Cardiorespiratory fitness and bone turnover markers in adults with metabolic syndrome: the mediator role of inflammation

The relationship between inflammatory markers and bone turnover in adults is well known, whilst a negative association between cardiorespiratory fitness (CRF) and inflammatory markers has also been described. Hence, we tested whether the association between CRF and bone turnover markers is mediated by inflammatory markers in adults with metabolic syndrome. A total of 81 adults (58.5±5.0 yrs, 62.7% women) were included in the analysis. CRF was measured by the six-minute walking test. Serum interleukine (IL)-1β, IL-6, IL-10, tumor necrosis factor alpha, high-sensitivity c-reactive protein (hsCRP) and vascular endothelial growth factor, collagen type I cross-linked C-telopeptide, procollagen type I N-terminal propeptide (P1NP) and total osteocalcin were assessed using a sensitive ELISA kit. Body composition was assessed by dual-energy x-ray absorptiometry. Partial correlation was used to test the relationship between CRF, inflammatory markers and bone turnover markers, controlling for sex, lean mass and fat mass. Boot-strapped mediation procedures were performed and indirect effects with confidence intervals not including zero were interpreted as statistically significant. CRF was positively correlated with P1NP levels (r=0.228, p=0.044) and osteocalcin levels (r=0.296, p=0.009). Furthermore, CRF was positively correlated with IL-1β levels (r=0.340, p=0.002) and negatively correlated with hsCRP levels (r=-0.335, p=0.003), whereas IL-1β levels were positively correlated with P1NP levels (r=0.245, p=0.030) and hsCRP levels were negatively correlated with P1NP levels (r=-0.319, p=0.004). Finally, the association between CRF and P1NP levels was totally mediated by hsCRP (PM=39.9). Therefore, CRF benefits on bone formation could be dependent on hsCRP concentrations in this population.Heart and Diseases Foundation (Fondation 234 Coeur et Artères) 59200 Loos, Franc

Effect of exercise on bone health in children and adolescents with cancer during and after oncological treatment: A systematic review and meta-analysis

Background: Although regular physical activity and exercise programs might improve bone health caused by oncological treatment and the disease itself, it remains unknown the pooled effect of exercise interventions following frequency, intensity, time and type prescriptions. Objective: This systematic review and meta-analysis aimed to synthesise evidence regarding the effectiveness of exercise interventions on bone health in children and adolescents with cancer during and after oncological treatment. Methods: A systematic search was conducted in the MEDLINE (via PubMed), Web of Science and Scopus databases from November 2021 to January 2022. Randomised controlled trials (RCTs) and non-RCTs reporting pre-post changes of the effectiveness of exercise interventions on DXA-measured bone parameters in young population (1–19 years) during or after oncological treatment were included. Pooled (ESs) and 95% confidence intervals (95%CIs) were calculated. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results: A total of eight trials with 341 participants were included. The metaanalyses did not reveal a statistically significant increase in whole body areal bone mineral density (ES = 0.10; 95%CI: −0.14, 0.34), lumbar spine (ES = 0.03; 95%CI: −0.21, 0.26) or femoral neck (ES = 0.10; 95%CI: −0.37, 0.56). Similarly, during the oncological treatment phase the ES was 0.04 (95%CI: −0.17, 0.25) and after the ES was 0.07 (95%CI: −0.20, 0.33). Conclusion: To date, exercise interventions have been inappropriate and therefore, ineffective to illustrate any beneficial effect on bone health in children and adolescents with cancer during and after oncological treatment.Spanish Ministry of Science and Innovation (ref: PID2020-117302RA-I00La Caixa Foundation (ref: LCF/BQ/PR19/11700007)the University of Granada Plan Propio de Investigación 2021-Excellence actions: Unit of Excellence on Exercise, Nutrition and Health (UCEENS)CIBEROBN, Centro de Investigación Biomédica en Red (CB22/03/ 00058Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea – European Regional Development Fund. AM-P is recipient of a predoctoral fellowship (FPU20/05530) by the Spanish Ministry of Education, Culture and Sport. EU-G is supported by the Maria Zambrano fellowship by the Ministerio de Universidades y la Unión Europea—NextGenerationEU

