Association between bullying victimization and health risk behavior in adolescents / Associação entre vitimização de bullying e comportamentos de risco à saúde em adolescentes

ABSTRACT Objective: The aim of this study was to examine the association between bullying victimization and health risk behaviors in adolescents. Methods: A representative sample of 1020 adolescents participated in the study. The variables such as bullying, health risk behaviors (tobacco, drugs, alcohol, sedentary behavior, smartphone use, level of physical activity, and sleep), and economic status were assessed using self-reported questionnaires. Odds ratios with 95% confidence intervals (95%CI) were obtained using binary logistic regression and ordinal, gross, and adjusted logistic regression (p<0.05). Results: Victims of bullying were more likely to smoke (OR 1.75; 95%CI 1.28-2.40), consume alcohol (OR1.43; 95%CI 1.05-1.94), have worse sleep quality (OR 1.94; 95%CI 1.28-2.91), and more sedentary behavior (OR 1.43; 95%CI 1.08-1.89) than those who were not bullied. However, victims were more likely to have high levels of physical activity than their non-bullied peers (OR 1.66; 95%CI 1.22-2.27). Conclusions: Bullying victimization was associated with an increased predisposition for the adoption of health risk behaviors. Interestingly, victims were also more prone to participate in physical activity.

RESUMO Objetivo: Examinar a associação entre vitimização por bullying e comportamentos de risco à saúde em adolescentes. Métodos: Uma amostra representativa de 1.020 adolescentes participou do estudo. As variáveis bullying, comportamentos de risco à saúde (tabaco, drogas, álcool, comportamento sedentário, uso de smartphone, nível de atividade física, sono) e situação econômica foram avaliadas por meio de questionários autorreportados. Razões de chance com intervalos de confiança de 95% (IC95%) foram obtidas por meio de regressão logística binária e regressão logística ordinal, bruta e ajustada (p<0,05). Resultados: As vítimas de bullying apresentaram maior probabilidade de fumar (OR 1,75; IC95% 1,28-2,40), consumir álcool (OR 1,43; IC95% 1,05-1,94), ter pior qualidade de sono (OR 1,94; IC95% 1,28-2,91) e apresentar mais comportamento sedentário (OR 1,43; IC95% 1,08-1,89) do que aqueles que não sofreram bullying. No entanto, as vítimas eram mais propensas a ter níveis elevados de atividade física do que os seus pares não vítimas de bullying (OR 1,66; IC95% 1,22-2,27). Conclusões: A vitimização por bullying esteve associada ao aumento da predisposição para a adoção de comportamentos de risco à saúde. Curiosamente, as vítimas também eram mais propensas a participar de atividades físicas.

Assessment of Quality of Life for Elderly Residents: A Cross Sectional Study in Nursing Home Settings / Evaluación de la calidad de vida de los residentes de edad avanzada: un estudio transversal en entornos de hogares de ancianos

Abstract Objective: We aim to assess the quality of life of older individuals living in nursing homes. Methodology: A descriptive cross-sectional study was conducted on institutionalized elderly individuals for over three months. The sample size of the study was 260 and Non-randomized convenience sampling was used. The study excluded participants with cognitive impairment, severe medical conditions, physical limitations, communication barriers, severe pain, recent surgery, acute illness, or psychiatric disorders. Ethical approval was obtained, and participants were given informed consent. The study took place in various nursing homes in Lahore in June and July 2023, for the analysis of data Statistical Package for Social Sciences (SPSS version 22) was used, employing frequency distribution, mean, standard deviation, and correlation. Results: The Pearson Correlation coefficient of 0.459 suggests a significant positive correlation between these variables (p < 0.01). This correlation is evident in both directions: Quality of life (QoL) score to Mini Mental Scale and vice versa. Conclusion: While assessing the QoL in elderly inhabitants of nursing residences, cognitive impairment, and high Body mass index (BMI) appeared to influence the overall QoL.

