Relationships among cardiorespiratory fitness, muscular fitness, and cardiometabolic risk factors in Japanese adolescents: Niigata screening for and preventing the development of non-communicable disease study-Agano (NICE EVIDENCE Study-Agano) 2

Associations among metabolic health, weight status, and various physical fitness components in Japanese adolescents: a cross-sectional study (NICE EVIDENCE study- Agano 3)

Aim was to examine associations among metabolic health, weight status, and various physical fitness (PF) components in 1744 Japanese adolescents aged 13-14. Anthropometric measurements and PF tests (20 m shuttle run test [20mSRT], handgrip strength/body mass [HG], standing long jump [SLJ], and sit ups [SU]) were administered. The bottom sex-specific quintile of PF indicated "low fit". Participants were classified as non-overweight (non-OW) or overweight/obese (OW) according to the International Obesity Task Force. Clustered metabolic risk was defined as the sum of Z scores for mean arterial pressure, non-high-density lipoprotein cholesterol, and HbA1c, divided by three, and ≥ 1 SD. Combination of weight status and scores for HG or SU were additively associated with clustered metabolic risk. Compared with the non-OW-moderate-high fit group, the OW-low HG group was 3.05 (95%CI: 1.88-4.97) times more likely to have clustered metabolic risk although risk was not significantly elevated in the OW-moderate-high HG group (1.52 [95%CI: 0.88-2.62]). A similar association was observed between OW and low SU scores but not between OW and low 20mSRT or SLJ scores. Adolescents with OW and moderate-high HG or SU scores had a lower prevalence of an unfavourable metabolic state than those with OW and low HG or SU results.

Metabolic risk is associated with sociodemographic characteristics in adolescents from both rural and urban regions from southern Brazil

Background

The prevalence of several cardiovascular metabolic disorders are increasingly cause for concern in adolescents worldwide. Given the complex interrelations between metabolic risk (MR) and sociodemographic variables, the present study aims to examine the association between the presence of MR with sociodemographic characteristics (sex, skin color, residential area, and parental socioeconomic status) in adolescents from Southern Brazil.

Methods

Cross-sectional study conducted with 1,152 adolescents (507 males) aged between 12 and 17 years. MR was assessed using a continuous score (cMetS; sum of Z-scores of the following variables: waist circumference, systolic blood pressure (SBP), glucose, high-density lipoprotein cholesterol [HDL-C, inverse], triglycerides [TG], and estimated cardiorespiratory fitness [CRF, inverse]). Poisson regression was used to examine associations between sociodemographic variables with the dichotomized cMetS and separate metabolic variables. The results were expressed with prevalence ratios (PR) and 95% confidence intervals (CI).

Results

The presence of MR (evaluated by the cMetS) was observed in 8.7% of adolescents. Higher MR was less prevalent among non-white adolescents (PR: 0.96; 95% CI: 0.93; 0.99). Adolescents living in rural areas had a lower prevalence of the following metabolic variables; low HDL-C (PR: 0.95; 95% CI: 0.94; 0.97), elevated TG (PR: 0.95; 95% CI: 0.92; 0.99), elevated glucose (PR: 0.96; 95% CI: 0.95; 0.98), and low CRF levels (PR: 0.88; 95% CI: 0.85; 0.92). Whereas, SBP was higher in those living in rural areas (PR: 1.11; 95% CI: 1.05; 1.17). In girls, there was a higher prevalence of raised TG (PR: 1.06; 95% CI: 1.02; 1.10) and lower levels of CRF (PR: 1.20; 95% CI: 1.16; 1.24), but a lower prevalence of elevated glucose (PR: 0.97; 95% CI: 0.97; 0.99).

Conclusion

Higher MR prevalence was lower in those self-reporting non-white skin color and selected MR factors were less prevalent in those living in rural areas. The identification of groups at higher MR is important for early prevention and monitoring strategies for both Type 2 diabetes and later cardiovascular disease. Future studies should be conducted to assess the socio-cultural aspects of the relationships between MR and socio-cultural and lifestyle variables.

Muscular Fitness and Cardiometabolic Variables in Children and Adolescents: A Systematic Review

BACKGROUND

The importance of muscular fitness (MF) in the performance of activities of daily living is unequivocal. Additionally, emerging evidence has shown MF can reduce cardiometabolic risk in children and adolescents.

OBJECTIVES

The purpose of this study was to examine and summarize the evidence regarding the relationship between MF phenotypes (i.e., maximum muscular strength/power, muscular endurance, and maximum muscular strength/power/endurance) and cardiometabolic variables (obesity, blood pressure, lipids, glucose homeostasis, inflammatory markers, and clustered cardiometabolic variables) in children and adolescents.

