El fitness como factor determinante en el riesgo de discapacidad, su relación con la composición corporal y el estado cognitivo en población mayor institucionalizada y de vida independiente = Fitness as a determinant factor in the risk of disability, and its relationship to body composition and cognitive status in institutionalized elderly population and independent living

La condición física, o como mejor se la conoce hoy en día el “fitness”, es una variable que está cobrando gran protagonismo, especialmente desde la perspectiva de la salud. La mejora de la calidad de vida que se ha experimentado en los últimos años en las sociedades desarrolladas, conlleva un aumento de la esperanza de vida, lo que hace que cada vez más personas vivan más años. Este rápido crecimiento de la población mayor de 60 años hace que, un grupo poblacional prácticamente olvidado desde el punto de vista de la investigación científica en el campo de la actividad física y del deporte, cobre gran relevancia, con el fin de poder ayudar a alcanzar el dicho “no se trata de aportar años a la vida sino vida a lo años”. La presente memoria de Tesis Doctoral tiene como principal objetivo valorar los niveles de fitness en población mayor española, además de analizar la relación existente entre el fitness, sus condicionantes y otros aspectos de la salud, tales como la composición corporal y el estado cognitivo. Entendemos que para poder establecer futuras políticas de salud pública en relación a la actividad física y el envejecimiento activo es necesario conocer cuáles son los niveles de partida de la población mayor en España y sus condicionantes. El trabajo está basado en los datos del estudio multicéntrico EXERNET (Estudio Multi-céntrico para la Evaluación de los Niveles de Condición Física y su relación con Estilos de Vida Saludables en población mayor española no institucionalizada), así como en los datos de dos estudios, llevados a cabo en población mayor institucionalizada. Se han analizado un total de 3136 mayores de vida independiente, procedentes de 6 comunidades autónomas, y 153 mayores institucionalizados en residencias de la Comunidad de Madrid. Los principales resultados de esta tesis son los siguientes: a) Fueron establecidos los valores de referencia, así como las curvas de percentiles, para cada uno de los test de fitness, de acuerdo a la edad y al sexo, en población mayor española de vida independiente y no institucionalizada. b) Los varones obtuvieron mejores niveles de fitness que las mujeres, excepto en los test de flexibilidad; existe una tendencia a disminuir la condición física en ambos sexos a medida que la edad aumenta. c) Niveles bajos de fitness funcional fueron asociados con un aumento en la percepción de problemas. d) El nivel mínimo de fitness funcional a partir del cual los mayores perciben problemas en sus actividades de la vida diaria (AVD) es similar en ambos sexos. e) Niveles elevados de fitness fueron asociados con un menor riesgo de sufrir obesidad sarcopénica y con una mejor salud percibida en los mayores. f) Las personas mayores con obesidad sarcopénica tienen menor capacidad funcional que las personas mayores sanas. g) Niveles elevados de fuerza fueron asociados con un mejor estado cognitivo siendo el estado cognitivo la variable que más influye en el deterioro de la fuerza, incluso más que el sexo y la edad. ABSTRACT Fitness is a variable that is gaining in prominence, especially from the health perspective. Improvement of life quality that has been experienced in the last few years in developed countries, leads to an expanded life expectancy, increasing the numbers of people living longer. This population consisting of people of over 60 years, an almost forgotten population group from the point of view of scientific research in the field of physical activity and sport, is becoming increasingly important, with the main aim of helping to achieve the saying “do not only add years to life, but also add life to years”. The principal aim of the current thesis was to assess physical fitness levels in Spanish elderly people, of over 65 years, analyzing relationship between physical fitness, its determinants, and other aspects of health such as body composition and cognitive status. In order to establish further public health policies in relation to physical activity and active ageing it is necessary to identify the starting physical fitness levels of the Spanish population and their determinants. The work is based on data from the EXERNET multi-center study ("Multi-center Study for the Evaluation of Fitness levels and their relationship to Healthy Lifestyles in noninstitutionalized Spanish elderly"), and on data from two studies conducted in institutionalized elderly people: a total of 3136 non-institutionalized elderly, from 6 Regions of Spain, and 153 institutionalized elderly in nursing homes of Madrid. The main outcomes of this thesis are: a) sex- and age-specific physical fitness normative values and percentile curves for independent and non-institutionalized Spanish elderly were established. b) Greater physical fitness was present in the elderly men than in women, except for the flexibility test, and a trend toward decreased physical fitness in both sexes as their age increased. c) Lower levels of functional fitness were associated with increased perceived problems. d) The minimum functional fitness level at which older adults perceive problems in their ADLs, is similar for both sexes e) Higher levels of physical fitness were associated with a reduced risk of suffering sarcopenic obesity and better perceived health among the elderly. f) The elderly with sarcopenic obesity have lower physical functioning than healthy counterparts. g) Higher strength values were associated with better cognitive status with cognitive status being the most influencing variable in strength deterioration even more than sex and age