Resumen Objetivo: Nuestro objetivo es evaluar la calidad de vida de las personas mayores que viven en residencias de ancianos. Metodología: Se realizó un estudio descriptivo transversal en ancianos institucionalizados durante más de tres meses. El tamaño de la muestra del estudio fue de 260 y se utilizó un muestreo de conveniencia no aleatorizado. El estudio excluyó a los participantes con deterioro cognitivo, afecciones médicas graves, limitaciones físicas, barreras de comunicación, dolor intenso, cirugía reciente, enfermedad aguda o trastornos psiquiátricos. Se obtuvo la aprobación ética y los participantes dieron su consentimiento informado. El estudio se llevó a cabo en varias residencias de ancianos de Lahore en junio y julio de 2023. Para el análisis de los datos se utilizó Statistical Package for Social Sciences (SPSS versión 22), empleando distribución de frecuencias, media, desviación estándar y correlación. Resultados: El coeficiente de correlación de Pearson de 0,459 sugiere una correlación positiva significativa entre estas variables (p < 0,01). Esta correlación es evidente en ambas direcciones: puntuación de calidad de vida a Escala Mini-Mental y viceversa. Conclusión: Al evaluar la calidad de vida de los ancianos que viven en residencias, el deterioro cognitivo y un índice de masa corporal (IMC) elevado parecen afectar la calidad de vida general.

Genetic Signature of a Healthy Lifestyle: New Horizons for Preventing Noncommunicable Chronic Diseases by Modulating MicroRNA-155.

The development and progression of several noncommunicable diseases (NCDs) are associated with microRNA (miR) 155 (miR-155) activation, which promotes inflammation and oxidative stress. In particular, miR-155 regulates nuclear transcription factor-kappa B (NF-κB) by silencing gene expression of proteins involved in NF-κB suppression, such as suppressor of cytokine signaling 1 (SOCS1) and SH-2 containing inositol 5' polyphosphate 1 (SHIP1), increases the production of reactive oxygen species, and suppresses gene expression of antioxidant enzymes through nuclear factor erythroid 2-related factor 2 (Nrf2) inhibition. In this context, a healthy lifestyle based on a diet rich in nutrients and bioactive compounds as well as regular physical activity may modulate the activity of several miRs. Following this concept, studies involving nutrients, bioactive compounds, and physical activity have been developed to modulate miR-155 activation. This narrative review aims to discuss how a healthy lifestyle based on a diet rich in nutrients, bioactive compounds, and physical activity may modulate the miR-155 pathway and consequently prevent the development and progression of NCDs. Nutrients and bioactive compounds from food may act by inhibiting pathways that promote miR-155 activation such as NF-κB and promote activation of pathways that are associated with the downregulation of miR-155, such as Nrf2, and SOCS1 pathways. Regular physical activity also seems to influence miR-155 levels through an improvement in the immune system during muscle recovery. There is relevant evidence that shows a positive effect of nutrients, bioactive compounds, and physical activity with the modulation of miR-155, which can potentially provide benefits in the clinical setting in cases of NCDs.

Could aerobic exercise applied before constraint-induced movement therapy change circulating molecular biomarkers in chronic post-stroke?

BACKGROUND: Integrating aerobic exercise (AE) into rehabilitation programs for post-stroke individuals could enhance motor recovery and cardiovascular health by increasing brain-derived neurotrophic factor (BDNF) and the myokine irisin. Chronic stroke survivors typically exhibit elevated matrix metalloproteinase-9 (MMP-9) activity, which is negatively correlated with steps and time in medium cadence, although the impact of AE on this biomarker remains unclear. OBJECTIVE: To evaluate the effect of high-intensity AE training prior to modified constraint-induced movement therapy (mCIMT) on BDNF and irisin concentration, and on MMP-2 and MMP-9 activity in chronic post-stroke individuals and to associate these results with functional improvements. METHODS: Nine participants received AE combined with mCIMT for two weeks, while the control group (n = 7) received mCIMT alone. Manual dexterity and functional capacity were assessed before and after the intervention. Serum samples were analyzed for BDNF, irisin, MMP-2 and MMP-9. RESULTS: There were no significant main effects of assessment, group or interaction on molecular biomarkers. However, the AE group had a significant increase in MMP-9 activity post-intervention (p = .033; d = 0.67). For the Box and Block Test, there were significant main effects of assessment (F [1, 14] = 33.27, p = .000, ηp2 = 0.70) and group (F [1, 14] = 5.43, p = .035, ηp2 = .28). No correlations were found between biomarkers and clinical assessments. CONCLUSION: AE prior to mCIMT did not influence circulating BDNF and irisin levels but did induce an acute rise in MMP-9 activity, suggesting potential effects on cardiovascular remodeling in this population.

Screen time, sleep duration, leisure physical activity, obesity, and cardiometabolic risk in children and adolescents: a cross-lagged 2-year study.