DESIGN

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered with PROSPERO, number CRD42020179273.

DATA SOURCES

A systematic review was performed on five databases (PubMed, EMBASE, SciELO, Scopus, and Web of Knowledge) from database inception to May 2020, with complementary searches in reference lists.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Eligibility criteria included (1) a study sample of youth aged ≤ 19 years, (2) an assessment of MF with individual or clustered cardiometabolic variables derived from adjusted models (regardless of test/measurement adopted or direction of reported association), and (3) a report of the association between both, using observational studies. Only original articles published in peer-reviewed journals in English, Portuguese, and Spanish languages were considered. The quality of the included studies was assessed by using the National Heart, Lung, and Blood Institute checklist. The percentage of results reporting a statistically significant inverse association between each MF phenotype and cardiometabolic variables was calculated.

RESULTS

Of the 23,686 articles initially identified, 96 were included (77 cross-sectional and 19 longitudinal), with data from children and adolescents from 35 countries. The score for the quality of evidence ranged from 0.33 to 0.92 (1.00 maximum). MF assessed by maximum muscular strength/power was inversely associated with lower obesity (64/113 total results (56.6%)) and reduction in clustered cardiometabolic risk (28/48 total results (58.3%)). When assessed by muscular endurance, an inverse association with obesity (30/44 total results (68.1%)) and cardiometabolic risk (5/8 total results (62.5%)) was identified. Most of the results for the relationship between MF phenotypes with blood pressure, lipids, glucose homeostasis, and inflammatory markers indicated a paucity of evidence for these interrelationships (percentage of results below 50.0%).

CONCLUSION

MF assessed by maximum muscular strength/power or muscular endurance is potentially associated with lower obesity and lower risk related to clustered cardiometabolic variables in children and adolescents. There is limited support for an inverse association between MF with blood pressure, lipids, glucose homeostasis biomarkers, and inflammatory markers in children and adolescents.

Encouraging physical fitness in Brazilian adolescents with excess weight: can they outperform their eutrophic peers in some activities?

BACKGROUND

There is the need to encourage physical activity (PA) among adolescents with overweight or obesity.

OBJECTIVES

The present study aimed to assess the relationship between health-related physical fitness (PF) and nutritional status, and to identify those activities more suited to adolescents with excess weight.

METHODS

This cross-sectional study included 3,062 in-school adolescents, aged 10-18 years. We collected information on sex, age, weight, height, skinfold thickness, trunk height and leg length, and calculated body mass index (BMI) z-score, fat mass percentage, and peak height velocity (PHV). Participants were tested for PF by the 20-m shuttle run test (cardiorespiratory fitness); medicine ball throw and standing long jump tests (musculoskeletal fitness) and sit and reach test (flexibility). We used generalized linear mixed models (GLMM) to analyze the relationship between nutritional status and performance in the fitness tests, controlled for maturity offset and fat mass percentage.

RESULTS

1,563 (51%) were boys, mean age 12.6 years (±1.8), 22.8% were overweight and 12.5% had obesity. In both sexes, adolescents with obesity did better in the upper body strength test than their eutrophic peers. Boys with obesity had worse cardiorespiratory fitness and lower body muscular strength than eutrophic boys. Girls with obesity had similar cardiorespiratory fitness and better lower body strength than eutrophic girls.

CONCLUSION

In muscular strength fitness tests, adolescents with obesity performed similarly to, or better than, their eutrophic peers. Motivation to maintain regular PA is reinforced by positive experiences. Interventions that emphasize muscular strength PF should be developed for adolescents with obesity.

Separate and combined relationships for cardiorespiratory fitness and muscular strength with visceral fat and insulin sensitivity in adolescents with obesity