Biomarkers of physical activity and exercise

Tradicionalmente, los biomarcadores han sido de interés en las ciencias del deporte para medir el rendimiento, el progreso en el entrenamiento y para identificar el sobreentrenamiento. Durante los últimos años, cada vez hay mayor interés en evaluar los efectos relacionados con la salud que se producen en el organismo debidos a una actividad física regular y al deporte. El valor o la concentración de un biomarcador depende de muchos factores, como el grado de entrenamiento, el grado de fatiga y del tipo, la intensidad y la duración del ejercicio, aparte de la edad y del sexo. La mayor parte de los biomarcadores se miden en sangre, orina y saliva. Una de las principales limitaciones que presentan los biomarcadores bioquímicos es la falta de valores de referencia adaptados específicamente para deportistas y personas físicamente activas. Las concentraciones pueden variar considerablemente de los valores de referencia normales. Por lo tanto, es importante adaptar los valores de referencia siempre y cuando sea posible y controlar a cada sujeto regularmente, con el fin de establecer su propia escala de referencia. Otros biomarcadores útiles son la composición corporal (específicamente masa muscular, masa grasa, peso), la condición física (capacidad cardiorrespiratoria, fuerza, agilidad, flexibilidad), frecuencia cardíaca y presión arterial. Dependiendo de la finalidad, será conveniente analizar uno o varios biomarcadores. Para esta revisión, profundizaremos en los biomarcadores que se emplean para evaluar condición física, fatiga crónica, sobreentrenamiento, riesgo cardiovascular, estrés oxidativo e inflamación

Higher levels of physical fitness are associated with a reduced risk of suffering sarcopenic obesity and better perceived health among elderly. The EXERNET multi-center study

Objective: To evaluate the associations between physical fitness levels, health related quality of life (HRQoL) and sarcopenic obesity (SO) and to analyze the usefulness of several physical fitness tests as a screening tool for detecting elderly people with an increased risk of suffering SO. Design: Cross-sectional analysis of a population-based sample. Setting: Non-institutionalized Spanish elderly participating in the EXERNET multi-centre study. Participants: 2747 elderly subjects aged 65 and older. Measurements: Body weight, height and body mass index were evaluated in each subject. Body composition was measured by bioelectrical impedance. Four SO groups were created based on percentage of body fat and relative muscle mass; 1) normal group, 2) sarcopenic group, 3) obesity group and 4) SO group. Physical fitness was evaluated using 8 tests (balance, lower and upper body strength, lower and upper body flexibility, agility, walking speed and aerobic capacity). Three tertiles were created for each test based on the calculated scores. HRQoL was assessed using the EuroQol visual analogue scale. Results: Participants with SO showed lower physical fitness levels compared with normal subjects. Better balance, agility, and aerobic capacity were associated to a lower risk of suffering SO in the fittest men (odds ratio < 0.30). In women, better balance, walking speed, and aerobic capacity were associated to a lower risk of suffering SO in the fittest women (odds ratio < 0.21) Superior perceived health was associated with better physical fitness performance. Conclusions: Higher levels of physical fitness were associated with a reduced risk of suffering SO and better perceived health among elderly. SO elderly people have lower physical functional levels than healthy counterparts

Role of Dietary Intake and Serum 25(OH)D on the Effects of a Multicomponent Exercise Program on Bone Mass and Structure of Frail and Pre-Frail Older Adults