BACKGROUND: Considering the previous research that suggested that screen time (ST), sleep duration, physical activity (PA), obesity and cardiometabolic risk factors are related, it is essential to identify how these variables are associated over time, to provide knowledge for the development of intervention strategies to promote health in pediatric populations. Also, there is a lack of studies examining these associations longitudinally. The aims of the present study were: (1) to investigate the longitudinal relationships between ST, sleep duration, leisure PA, body mass index (BMI), and cardiometabolic risk score (cMetS) in children and adolescents; and (2) to verify scores and prevalence of cMetS risk zones at baseline and follow-up. METHODS: This observational longitudinal study included 331 children and adolescents (aged six to 17 years; girls = 57.7%) from schools in a southern city in Brazil. ST, sleep duration, and leisure PA were evaluated by a self-reported questionnaire. BMI was evaluated using the BMI z-scores (Z_BMI). The cMetS was determined by summing sex- and age-specific z-scores of total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio, triglycerides, glucose, and systolic blood pressure and dividing it by four. A two-wave cross-lagged model was implemented. RESULTS: ST, sleep duration, and leisure PA were not associated with cMetS after 2-years. However, it was observed that higher ST at baseline was associated with shorter sleep duration at follow-up (B=-0.074; 95%IC=-0.130; -0.012), while higher Z_BMI from baseline associated with higher cMetS of follow-up (B = 0.154; 95%CI = 0.083;0.226). The reciprocal model of relationships indicated that the variance of ST, sleep time, leisure PA, Z_BMI, and cMetS explained approximately 9%, 14%, 10%, 67% and 22%, respectively, of the model. Individual change scores and prevalence indicated that cMetS had individual changes from 2014 to 2016. CONCLUSION: Sleep duration, ST and leisure PA were not associated with cMetS after 2 years. ST showed an inverse association with sleep duration, and Z_BMI was positively associated with cMetS after a 2-year follow-up. Finally, the prevalence of no clustering of risk factors increased after two years. These findings suggest the need to promote healthy lifestyle habits from childhood and considering individual factors that can influence cardiometabolic health in children and adolescents.

Maintaining exercise in fitness centre settings: insights from the physical activity maintenance theory.

PURPOSE: This study examines factors that influence long-term fitness centre participation, applying the Physical Activity Maintenance Theory to assess psychological and contextual influences on exercise adherence. METHODS: Semi-structured interviews were conducted with 17 regular fitness centre attendees in Taubaté, São Paulo, Brazil. Data were analysed using Bardin's Content Analysis, exploring the participants' experiences and the factors contributing to their sustained activity. RESULTS: Autonomous motivation, such as enjoyment and satisfaction from workouts, along with self-efficacy, emerged as crucial for continued fitness centre attendance. The environment, including ambiance, social support, and facility quality, significantly impacted exercise persistence. However, challenges like time constraints, weather conditions, and personal issues occasionally hindered engagement. The study also highlights the role of personalized fitness programmes in supporting long-term adherence, suggesting that tailoring these programmes to individual goals could further enhance commitment. CONCLUSIONS: The findings underscore the importance of fitness centres creating environments that align with individual needs and preferences. Customized programmes that cater to both personal and communal needs could bolster long-term adherence. Future research should explore the impact of personalized, community-integrated fitness approaches on sustaining active lifestyles, emphasizing the importance of accommodating individual preferences in maintaining regular exercise habits.

The association of telomere length with body mass index and immunological factors differs according to physical activity practice among children and adolescents.

BACKGROUND: This study aims to verify the relationship between screen and sleep time, body mass index (BMI) and immunological factors with telomere length according to leisure-time physical activity (PA) in children and adolescents. METHODS: A cross-sectional study involving a sample of 476 schoolchildren of both sexes, aged seven to 17 years, from a community in southern Brazil. Behavioral variables (PA, sleep time, and screen time) were self-reported using a questionnaire. PA was classified as inactive and any PA (doing some physical activity). The associations of screen time, sleep time, BMI, and immunologic factors with telomere length were tested using multiple linear regression models, with the sample divided according to the schoolchildren's leisure-time physical activity practices. RESULTS: An inverse association between BMI and telomere length (ß: -0.239; 95% CI: -0.468; -0.010) and a direct association of leukocytes (ß: 0.151; 95% CI: 0.029; 0.278) and neutrophils (ß: 0.131; 95% CI: 0.008; 0.254) with telomeres were found in the inactive students. No association was found between screen time and sleep time and telomeres. No association was found among students who engaged in any PA. CONCLUSION: The associations between telomeres, BMI, and immunologic factors were found only in inactive students. These results suggest that the association between BMI and immunological factors and telomere length may be influenced by physical activity.

Physical exercise in Chilean breast cancer survivors: Qualitative study of barriers, facilitators and preferences. / Actividad física en chilenas sobrevivientes de cáncer de mama: estudio cualitativo de barreras, facilitadores y preferencias.