Comparative effects of different types of exercise on health-related quality of life during and after active cancer treatment: A systematic review and network meta-analysis

Background: The positive influence of most types of exercise has been reported repeatedly, but what the most effective exercise approaches are for improving health-related quality of life (HRQoL) in people with cancer remains unknown. The aim of this systematic review and network meta-analysis was to synthesize the evidence from intervention studies to assess the effects of different types of exercise on HRQoL during and after cancer treatment. Methods: MEDLINE, SPORTDiscus, the Cochrane Library, Web of Science, and Scopus were searched for randomized controlled trials aimed at testing the effects of exercise interventions meant to improve HRQoL in people with cancer. Separate analyses were conducted for HRQoL as measured by general and cancer-specific questionnaires. We also evaluated whether the effects of exercise were different during and after cancer treatment in both the physical and mental HRQoL domains. Results: In total, 93 studies involving 7435 people with cancer were included. Network effect size estimates comparing exercise intervention vs. usual care were significant for combined exercise (0.35, 95% confidence interval (95%CI): 0.14-0.56) for HRQoL as measured by general questionnaires, and for combined (0.31, 95%CI: 0.13-0.48), mind-body exercise (0.54, 95%CI: 0.18-0.89), and walking (0.39, 95%CI: 0.04-0.74) for HRQoL as measured by cancer-specific questionnaires. Conclusion: Exercise programs combining aerobic and resistance training can be recommended to improve HRQoL during and after cancer treatment. The scarcity and heterogeneity of these studies prevents us from making recommendations about other exercise modalities due to insufficient evidence.European Regional Development FundConsejería de Educación, Cultura y Deportes-JCCMFondo Europeo de Desarrollo Regional funds (grant no. SBPLY/17/180501/000533)Grant from the University of Castilla-La Mancha (2020-PREDUCLM-15596)Grant from the Universidad de Castilla-La Mancha co-financed by the European Social Fund (2020-PREDUCLM-16746

Effects of an Exercise Program on Cardiometabolic and Mental Health in Children With Overweight or Obesity: A Secondary Analysis of a Randomized Clinical Trial