The multicomponent training (MCT) effect on bone health in frail and pre-frail elders, which is influenced by dietary intake, is still unknown. The objective of this non-randomized intervention trial was to assess the effects of a 6-month MCT on bone structure in frail and pre-frail elders, and to analyse the influence of dietary intake and serum vitamin D (25(OH)D) in these changes. Thirty MCT (TRAIN) and sixteen controls (CON), frail and pre-frail completed the information required for this study. Peripheral quantitative computed tomography measurements were taken at 4% and 38% of the tibia length and dietary intake was registered. The 25(OH)D values were obtained from blood samples. Analyses of covariance (ANCOVA) for repeated measures showed significant decreases for CON in total bone mineral content at 38% of tibia length. One factor ANOVAs showed smaller decreases in bone mineral density and cortical thickness percentage of change in TRAIN compared to CON. Linear regression analyses were performed to study the influence of nutrients and 25(OH)D on bone changes. Alcohol showed a negative influence on fracture index changes, while polyunsaturated fatty acid and vitamin A showed a positive association with some bone variables. The 25(OH)D only affected positively the cortical bone mineral density. In conclusion, our MCT seems to slow down some of the bone detriments associated with ageing in frail and pre-frail older adults, with alcohol showing a negative effect on the bone and apparent limited effect of nutrients and serum 25(OH)D on training related changes

Organized physical activity in the elderly, a tool to improve physical fitness during ageing

FUNDAMENTOS. Un nivel adecuado de condición física (CF) es fundamental para el logro de un envejecimiento saludable. El objetivo de este estudio consistió en evaluar el impacto de la actividad física (AF) organizada y el número de horas de práctica sobre el nivel de CF de las personas mayores. MÉTODO. En el estudio participaron 3104 personas mayores de 65 años de España, pertenecientes al Proyecto Multicéntrico EXERNET (722 hombres y 2382 mujeres; edad media: 72,1±5,3 años). La CF se evaluó mediante 8 test específicos para esta población. La participación en AF organizada se registró mediante un cuestionario. Las diferencias en la CF en función de la práctica y número de horas de AF se midieron con ANCOVA ajustando por edad, horas de caminar y de estar sentado. RESULTADOS. Aquellos que no participaban en este tipo de actividad incrementaban su riesgo de tener un nivel bajo de CF en la mayoría de las variables evaluadas, observándose algunas diferencias entre sexos (OR: desde 1,6 hasta 2,6 en hombres y desde 1,4 hasta 2,2 en mujeres). En los hombres no se observó ninguna diferencia significativa entre practicar menos de 2, 2-4 o más de 4 horas (todos P>0,05), a excepción de la fuerza del brazo izquierdo; sin embargo, las mujeres que realizaban más de 2 horas de AF organizada a la semana tenían mayor equilibrio, fuerza de piernas y de brazos, flexibilidad de piernas, velocidad al caminar y resistencia aeróbica que aquellas que asistían a este tipo de sesiones menos de 2 horas a la semana (P<0,05). CONCLUSIONES. La práctica de AF organizada produce un efecto beneficioso sobre la CF de las personas mayores independientemente de la edad, las horas que estén sentados o el tiempo que dediquen a caminar.BACKGROUND. An adequate level of fitness is critical to achieving healthy ageing. The aim of this study was to evaluate the impact of organized physical activity (PA) and the number of hours of practice on the fitness levels of the elderly. METHOD. A total of 3104 people over 65 years old from Spain, belonging to the EXERNET Multicenter Project (722 men and 2382 women, mean age: 72.1 ± 5.3 years) participated in the study. Fitness was evaluated by 8 specific tests for this population. Participation in organized PA was recorded through a questionnaire. Differences in fitness values depending on the participation in PA and the number of hours were measured with ANCOVA adjusting for age, hours of walking and sitting time. RESULTS. Those who did not participate in this type of activity increased their risk of having a low level of fitness in most variables evaluated, with some differences between sexes (OR: from 1.6 to 2.6 in men and from 1.4 to 2.2 in women). In men, no significant differences were observed between practicing less than 2, 2-4 or more than 4 hours (P>0,05), with an exception in the strength of the left arm. However, women who performed more than 2 hours a week in organized PA had better balance, strength of lower and upper extremities, flexibility of lower extremities, walking speed and aerobic capacity than those who performed less than 2 hours of PA a week (P<0,05). CONCLUSIONS. The practice of organized PA produces a beneficial effect on the fitness of the elderly regardless of age, hours of walking and time sitting per day.• Ministerio de Trabajo y Asuntos Sociales. Ayuda IMSERSO 104/07 • Universidad de Zaragoza. Ayuda UZ 2008-BIO-01 • Centro Universitario de la Defensa de Zaragoza. Ayuda UZCUD2016-BIO-01 • Ministerio de Economía, Industria y Competitividad. Ayuda DEP2016-78309-R • Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable. AyudapeerReviewe