Introduction: Breast cancer survivors often experience pre and post-treatment physical and psychological symptoms, negatively affecting their quality of life. Regular physical exercise is associated with better quality of life and lower recurrence of cancer, and therefore all oncological patients are recommended to practice it in a regular basis. Despite this, breast cancer survivors have low adherence to physical exercise. The purpose of this study is to identify barriers, facilitators and preferences of Chilean breast cancer survivors to practice physical exercise. Methods: Phenomenological qualitative study of 12 in-depth interviews with adjuvant radiation therapy concluded at least three months ago. Results: Breast cancer survivors ignored the benefits of physical exercise during and after treatment. The barriers were physical symptoms, psychological barriers, sociocultural barriers, health system barriers, disinformation and sedentary lifestyle. Facilitators were coping with physical symoptoms, psychological issues, having information and active lifestyle. The preferences were painless and familiar exercises. Preferred exercise was walking. Conclusions: Breast cancer survivors may adhere to physical exercise despite barriers when certain facilitators are present, which may be promoted by the health team when reporting the benefits of the physical exercise, prescribing personalized, safe and painless physical exercise and educating both patient and her family about the role of the physical exercise in cancer recovering process.

Introducción: Las sobrevivientes de cáncer de mama suelen ver afectada negativamente su calidad de vida por síntomas físicos y psicológicos pre y post tratamiento. La práctica regular de ejercicio físico se asocia a mejor calidad de vida y menor recurrencia del cáncer, por esto es recomendado a todos los pacientes oncológicos. Sin embargo, existe baja adherencia a este. El propósito de este artículo es identificar barreras, facilitadores y preferencias de sobrevivientes de cáncer de mama chilenas para realizar ejercicio físico. Métodos: Estudio cualitativo fenomenológico, basado en entrevistas en profundidad a 12 sobrevivientes de cáncer de mama que terminaron la radioterapia adyuvante hace tres o más meses. Resultados: Las sobrevivientes de cáncer de mama desconocían la importancia del ejercicio físico durante y después del tratamiento. Las barreras identificadas fueron síntomas físicos, barreras psicológicas, socioculturales, del sistema de salud; desinformación y sedentarismo. Los facilitadores fueron físicos, psicológicos, contar con información y práctica de ejercicio físico antes del diagnóstico. Las preferencias fueron ejercicios indoloros y familiares. El ejercicio preferido fue caminar. Conclusiones: Es posible que las sobrevivientes de cáncer de mama adhieran al ejercicio físico, a pesar de las barreras cuando hay ciertos facilitadores presentes. Estos pueden ser generados por el equipo médico al informar los beneficios del ejercicio físico, prescribir ejercicio físico personalizado, seguro e indoloro y educar a la paciente y a su familia sobre el rol del ejercicio físico en la recuperación de sobrevivientes de cáncer de mama.

The impact of exercise intensity on depression in fibromyalgia: a randomized controlled trial.

Background: Fibromyalgia (FM) is characterized by widespread chronic pain. Although pain is the main symptom, approximately 90% of patients have depression. This study aimed to analyze the effects of Resistance Training (RT) with low and high intensity on depression in patients with FM. Methods: Thirty-eight women with FM and 31 healthy women were allocated to the low-intensity, high-intensity, preferred-intensity, and control groups. The patients underwent 8 weeks of supervised RT, with two sessions per week of approximately 1 h. The low-intensity resistance training group (LIRT) performed two sets of 12 maximum repetitions. The high-intensity resistance training group (HIRT) performed four sets with six maximum repetitions, and the preferred intensity group (PI) performed three sets, with eight to 12 repetitions, according to the patient's tolerance. The healthy control group did not perform any type of exercise. Depression was assessed using the Beck depression inventory before the start of the intervention, after 4 and 8 weeks. Results: FM patients have higher levels of depression than women without the disease. After 4 weeks, there was a difference in depressive symptoms between the HIRT and LIRT (p = 0.048), and the PI and LIRT (p = 0.048). Conclusion: Prescribing RT with low or high intensity did not significantly reduce depression in patients with FM after 8 weeks, however, analyses between groups after 4 weeks indicated that low-intensity training is more effective than high-intensity training. The prescription of RT exercise to FM could vary among low, high, and preferred intensity, following the patient's tolerance for pain. Clinical trial registration: https://ensaiosclinicos.gov.br/rg/RBR-74pcmw, RBR-74pcmw.

Determinant factors of sedentary time in individuals with COPD.