This project was supported with grants DEP2013-47540, DEP2016-79512-R, DEP2017-91544-EXP, and RYC-2011-09011 from the Spanish Ministry of Economy and Competitiveness and the Fondo Europeo de Desarrollo Regional (FEDER) and by grant PID2020-120249RB-I00 from the MCIN/AEI /10.13039/501100011033. Additional funding was obtained from the Andalusian Operational Programme supported with grant B-CTS-355-UGR18 from the European Regional Development Fund (FEDER in Spanish). Dr Cardenas-Sanchez is supported by grant FJC2018-037925-I from the Spanish Ministry of Science and Innovation and by a grant from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement No 101028929. Dr Migueles is supported by grant FPU15/02645 from the Spanish Ministry of Education, Culture and Sport, and grant 2012–00036 from the Swedish Research Council for Health, Working Life and Welfare. Dr Torres-Lopez is supported by grant FPU17/04802 from the Spanish Ministry of Science, Innovation and Universities. Dr Rodriquez-Ayllon was funded by grant DEP2017-91544-EXP from the Ramón Areces Foundation. Additional support was obtained from grant ALICIAK-2018 from the Alicia Koplowitz Foundation, University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence, Unit of Excellence on Exercise, Nutrition and Health, the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades; and grant DEP2005-00046/ACTI from the EXERNET Research Network on Exercise and Health in Special Populations. This research was supported by grant CB22/03/00058 from the Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea–European Regional Development Fund.IMPORTANCE Childhood obesity is a risk factor associated with type 2 diabetes, cardiovascular disease, and mental disorders later in life. Investigation of the parallel effects of a defined exercise program on cardiometabolic and mental health in children with overweight or obesity may provide new insights on the potential benefits of exercise on overall health. OBJECTIVE To investigate the effects of a 20-week exercise program on cardiometabolic and mental health in children with overweight or obesity. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of a parallel-group randomized clinical trial was conducted in Granada, Spain, from November 1, 2014, to June 30, 2016. Data analyses were performed between February 1, 2020, and July 14, 2022. Children with overweight or obesity aged 8 to 11 years were eligible, and the study was performed in an out-of-school context. INTERVENTION The exercise program included 3 to 5 sessions/wk (90 min/session) of aerobic plus resistance training for 20 weeks. The wait-list control group continued with their usual routines. MAIN OUTCOMES AND MEASURES Cardiometabolic outcomes as specified in the trial protocol included body composition (fat mass, fat-free mass, and visceral adipose tissue), physical fitness (cardiorespiratory, speed-agility, and muscular), and traditional risk factors (waist circumference, blood lipid levels, glucose levels, insulin levels, and blood pressure). Cardiometabolic risk score (z score) was calculated based on age and sex reference values for levels of triglycerides, inverted high- density lipoprotein cholesterol, and glucose, the mean of systolic and diastolic blood pressure, and waist circumference. An additional cardiometabolic risk score also included cardiorespiratory fitness. Mental health outcomes included an array of psychological well-being and ill-being indicators. RESULTS The 92 participants included in the per-protocol analyses (36 girls [39%] and 56 boys [61%]) had a mean (SD) age of 10.0 (1.1) years. The exercise program reduced the cardiometabolic risk score by approximately 0.38 (95% CI, −0.74 to −0.02) SDs; decreased low-density lipoprotein cholesterol level by −7.00 (95% CI, −14.27 to 0.37) mg/dL (to convert to mmol/L, multiply by 0.0259), body mass index (calculated as weight in kilograms divided by height in meters squared) by −0.59 (95% CI, −1.06 to −0.12), fat mass index by −0.67 (95% CI, −1.01 to −0.33), and visceral adipose tissue by −31.44 (95% CI, −58.99 to −3.90) g; and improved cardiorespiratory fitness by 2.75 (95% CI, 0.22-5.28) laps in the exercise group compared with the control group. No effects were observed on mental health outcomes. CONCLUSIONS AND RELEVANCE In this secondary analysis of a randomized clinical trial, an aerobic plus resistance exercise program improved cardiometabolic health in children with overweight or obesity but had no effect on mental health.Spanish Ministry of Economy and Competitiveness DEP2013-47540, DEP2016-79512-R, DEP2017-91544-EXP, and RYC-2011-09011Fondo Europeo de Desarrollo Regional (FEDER)MCIN/AEI /10.13039/501100011033: PID2020-120249RB-I00Andalusian Operational Programme B-CTS-355-UGR18European Regional Development Fund (FEDER in Spanish)Spanish Ministry of Science and Innovation FJC2018-037925-IEuropean Union’s Horizon 2020 research and innovation programme Marie Sklodowska Curie 101028929Spanish Ministry of Education, Culture and Sport FPU15/02645Swedish Research Council for Health, Working Life and Welfare 2012–00036Spanish Ministry of Science, Innovation and Universities FPU17/04802Ramón Areces Foundation DEP2017-91544-EXPAlicia Koplowitz Foundation ALICIAK-2018University of GranadaJunta de AndalucíaEXERNET Research Network on Exercise and Health in Special Populations DEP2005-00046/ACTIInstituto de Salud Carlos III: CB22/03/00058Ministerio de Ciencia e Innovación and Unión Europea–European Regional Development Fun

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

Aim: Adipokines seem to play a role in bone morphogenesis, although this also depends on the mechanical forces applied to the skeleton. The aim was to assess the relationships of resting leptin and adiponectin with bone parameters and whether high muscular fitness levels affect these relationships in children with overweight or obesity. Methods: This cross-sectional study took part from 2014 to 2016 in Granada, Spain. Participants were recruited from University Hospitals, and we also used advertisements in local media and school contacts in the city. Adipokines were analysed in plasma. Muscular fitness was assessed by one repetition maximum in bench and leg press tests. Dual-energy X-ray absorptiometry was used to measure bone parameters. Results: We included 84 children (10.0 ± 1.2y; 63% boys) in this analysis. Leptin was negatively associated with lumbar spine bone mineral content (β = −0.162, p = 0.053)