the exernet multicenter study

Performing activities of daily living independently and safely requires adequate levels of strength, endurance and agility. However, functional fitness (FF) components have been usually evaluated separately. We aimed to create a novel global FF score and to calculate its relationship with adiposity levels in the elderly. Methods: Muscle mass, body fat and waist circumference were obtained in 3,136 non-institutionalized Spanish elderly subjects. Physical performance was evaluated by the Senior Fitness Test battery (upper- and lower-body strength, agility and endurance). The participants were categorized as highly fit (HF; moderate-high functioning in all FF capacities), moderately fit (MF; low-functioning in 1-3 FF measures) and unfit (UF; low-functioning in all FF capacities) according to the FF score. Odds ratios for obesity, central obesity and sarcopenic obesity were calculated according to the FF score. Results: The percentage of UF older adults was 6.9%. Agility was the most impaired physical condition among all the participants. A lower FF score was significantly related with a higher prevalence of obesity, central obesity and arcopenic obesity. Conclusion: A strong relationship between lower levels of FF and higher levels of adiposity was observed. In order to provide a greater independence in later life we should emphasize about the need for concerted efforts to prevent and treat the FF decline with aging.Las personas mayores requieren de unos adecuados niveles de fuerza, resistencia y agilidad para llevar a cabo las actividades de la vida diaria de manera independiente y segura. Sin embargo, normalmente los componentes del fitness funcional (FF) han sido evaluados de manera individual. Nuestro objetivo fue crear una nueva puntuación global de FF y evaluar su relación con los niveles de adiposidad en las personas mayores. Métodos: Se obtuvieron medidas de masa muscular, grasa corporal y circunferencia de cintura en un total de 3,136 personas mayores no institucionalizadas en España. La función física se evaluó por medio de la batería Senior Fitness Test (fuerza de brazos y piernas, agilidad y resistencia). Los participantes fueron clasificados como nivel de fitness alto (FA; funcionalidad moderada-alta en todas las capacidades de FF), fitness moderado (FM; baja funcionalidad en 1-3 medidas de FF) y fitness bajo (FB; baja funcionalidad en todas las capacidades de FF) de acuerdo a la puntuación de FF. Se calcularon los odds ratios para obesidad, obesidad central y obesidad sarcopénica en función de la puntuación de FF. Resultados: El porcentaje de personas mayores con FB fue del 6.9%. La agilidad fue la medida más deteriorada entre los participantes. Una menor puntuación de FF estuvo significativamente relacionada con una mayor prevalencia de obesidad, obesidad central y obesidad sarcopénica. Conclusión: Se observó una fuerte relación entre unos bajos niveles de FF y altos niveles de adiposidad. Para alcanzar un alto grado de independencia funcional en las personas mayores, es importante implementar medidas que consigan prevenir y tratar el deterioro del FF asociado al envejecimiento

Organized physical activity in the elderly, a tool to improve physical fitness during ageing