BACKGROUND: The factors influencing sedentary time (ST) of individuals with chronic obstructive pulmonary disease (COPD) have not been thoroughly explored. AIM: To identify determinant factors of ST in individuals with stable COPD. METHODS: Individuals with COPD had their ST and variables of physical activity (PA) cross-sectionally assessed during seven days with an activity monitor. Main variables were ST/day (<1.5 METs), steps/day, time/day in light PA (light PA/day, 1.5-2.9 METs) and in moderate-to-vigorous PA (MVPA/day, ≥3 METs). Additional assessments included 6-min walking test (6MWT), Medical Research Council (MRC) scale, lung function and body composition. Multiple linear regression models were built with variables correlating significantly with ST/day. RESULTS: 50 individuals were analyzed (44 % males; 66 ± 8 years; FEV1 50 ± 19%pred). ST/day was 488 ± 160 min (61 ± 15 % of the day). 6MWT, MRC scale, MVPA/day, steps/day and light PA/day correlated significantly with ST expressed as minutes/day or as % of the day. In the multiple regression analyses, variables explaining the variance of ST in minutes/day were MRC scale (1 %) and light PA/day (53 %) (model R2 = .541, p < 0.001) and of ST in % of the day were steps/day (53 %) and light PA/day (46 %) (model R2 = .994, p < 0.001). CONCLUSION: In individuals with COPD, the variance in sedentary time can be explained by dyspnea in daily life, step count and specially time/day in light PA, which reinforces the increase in light PA (rather than necessarily MVPA) as a strategy to reduce sedentary time.

Symptoms of depression and lifestyle in adolescents: A network analysis.

PURPOSE: Life experiences that could either promote or attenuate depression have primarily been studied in adults. Therefore, we investigated the association between lifestyle factors and symptoms of depression in adolescents. DESIGN AND SETTING: A cross-sectional study was carried out in Brazilians. SUBJECTS: Data from 93 individuals were analyzed out of the 150 invited participants (age 14.2±1.8, 67.74% girls). MEASURES: Lifestyle habits (SMILE-C), physical activity and sitting time (IPAQ), as well as symptoms of depression (DASS-21) were evaluated. ANALYSIS: A network analysis was performed using the EBIC-LASSO model, with the expected influence as a centrality parameter. RESULTS: The lifestyle domains with the highest expected influence were diet and nutrition (1.423), walking (1.126) and Stress Management (1.015). The variables with the highest direct partial negative correlation with depression were social support (-0.307) and moderate-vigorous physical activity (-0.244), suggesting a bidirectional relationship between these variables with lower symptoms of depression. CONCLUSION: Specific lifestyle areas such as social support, physical activity and nutrition appear to impact other healthy habits while reducing teen depressive symptoms.

Are perceived barriers to physical activity related to depression, anxiety and stress among adolescents? The EHDLA study.

Objective: The aim of this study was twofold: first, to examine the association between perceived barriers to physical activity (PA) practice and depression, anxiety and stress in a sample of Spanish adolescents; and second, to determine which barriers are specifically associated with depression, anxiety and stress. Methods: This cross-sectional study was conducted with 765 adolescents aged 12-17 (55.6% girls) in the Valle of Ricote, Murcia, Spain. Depression, anxiety and stress symptoms were assessed using the Depression, Anxiety and Stress Scale (DASS-21), with validated cut points employed to determine the presence of each of these mental conditions. The perception of barriers to PA was assessed using a validated questionnaire for the Spanish adolescent population. Results: The barrier 'Because I feel that my physical appearance is worse than that of others' was related to a higher likelihood of having depression (OR=2.41; 95% CI 1.35 to 4.28; p=0.003), anxiety (OR=2.65; 95% CI 1.51 to 4.71; p=0.001) and stress (OR=2.82; 95% CI 1.59 to 5.07; p<0.001). Similarly, the barrier 'Because nobody encourages me to engage in physical activity' was related to a higher likelihood of having depression (OR=1.92; 95% CI 1.08 to 3.43; p=0.026), anxiety (OR=1.97; 95% CI 1.11 to 3.50; p=0.021) and stress (OR=1.99; 95% CI 1.12 to 3.59; p=0.021). Conclusion: Perceived barriers to PA related to physical appearance and social support seem to be associated with a greater likelihood of depression, anxiety and stress among Spanish adolescents.

Sociodemographic Factors Related to Perceived Physical Activity on Chilean Adults after COVID-19 Pandemic.