The effect of an online exercise programme on bone health in paediatric cancer survivors (iBoneFIT): study protocol of a multi-centre randomized controlled trial

Background: New approaches on paediatric cancer treatment aim to maintain long-term health. As a result of radiotherapy, chemotherapy or surgery, paediatric cancer survivors tend to suffer from any chronic health condition. Endocrine dysfunction represents one of the most common issues and affects bone health. Exercise is key for bone mass accrual during growth, specifically plyometric jump training. The iBoneFIT study will investigate the effect of a 9-month online exercise programme on bone health in paediatric cancer survivors. This study will also examine the effect of the intervention on body composition, physical fitness, physical activity, calcium intake, vitamin D, blood samples quality of life and mental health. Methods: A minimum of 116 participants aged 6 to 18 years will be randomized into an intervention (n = 58) or control group (n = 58). The intervention group will receive an online exercise programme and diet counselling on calcium and vitamin D. In addition, five behaviour change techniques and a gamification design will be implemented in order to increase the interest of this non-game programme. The control group will only receive diet counselling. Participants will be assessed on 3 occasions: 1) at baseline; 2) after the 9 months of the intervention; 3) 4 months following the intervention. The primary outcome will be determined by dual energy X-ray absorptiometry (DXA) and the hip structural analysis, trabecular bone score and 3D-DXA softwares. Secondary outcomes will include anthropometry, body composition, physical fitness, physical activity, calcium and vitamin D intake, blood samples, quality of life and mental health. Discussion: Whether a simple, feasible and short in duration exercise programme can improve bone health has not been examined in paediatric cancer survivors. This article describes the design, rationale and methods of a study intended to test the effect of a rigorous online exercise programme on bone health in paediatric cancer survivors. If successful, the iBoneFIT study will contribute to decrease chronic health conditions in this population and will have a positive impact in the society.The iBoneFIT project is funded by a fellowship from 'la Caixa' Foundation (ID 100010434). The fellowship code is LCF/BQ/PR19/11700007. This study has been partially supported by the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES), and by the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades and European Regional Development Fund (ERDF), ref. SOMM17/6107/UGR

Salud ósea en niños con sobrepeso/obesidad: Rol de la inflamación sistémica crónica, la vitamina D y la fuerza muscular

