outcomes and FMSs. Results: Fifty-six trials composed of 48 185 youths (48% girls) were included in the meta-analysis. Quality-based PE interventions were associated with small increases in health-related physical fitness (cardiorespiratory fitness [Hedges g = 0.24; 95% CI, 0.16-0.32] and muscular strength [Hedges g = 0.19; 95% CI, 0.09-0.29]) and FMSs (Hedges g = 0.38; 95% CI, 0.27-0.49). Subgroup analyses found stronger associations for quality-based PE interventions on body mass index (Hedges g = -0.18; 95% CI, -0.26 to -0.09), body fat (Hedges g = -0.28; 95% CI, -0.37 to -0.18), cardiorespiratory fitness (Hedges g = 0.31; 95% CI, 0.23-0.39), and muscular strength (Hedges g = 0.29; 95% CI, 0.18-0.39). Quantity-based PE interventions were associated with small increases in only cardiorespiratory fitness (Hedges g = 0.42; 95% CI, 0.30-0.55), muscular strength (Hedges g = 0.20; 95% CI, 0.08-0.31), and speed agility (Hedges g = 0.29; 95% CI, 0.07-0.51). Conclusions and Relevance: The findings suggest that quality-based PE interventions are associated with small increases in both student health-related physical fitness components and FMSs regardless of frequency or duration of PE lessons. Because PE aims to improve more than health, high levels of active learning time may need to be balanced with opportunities for instruction, feedback, and reflection.