The current study aimed to examine the relationship between sociodemographic variables (i.e., sex, age, marital status, educational level, socioeconomic status, and working mode) and physical activity levels declared by Chilean adults. The sample comprised 483 Chilean adults, 159 men (32.9%) and 324 women (67.1%) aged from 18 to 69 years old (36.5 ± 12.0). The participants completed an ad hoc sociodemographic online survey between December 2022 and March 2023 that included questions about characteristics of participants such as sex, age, educational level, household income, marital status, and working mode. Vigorous, moderate, and walking activities were measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), a self-administered questionnaire. Men declared significantly higher vigorous and moderated physical activity than women. People aged 18 to 25, single or unmarried, and with the lowest household income, showed significantly higher scores in vigorous physical activity than those aged 26 to 45, cohabiting with a partner or married, and middle household income, respectively. Regarding working mode, people working at their job site said walking more than people not working, working in a hybrid mode, and working online. Our findings suggest that promoting strategies that increase physical activity during the pandemic is necessary to avoid health problems.

Does frailty affect barriers to physical activity in patients with symptomatic peripheral artery disease? A cross-sectional study.

BACKGROUND: Frailty syndrome is prevalent among many patients experiencing intermittent claudication symptoms. Considering that components of the frailty syndrome can affect both physical and psychological functions, it is likely that barriers to physical activity are heightened in these individuals. AIM: To analyze the association between barriers to physical activity and frailty in patients with symptomatic peripheral artery disease (PAD). METHODS: This cross-sectional study included 216 patients with symptomatic PAD (64.8% men, 65.6±9.4 yrs.). Nine personal and 8 environmental barriers to physical activity were investigated through a questionnaire on barriers to practicing physical activity in patients with intermittent claudication. Frailty was defined according to Fried et al. (2001) criteria which included unintentional weight loss, exhaustion, low grip strength, slow walking speed, physical inactivity. Three or more criteria defined frail, one or 2 criteria defined pre-frail, and absence of criteria defined non-frail. Data are presented as median (interquartile range). RESULTS: Frail and pre-frail patients have more barriers than non-frail patients [frail: 11 (4); pre-frail: 10 (6); non-frail: 8 (7), p = 0.001]. Absence of a companion for physical activity, lack of knowledge and uncertainty about the benefits of physical activity, pain induced by walking and presence of obstacles that worsen leg pain were associated with frail and pre-frail status, independent of sex, age, ankle-brachial index, and total walking distance. CONCLUSION: Patients with PAD who are frail and pre-frail have more barriers to physical activity than non-frail patients. Therefore, specific interventions promoting PA are essential for these patients to improve their health outcomes.

Lifestyle and Cardiometabolic Risk Factors Associated with Impoverishment Due to Out-of-Pocket Health Expenditure in São Paulo City, Brazil.

The rise in obesity and related chronic noncommunicable diseases (NCDs) during recent decades in Brazil has been associated with increases in the financial burden and risk of impoverishment due to out-of-pocket (OOP) health expenditure. Thus, this study investigated trends and predictors associated with impoverishment due to health expenditure, in the population of São Paulo city, Brazil, between 2003 and 2015. Household data from the São Paulo Health Survey (n = 5475) were used to estimate impoverishment linked to OOP health expenses, using the three thresholds of International Poverty Lines (IPLs) defined by the World Bank at 1.90, 3.20, and 5.50 dollars per capita per day purchasing power parity (PPP) in 2011. The results indicated a high incidence of impoverishment due to OOP disbursements for health care throughout the period, predominantly concentrated among low-income individuals. Lifestyle choices referring to leisure-time physical activity (OR = 0.766 at $3.20 IPL, and OR = 0.789 at $5.50 IPL) were linked to reduction in the risk for impoverishment due to OOP health expenditures whilst there were increases in the probability of impoverishment due to cardiometabolic risk factors referring to obesity (OR = 1.588 at $3.20 IPL, and OR = 1.633 at $5.50 IPL), and diagnosis of cardiovascular diseases (OR = 2.268 at $1.90 IPL, OR = 1.967 at $3.20 IPL, and OR = 1.936 at $5.50 IPL). Diagnosis of type 2 diabetes mellitus was associated with an increase in the probability of impoverishment at only the $1.90 IPL (OR = 2.506), whilst coefficients for high blood pressure presented lack of significance in the models. Health policies should focus on interventions for prevention of obesity to ensure the financial protection of the population in São Paulo city, Brazil, especially targeting modifiable lifestyle choices like promotion of physical activity and reduction of tobacco use.

Sum of Skinfold-Corrected Girths Correlates with Resting Energy Expenditure: Development of the NRGCO Equation.