Background Previous research suggests a link between obesity and bone morphogenesis which may be explained by inflammatory markers and adipokines. It is known that bone development is regulated by modelling and remodelling processes that depend on the mechanical forces applied by the muscles to the skeleton. Furthermore, the relationships of vitamin D and muscular strength with bone have been described, but no study has jointly examined the association of these predictors with bone. Objectives The present Doctoral Thesis aimed to study which inflammatory markers and adipokines are associated with bone health and whether these associations are modified by muscular fitness levels in children with overweight/obesity (study 1 and study 2). In addition, this Thesis examined whether the relationship between vitamin D (i.e., plasma calcidiol) and bone health was mediated by muscular fitness (study 3). Methods To address these aims, we used baseline data from the ActiveBrains project. Plasma interleukin (IL)-1β, IL-6, tumour necrosis factor-α (TNF-α), epidermal growth factor, vascular endothelial growth factor A (VEGF), C-reactive protein, leptin, adiponectin and calcidiol were analysed. Muscular fitness was assessed in laboratory (through determining each participant’s 1 repetition maximum at bench and leg press) and in field-based conditions (handgrip strength and standing long jump). Bone outcomes, fat and lean mass were assessed by dual-energy x-ray absorptiometry. For study 1 and study 2, the association between these biochemical markers and bone outcomes was tested with multiple regression analyses controlling for sex, somatic maturation and lean mass. Additionally, the muscular fitness interaction was examined in the associations of inflammatory markers and adipokines with bone outcomes. For study 3, the mediator role of muscular fitness was examined in the association between calcidiol and bone outcomes controlling for sex, somatic maturation, lean mass and season. Results and main findings In study 1, IL-6 and VEGF levels were negatively associated with bone mineral content at the total body, whereas TNF-α (negatively) and IL-1β (positively) levels were associated with bone mineral content at the lumbar spine. In study 2, no association was found between leptin or adiponectin levels and bone outcomes. Furthermore, high levels of objectively measured muscular fitness may attenuate the adverse effects of VEGF and TNF-α on bone mineral content at the total body and lumbar spine, respectively (study 1). In addition, a negative association between leptin and bone mineral content at the lumbar spine was observed in the low lower-body muscular fitness group, whereas no significant association was found in the high lower-body muscular fitness group (study 2). In study 3, calcidiol was indirectly associated with areal bone mineral density at the total body, arms and legs through relative muscular fitness. Overall conclusions The results of this Thesis suggest that IL-1β, IL-6, TNF-α, VEGF and leptin (to a lesser extent) could be contributing factors explaining the link between obesity and bone health in children with overweight/obesity. Optimal muscular fitness levels may attenuate the adverse effects of TNF-α, VEGF and leptin on bone. Moreover, muscular fitness seems to play a key role in the relationship of calcidiol levels and bone outcomes in this population. Altogether, appropriate levels of vitamin D and muscular fitness may preserve normal bone accretion in children with overweight/obesity.Antecedentes Investigaciones previas sugieren un vínculo entre la obesidad y el desarrollo óseo, y este vínculo puede estar explicado por los marcadores de inflamación y las adipocinas. Se sabe que el desarrollo óseo también está regulado por procesos de modelado y remodelado, que dependen de las fuerzas mecánicas aplicadas por los músculos al esqueleto. Además, se han descrito previamente las relaciones de la vitamina D y la fuerza muscular con el hueso, pero ningún estudio ha examinado conjuntamente la asociación de estos predictores con el hueso. Objetivos La presente Tesis Doctoral tuvo como objetivo estudiar qué marcadores de inflamación y adipocinas se asocian con la salud ósea, y si estas asociaciones se ven modificadas por los niveles de fuerza muscular en niños con sobrepeso u obesidad (estudio 1 y estudio 2). Además, esta Tesis examinó si la relación entre la vitamina D (es decir, calcidiol en plasma) y la salud ósea estaba mediada por la fuerza muscular (estudio 3). Métodos Para abordar estos objetivos, utilizamos datos de la evaluación inicial del proyecto ActiveBrains. Se analizaron niveles plasmáticos de interleucina (IL)-1β, IL-6, factor de necrosis tumoural-α (TNF-α), factor de crecimiento epidérmico, factor de crecimiento endotelial vascular A (VEGF), proteína C reactiva, leptina, adiponectina y calcidiol. La fuerza muscular se evaluó en el laboratorio (determinando la 1RM de cada participante en press de banca y press de piernas) y en condiciones de campo (fuerza de agarre y salto de longitud desde parado). Los resultados óseos, la grasa y la masa magra se evaluaron mediante absorciometría de rayos X de energía dual. Para el estudio 1 y el estudio 2, la asociación entre estos marcadores bioquímicos y los resultados óseos se verificó mediante análisis de regresión múltiple que controlan el sexo, la maduración somática y la masa magra. Además, se examinó la interacción de la fuerza muscular en las asociaciones de los marcadores bioquímicos con los resultados óseos. Para el estudio 3, se examinó el papel mediador de la fuerza muscular en la asociación entre el calcidiol y los resultados óseos controlando el sexo, la maduración somática, la masa magra y la estación del año. Resultados y hallazgos principales En el estudio 1, los niveles de IL-6 y VEGF se asociaron negativamente con el contenido mineral óseo del cuerpo entero, mientras que los niveles de TNF-α (negativamente) e IL-1β (positivamente) se asociaron con el contenido mineral óseo de la columna lumbar. En el estudio 2, no se encontró asociación entre los niveles de leptina o adiponectina y los resultados óseos. Además, los altos niveles de fuerza muscular medidos objetivamente pueden atenuar los efectos adversos de VEGF y TNF-α en el contenido mineral óseo del cuerpo entero y en la columna lumbar, respectivamente (estudio 1). Además, se observó una asociación negativa entre la leptina y el contenido mineral óseo de la columna lumbar en el grupo de menor fuerza en el tren inferior, mientras que no se encontró una asociación significativa en el grupo de mayor fuerza en el tren inferior (estudio 2). En el estudio 3, el calcidiol se asoció indirectamente con la densidad mineral ósea del cuerpo entero, los brazos y las piernas a través de la fuerza muscular relativa. Conclusiones generales Los resultados de la presente Tesis sugieren que IL-1β, IL-6, TNF-α, VEGF y leptina (en menor medida) pueden contribuir a explicar el vínculo entre la obesidad y el hueso en niños con sobrepeso u obesidad. Unos niveles óptimos de fuerza muscular pueden atenuar los efectos adversos de TNF-α, VEGF y leptina en los huesos. Además, la fuerza muscular parece jugar un papel importante en la relación de los niveles de calcidiol y el hueso en esta población. En conjunto, los niveles apropiados de vitamina D y de fuerza muscular pueden contribuir a mantener un desarrollo óseo saludable en niños con sobrepeso u obesidad.Tesis Univ. Granada.Spanish Ministry of Economy and Competitiveness and Fondo Europeo de Desarrollo Regional (FEDER) (DEP-2013-47540, DEP2016-79512-R, DEP2017-91544-EXP, BES-2014-068829, FJCI-2014- 19563, IJCI-2017-33642, and RYC-2011-09011)Spanish Ministry of Education (FPU 14/06837, FPU 15/02645, and FPU 16/02760)University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence, Unit of Excellence on Exercise and Health (UCEES); and Visiting Scholar grantsHorizon 2020 Framework Programme, Grant/ Award Number: 667302Junta de Andalucía, Conserjería de Conocimiento, Investigación y Universidades and European Regional Development Fund (ERDF) (SOMM17/6107/UGR)Redes temáticas de investigación cooperativa RETIC (SAMID III) European Regional Development Fund (ERDF) (RD16/0022)EXERNET Research Network on Exercise and Health in Special Populations (DEP2005- 00046/ACTI)Additional funding was obtained from the Andalusian Operational Programme supported with European Regional Development Funds (ERDF in English, FEDER in Spanish, project ref: B-CTS-355-UGR18