We examined the separate and combined associations for cardiorespiratory fitness (CRF) and muscular strength (MS) with total and regional fat, and insulin sensitivity (IS) in 204 adolescents (BMI ≥85th percentile, 12-18 years) at UPMC Children's Hospital of Pittsburgh. CRF was measured by maximum oxygen consumption during a graded treadmill test. MS was quantified by combining 1-repetition maximum test for the leg and bench press. Participants were stratified as having either high or low CRF and MS based on sex-specific median split. Both high CRF and high MS groups had lower (P < 0.05) total fat after adjustment for sex, Tanner stage and ethnicity than the low CRF and MS groups (Difference: 6.6, 2.6-9.6% and 5.4, 2.4-8.3%, respectively). High CRF, but not high MS, had lower visceral (67.5 versus 77.9 cm², P < 0.01) and intermuscular fat (3.6 versus 4.0 kg, P = 0.01) than the low CRF groups. Differences by CRF remained significant after adjustment for MS. High CRF, but not high MS, was associated (P < 0.05) with lower fasting glucose and higher IS after accounting for sex, Tanner stage and ethnicity than the low CRF group, and high CRF remained associated with these markers after adjustment for MS. High CRF is associated with lower total and regional fat, and higher IS after adjustment for MS. Novelty: CRF is associated with lower total fat, visceral and intermuscular fat, and higher insulin sensitivity adjusting for muscular strength. Muscular strength is not associated with regional body fat and insulin sensitivity after accounting for CRF.

Analysis of hand-forearm anthropometric components in assessing handgrip and pinch strengths of school-aged children and adolescents: a partial least squares (PLS) approach

Background

The purpose of this study was to examine the influence of hand-forearm anthropometric dimensions on handgrip and pinch strengths among 7–18 years children and adolescents and to investigate the extent to which these variables can be used to predict hand strength.

Methods

Four types of hand strengths including handgrip, tip to tip, key, and three-jaw chuck pinches were measured in 2637 healthy children and adolescents (1391 boys and 1246 girls) aged 7–18 years using standard adjustable Jamar hydraulic hand dynamometer and pinch gauge. A set of 17 hand-forearm anthropometric dimensions were also measured with an accurate digital caliper and tape measure.

Results

No significant differences were found between the hand strengths of boys and girls up to the age of 10 years. Gender related differences in handgrip and pinches were observed from the age of 11 years onwards, with boys always being stronger. The dominant hand was stronger than the non-dominant hand (8% for handgrip and by about 10% for all three types of pinches). The strongest correlations were found between the hand length and hand strengths (r > 0.83 for handgrip and three all pinches; p < 0.001, 2-tailed). Based on the partial least squares (PLS) analysis, 8 out of 17 anthropometric indices including hand length, hand circumference, thumb length, index finger length, middle finger length, and forearm length had considerable loadings in the PLS analysis, which together accounted for 46% of the total variance.

Conclusions

These results may be used by health professionals in clinical settings as well as by designers to create ergonomic hand tools.

Bipedal hopping as a new measure to detect subtle sensorimotor impairment in people with multiple sclerosis

BACKGROUND

Bipedal hopping has the potential to detect subtle multiple sclerosis (MS)-related impairments, especially among patients who "pass" typical movement tests. In this narrative review, we outline the biomechanics of bipedal hopping and propose its usefulness as a novel outcome measure for people with MS having mild disability.

METHODS

We summarize articles that (1) examined the biomechanics of jumping or hopping and (2) tested the validity and/or reliability of hopping tests. We consolidated consistencies and gaps in research and opportunities for future development of the bipedal hop test.

RESULTS

Bipedal hopping requires immense power, coordination, balance, and ability to reduce co-contraction; movement components typically affected by MS. These impairments can be measured and differentiated by examining specific variables, such as hop length (power), symmetry (coordination), center of pressure (balance), and coefficient of variability (co-contraction/spasticity). Bipedal hopping challenges these aspects of movement and exposes sensorimotor impairments that may not have been apparent during walking.

CONCLUSIONS

Testing of bipedal hopping on an instrumented walkway may detect and monitor sensorimotor control in people with MS who do not currently present with clinical deficits. Early measurement is imperative for precise rehabilitation prescription to slow disability progression prior to onset of measurable gait impairment.Implications for rehabilitationJumping and hopping tests detect lower limb and balance impairments in children, athletes, and older adults.Bipedal hop test measures multiple domains: power, coordination, balance, and muscle timing.Bipedal hop test may expose subtle sensorimotor impairments in people with multiple sclerosis.Multiple variables measured can discern type of sensorimotor impairment to direct personalized rehabilitation programs.

Physical fitness as a moderator in the relationship between adiposity and cardiometabolic risk factors in children and adolescents

BACKGROUND

The aim of this study was to verify the moderator role of physical fitness in the relationship between adiposity and cardiometabolic risk factors in normal weight and overweight/obese children and adolescents.

METHODS

Cross-sectional study comprising 2482 children and adolescents, aged 7-17 years. Physical fitness was evaluated according the procedures of Projeto Esporte Brazil, and waist circumference (WC) with an inelastic tape. Cardiometabolic risk score was defined by the z-score sum of glucose, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. Moderation analysis was done through linear regression models.