Our study aimed to validate existing equations and develop the new NRGCO equation to estimate resting energy expenditure (REE) in the Colombian population with moderate-to-high physical activity levels. Upon satisfying the inclusion criteria, a total of 86 (43F, 43M) healthy adults (mean [SD]: 27.5 [7.7] years; 67.0 [13.8] kg) were evaluated for anthropometric variables and REE by indirect calorimetry using wearable gas analyzers (COSMED K4 and K5). Significant positive correlations with REE were found for body mass (r = 0.65), body mass-to-waist (r = 0.58), arm flexed and tensed girth (r = 0.66), corrected thigh girth (r = 0.56), corrected calf girth (r = 0.61), and sum of breadths (∑3D, r = 0.59). As a novelty, this is the first time a significant correlation between REE and the sum of corrected girths (∑3CG, r = 0.63) is reported. Although existing equations such as Harris-Benedict (r = 0.63), Mifflin-St. Jeor (r = 0.67), and WHO (r = 0.64) showed moderate-to-high correlations with REE, the Bland-Altman analysis revealed significant bias (p < 0.05), indicating that these equations may not be valid for the Colombian population. Thus, participants were randomly distributed into either the equation development group (EDG, n = 71) or the validation group (VG, n = 15). A new model was created using body mass, sum of skinfolds (∑8S), corrected thigh, corrected calf, and age as predictors (r = 0.755, R2 = 0.570, RMSE = 268.41 kcal). The new NRGCO equation to estimate REE (kcal) is: 386.256 + (24.309 × BM) - (2.402 × ∑8S) - (21.346 × Corrected Thigh) + (38.629 × Corrected Calf) - (7.417 × Age). Additionally, a simpler model was identified through Bayesian analysis, including only body mass and ∑8S (r = 0.724, R2 = 0.525, RMSE = 282.16 kcal). Although external validation is needed, our validation resulted in a moderate correlation and concordance (bias = 91.5 kcal) between measured and estimated REE values using the new NRGCO equation.

Role of sex and training characteristics on exercise effects on cardiovascular aging: protocol for a systematic review with meta-analysis of randomized trials.

BACKGROUND: Cardiovascular diseases remain a leading global cause of mortality worldwide especially in older adults. Although it is known that regular exercise reduces cardiovascular diseases incidence, its effects on specific cardiovascular aging parameters considering the influence of sex and different exercise designs are still not fully understood. Therefore, this systematic review and meta-analysis aims to evaluate the effects of different physical exercise protocols on age-related cardiovascular outcomes in older adults. METHODS: This systematic review and meta-analysis will be reported in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles will be eligible if they are randomized controlled trials with a primary objective of evaluating the chronic effects of exercise interventions on cardiovascular aging parameters. Search strategy will be performed from the inception to September 30th, 2023, in the following electronic databases: MEDLINE (Ovid), SCOPUS (Elsevier), Embase, Sport Discus (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science Core Collection (Clarivate Analytics). Data will be extracted and managed through Research Electronic Data Capture (REDCap) software. The Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) will be used to assess the methodological quality of included studies. Additionally, the quality of the findings will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) profiler. Meta-analysis based on the random-effects model will be performed (if deemed suitable, considering the methodological and clinical heterogeneity of the studies) to estimate the effects of exercise training on cardiovascular aging variables (i.e., cardiac output; arterial stiffness; stroke volume; endothelial function; and carotid intima-media thickness). Heterogeneity will be assessed with the I2 statistics, while the publication bias will be assessed based on Egger's test. DISCUSSION: To the best of our knowledge, this will be the first systematic review and meta-analysis to investigate the impact of sex and training protocols on the cardiovascular aging parameters. Moreover, the findings of this systematic review and meta-analysis will provide evidence for health professionals in the management of elderly patients in order to optimize the exercise prescription to face the cardiovascular alterations related to the aging process, considering the effects of different protocols according to sex. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023441015 .

Descending motor drive does not interact with muscle metaboreflex for ventilation regulation during rhythmic exercise in healthy humans.