European fitness landscape for children and adolescents: updated reference values, fitness maps and country rankings based on nearly 8 million test results from 34 countries gathered by the FitBack network

Objectives (1) To develop reference values for health-related fitness in European children and adolescents aged 6–18 years that are the foundation for the web-based, open-access and multilanguage fitness platform (FitBack); (2) to provide comparisons across European countries. Methods This study builds on a previous large fitness reference study in European youth by (1) widening the age demographic, (2) identifying the most recent and representative country-level data and (3) including national data from existing fitness surveillance and monitoring systems. We used the Assessing Levels of PHysical Activity and fitness at population level (ALPHA) test battery as it comprises tests with the highest test–retest reliability, criterion/construct validity and health-related predictive validity: the 20 m shuttle run (cardiorespiratory fitness); handgrip strength and standing long jump (muscular strength); and body height, body mass, body mass index and waist circumference (anthropometry). Percentile values were obtained using the generalised additive models for location, scale and shape method. Results A total of 7 966 693 test results from 34 countries (106 datasets) were used to develop sex-specific and age-specific percentile values. In addition, country-level rankings based on mean percentiles are provided for each fitness test, as well as an overall fitness ranking. Finally, an interactive fitness platform, including individual and group reporting and European fitness maps, is provided and freely available online ( www.fitbackeurope.eu). Conclusion This study discusses the major implications of fitness assessment in youth from health, educational and sport perspectives, and how the FitBack reference values and interactive web-based platform contribute to it. Fitness testing can be conducted in school and/or sport settings, and the interpreted results be integrated in the healthcare systems across Europe.Erasmus+ Sport Programme of the European Union within the project FitBack 13010-EPP-1-2019-1-SI-SPO-SCPSlovenian Research Agency within the Research programme Bio- psycho-social context of kinesiology P5-0142Units of ExcellenceUnit of Excellence on ExerciseNutrition and HealthJunta de AndaluciaInvestigacion y UniversidadesEuropean Commission SOMM17/6107/UGRCIBERobn Physiopathology of Obesity and Nutritio