RESULTS

Significant interaction term for cardiorespiratory fitness (CRF)×WC with cardiometabolic risk factors (P<0.001), as well as for lower limbs strength (LLS)×WC (P<0.001) and agility × WC (P=0.01) in normal weight girls. For normal weight boys it was found a significant interaction term for CRF×WC with cardiometabolic risk factor (P=0.007), and also for agility × WC (P=0.003), while overweight/obese boys showed a significant interaction term only for agility × WC with cardiometabolic risk factor (P=0.001).

CONCLUSIONS

CRF, LLS and agility are moderators in the relationship between WC and cardiometabolic risk factors in normal weight girls, while CRF and agility were moderators for normal weight boys and only agility for overweight/obese boys.

Health-related physical fitness indicators and clustered cardiometabolic risk factors in adolescents: A longitudinal study

Background/Objective

This study examined relationships between health-related physical fitness indicators and clustered cardiometabolic risk factors in adolescents between 2014 and 2017.

Methods

The sample consisted of 93 students (60% girls), with complete data sets in both 2014 and 2017. The physical fitness components evaluated were: flexibility (sit and reach), muscular fitness (curl-up and push-up), cardiorespiratory fitness (progressive aerobic cardiovascular endurance run), and body fat (BMI). The cardiometabolic risk factors were: waist circumference, blood pressure, high-density lipoprotein cholesterol (HDL-C), triglycerides and fasting blood glucose. Z-scores were calculated for each risk factor, with the sum of risk factor z-scores values used to represent clustered cardiometabolic risk.

Results

The results of cross-sectional analysis indicated that muscle fitness (curl-up: β = −0.37, p < 0.001; push-up: β = −0.38, p < 0.005) and cardiorespiratory fitness (β = −0.56, p < 0.001) were inversely associated with clustered cardiometabolic risk, with BMI positively associated (β = 0.58, p < 0.001). In the longitudinal analysis, cardiorespiratory fitness (β = −0.33; p < 0.005) and body fat (β = 0.46, p < 0.001) demonstrated a significant association with clustered cardiometabolic risk. However, no significant associations between the health-related physical fitness and clustered cardiometabolic risk were observed after adjustment for baseline values.

Conclusion

Our cross-sectional findings highlight the importance of health-related physical fitness indicators to adolescents. In regarding the longitudinal analysis, further studies are needed in order to clarify the influence of physical fitness in the adolescence and cardiometabolic risk later in life.

Optimal Adherence to a Mediterranean Diet May Not Overcome the Deleterious Effects of Low Physical Fitness on Cardiovascular Disease Risk in Adolescents: A Cross-Sectional Pooled Analysis

To examine the combined association of cardiorespiratory fitness (CRF), muscular fitness (MF), and adherence to a Mediterranean diet (MeDiet) on cardiovascular risk in adolescents, a pooled study, including cross-sectional data from two projects [2477 adolescents (1320 girls) aged 12–18 years], was completed. A shuttle run test was used to assess CRF. MF was assessed by the standing-long jump and handgrip tests. Adherence to a MeDiet was assessed by the Kidmed questionnaire. A cardiovascular risk score was computed from the following components: Age and sex, waist circumference, triglycerides, systolic blood pressure, high-density lipoprotein cholesterol (HDL), and glucose. Analysis of covariance showed that participants classified as having optimal (High) adherence to a MeDiet/HighMF/HighCRF, as well those classified as low adherence to a MeDiet/HighMF/HighCRF, had, on average, the lowest cardiovascular risk score (F = 15.6; p < 0.001). In addition, the high adherence to a MeDiet/LowMF/LowCRF group had the highest odds of having a high cardiovascular risk (OR = 7.1; 95% CI: 3.4–15.1; p < 0.001), followed by the low adherence to a MeDiet/LowMF/LowCRF group (OR = 3.7; 95% CI: 2.2–6.3; p < 0.001), high adherence to a MeDiet/HighMF/LowCRF group (OR = 3.1; 95% CI: 1.4–7.0; p = 0.006), and low adherence to a MeDiet/LowMF/HighCRF group (OR = 2.5; 95% CI: 1.5–4.4; p = 0.002) when compared to those with high adherence to a MeDiet/HighMF/HighCRF, after adjustments for potential confounders. In conclusion, our findings showed that, regardless of the MeDiet status, adolescents with low MF and low CRF cumulatively, presented the highest cardiovascular disease risk. Therefore, these findings suggest that the combination of these two fitness components may be beneficial to adolescents’ cardiometabolic profile, independent of MeDiet behaviour.