The muscle metaboreflex effect on pulmonary ventilation (V̇E) regulation is more apparent during rhythmic exercise than rest, possibly because this reflex interacts with other mechanisms regulating V̇E during voluntary contractions, such as central command. Therefore, we tested whether one part of central command, the descending component of motor execution (i.e., descending motor drive), and the muscle metaboreflex interact synergistically to regulate V̇E. Thirteen healthy adults (9 men) completed four experiments in random order under isocapnia. The muscle metaboreflex was activated by rhythmic handgrip exercise at 60% maximal voluntary contraction (MVC) force with the dominant hand. Then, the muscle metaboreflex remained active during a 4-minute recovery period via post-exercise circulatory occlusion (PECO), or it was inactivated, maintaining free blood flow to the dominant upper limb. During the last 2-minutes of the handgrip exercise recovery, participants either performed rhythmic voluntary plantar flexion with the dominant leg at 30% MVC torque to generate descending motor drive or the dominant leg's calf muscles were involuntarily activated by electrical stimulation at a similar torque level (i.e., without descending motor drive). V̇E increased to a similar level during handgrip exercise in all conditions (≈22 L/min, P = 0.364). PECO maintained V̇E elevated above recovery with free blood flow (≈17 L/min vs. ≈13 L/min, P = 0.009). However, voluntary and involuntary plantar flexion with or without PECO evoked similar V̇E responses (∆ ≈ 4 L/min, P = 0.311). Therefore, an interaction between descending motor drive and muscle metaboreflex is not ubiquitous for V̇E regulation during rhythmic exercise.

An internet-based self-help intervention for the reduction of consumption of ultra-processed products and increase of physical activity in Mexican university population: study protocol for a randomized controlled trial.

Introduction: The consumption of ultra-processed products has been associated with the etiology of various diseases, mainly metabolic diseases. On the other hand, physical activity acts as a protective factor that helps prevent the appearance of this type of disease. In addition to the physical effects, both the consumption of ultra-processed products (UPPs) and sedentary behaviors have been associated with a significant impact on people's mental health. These problems occur significantly in university students. Online internet interventions are an alternative that has the advantage of reaching a broader sample size and adapting to various problems. Methods: A randomized controlled clinical superiority trial with two independent groups will be developed with 176 participants. Participants in both groups will be evaluated in 5 steps: (1) pretest, (2) middle of the intervention, (3) post-test, (4) follow-up at 3 months, and (5) follow-up at 6 months. In the experimental group ("UNISALUD"), participants will receive an intervention composed of 11 sessions with interactive elements such as videos, audio, and infographics created through the user experience (UX) principles and based on the health action process approach (HAPA). The participants in the control group will be on the waiting list and will receive treatment 27 days after fulfilling the inclusion criteria. Thus, participants will not receive the treatment immediately. Discussion: The study is expected to establish the feasibility of a self-help internet-based intervention created based on the user experience methodology and the health action process model, leading to a significant decrease and increase in the consumption of UPPs, ultra-healthy products, and physical activity, respectively. Conclusion: Internet-based interventions are scarce in Latin America. Due to their potential, this study will provide data about consumption of UPPs, physical activity, and mental health of the Mexican population, which will influence the reduction of health-related complications through prevention strategies or measures.Clinical Trial Registration:ClinicalTrials.gov, NCT05834842.

Cardiovascular health of Brazilian adolescents within the framework of Life's Essential 8: Findings from the ERICA study.

BACKGROUND: The Life's Essential 8 (LE8) is an official cardiovascular health (CVH) assessment tool, however, its use remains limited within the adolescent population. We aim to describe the prevalence of CVH in Brazilian adolescents using the LE8 framework and to analyze its distribution considering sociodemographic factors. METHODS: The sample comprised 36,956 adolescents aged 12 to 17 years, who participated in the Study of Cardiovascular Risks in Adolescents, a nationwide, cross-sectional, school-based study. CVH was assessed by the LE8 score (0-100 points), comprising eight metrics categorized into two domains: health behaviors (diet, physical activity, nicotine exposure, and sleep) and health factors (body mass index, non-HDL cholesterol, blood glucose, and blood pressure). Sociodemographic factors were sex, age, type of school, skin color, and region of residence. The results were expressed as means with 95 % confidence intervals (95 % CI). RESULTS: The overall average score was 75.8 points (95 % CI: 75.3-76.3), classified as moderate CVH. The general score was higher among males (76.8; 95 % CI: 76.6-77.7) and younger adolescents (12-14 years old) (78.5; 95 % CI: 77.7-79.4). The health factors had a higher mean than behavioral factors (87.6, 95 % CI: 87.3-87.9 vs. 64.0, 95 % CI: 63.3-64.7). The best score was blood glucose (94.7; 95 % CI: 94.2-95.2), while the diet score was the lowest (48.5; 95 % CI: 46.3-50.6). CONCLUSION: The CVH of Brazilian adolescents is classified as moderate and varied according to sociodemographic characteristics. Intervention actions should prioritize behavioral factors to improve the LE8 score and consequently prevent cardiovascular events in adulthood.