3D DXA Hip Differences in Patients with Acromegaly or Adult Growth Hormone Deficiency

The skeleton is regulated by and responds to pituitary hormones, especially when the circulating levels are perturbed in disease. This study aims to analyse the between-group differences in 3D dual-energy X-ray absorptiometry (DXA) parameters at the hip site among patients with acromegaly or adult growth hormone deficiency (AGHD) and a healthy control group. The current cross-sectional study includes data for 67 adults, 20 with acromegaly, 14 with AGHD and 33 healthy controls. We obtained the areal bone mineral density (aBMD) outcomes using DXA and cortical and trabecular parameters using 3D-DXA software (3D-SHAPER). The mean-adjusted 3D-DXA parameters did not differ between acromegaly patients and the controls (p > 0.05); however, we found cortical bone impairment (-7.3% to -8.4%; effect size (ES) = 0.78) in AGHD patients (p < 0.05). Differences in the cortical bone parameters were more evident when comparing AGHD patients (-8.5% to -16.2%; ES = 1.22 to 1.24) with acromegaly patients (p < 0.05). In brief, the 3D mapping highlighted the trochanter as the site with greater cortical bone differences between acromegaly patients and the controls. Overall, AGHD patients displayed lower cortical parameters at the trochanter, femoral neck and intertrochanter compared to the controls and acromegaly patients. To sum up, 3D-DXA provided useful information about the characteristics of bone involvement in growth hormone (GH)-related disorders. Patients with AGHD showed distinct involvement of the cortical structure.Instituto de Salud Carlos IIIEuropean Commission PI18/01235La Caixa Foundation within the Junior Leader fellowship programme 100010434 LCF/BQ/PR19/1170000

The effect of an online exercise programme on bone health in paediatric cancer survivors (iBoneFIT): study protocol of a multi-centre randomized controlled trial

Background: New approaches on paediatric cancer treatment aim to maintain long-term health. As a result of radiotherapy, chemotherapy or surgery, paediatric cancer survivors tend to suffer from any chronic health condition. Endocrine dysfunction represents one of the most common issues and affects bone health. Exercise is key for bone mass accrual during growth, specifically plyometric jump training. The iBoneFIT study will investigate the effect of a 9-month online exercise programme on bone health in paediatric cancer survivors. This study will also examine the effect of the intervention on body composition, physical fitness, physical activity, calcium intake, vitamin D, blood samples quality of life and mental health. Methods: A minimum of 116 participants aged 6 to 18 years will be randomized into an intervention (n = 58) or control group (n = 58). The intervention group will receive an online exercise programme and diet counselling on calcium and vitamin D. In addition, five behaviour change techniques and a gamification design will be implemented in order to increase the interest of this non-game programme. The control group will only receive diet counselling. Participants will be assessed on 3 occasions: 1) at baseline; 2) after the 9 months of the intervention; 3) 4 months following the intervention. The primary outcome will be determined by dual energy X-ray absorptiometry (DXA) and the hip structural analysis, trabecular bone score and 3D-DXA softwares. Secondary outcomes will include anthropometry, body composition, physical fitness, physical activity, calcium and vitamin D intake, blood samples, quality of life and mental health.La Caixa Foundation 100010434 LCF/BQ/PR19/11700007University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES)Junta de Andalucía SOMM17/6107/UGREuropean Union (EU) SOMM17/6107/UG