FUNDAMENTOS. Un nivel adecuado de condición física (CF) es fundamental para el logro de un envejecimiento saludable. El objetivo de este estudio consistió en evaluar el impacto de la actividad física (AF) organizada y el número de horas de práctica sobre el nivel de CF de las personas mayores. MÉTODO. En el estudio participaron 3104 personas mayores de 65 años de España, pertenecientes al Proyecto Multicéntrico EXERNET (722 hombres y 2382 mujeres; edad media: 72,1±5,3 años). La CF se evaluó mediante 8 test específicos para esta población. La participación en AF organizada se registró mediante un cuestionario. Las diferencias en la CF en función de la práctica y número de horas de AF se midieron con ANCOVA ajustando por edad, horas de caminar y de estar sentado. RESULTADOS. Aquellos que no participaban en este tipo de actividad incrementaban su riesgo de tener un nivel bajo de CF en la mayoría de las variables evaluadas, observándose algunas diferencias entre sexos (OR: desde 1,6 hasta 2,6 en hombres y desde 1,4 hasta 2,2 en mujeres). En los hombres no se observó ninguna diferencia significativa entre practicar menos de 2, 2-4 o más de 4 horas (todos P>0,05), a excepción de la fuerza del brazo izquierdo; sin embargo, las mujeres que realizaban más de 2 horas de AF organizada a la semana tenían mayor equilibrio, fuerza de piernas y de brazos, flexibilidad de piernas, velocidad al caminar y resistencia aeróbica que aquellas que asistían a este tipo de sesiones menos de 2 horas a la semana (P<0,05). CONCLUSIONES. La práctica de AF organizada produce un efecto beneficioso sobre la CF de las personas mayores independientemente de la edad, las horas que estén sentados o el tiempo que dediquen a caminar.BACKGROUND. An adequate level of fitness is critical to achieving healthy ageing. The aim of this study was to evaluate the impact of organized physical activity (PA) and the number of hours of practice on the fitness levels of the elderly. METHOD. A total of 3104 people over 65 years old from Spain, belonging to the EXERNET Multicenter Project (722 men and 2382 women, mean age: 72.1 ± 5.3 years) participated in the study. Fitness was evaluated by 8 specific tests for this population. Participation in organized PA was recorded through a questionnaire. Differences in fitness values depending on the participation in PA and the number of hours were measured with ANCOVA adjusting for age, hours of walking and sitting time. RESULTS. Those who did not participate in this type of activity increased their risk of having a low level of fitness in most variables evaluated, with some differences between sexes (OR: from 1.6 to 2.6 in men and from 1.4 to 2.2 in women). In men, no significant differences were observed between practicing less than 2, 2-4 or more than 4 hours (P>0,05), with an exception in the strength of the left arm. However, women who performed more than 2 hours a week in organized PA had better balance, strength of lower and upper extremities, flexibility of lower extremities, walking speed and aerobic capacity than those who performed less than 2 hours of PA a week (P<0,05). CONCLUSIONS. The practice of organized PA produces a beneficial effect on the fitness of the elderly regardless of age, hours of walking and time sitting per day.• Ministerio de Trabajo y Asuntos Sociales. Ayuda IMSERSO 104/07 • Universidad de Zaragoza. Ayuda UZ 2008-BIO-01 • Centro Universitario de la Defensa de Zaragoza. Ayuda UZCUD2016-BIO-01 • Ministerio de Economía, Industria y Competitividad. Ayuda DEP2016-78309-R • Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable. AyudapeerReviewe

How important is current physical fitness for future quality of life? Results from an 8-year longitudinal study on older adults

A vast amount of research has focused on the effects of physical fitness (PF) on mortality, with little research evaluating the effects of PF on future expected health related quality of life (HRQoL). Aim: To evaluate how current PF influences future HRQoL measured in a prospective 8-year study in older adults. Methods: A total of 617 (157 males) older adults (>65y) participated in the study. PF was assessed with the EXERNET battery in 2008–2009 (baseline) and 2016–2017 (follow-up). HRQoL was assessed using the EQ-5D-3L questionnaire in both evaluations. PF tertiles were developed from baseline PF variables: FIT (highest PF values), REGULAR and UNFIT (lowest PF values) taking into account age and sex. Follow-up HRQoL values were compared to sex and age-specific expected values. Logistic regressions were performed to test differences be tween PF tertiles regarding future expected quality of life. Linear regressions were developed to test whether baseline PF could predict future HRQoL scores. Results: The FIT group showed higher probabilities of an improved HRQoL when compared to the UNFIT group. All PF variables seemed to be important at some point of the study except upper extremities flexibility. Aerobic endurance was the variable that showed to be significant for most of the HRQoL predictions. Conclusion: PF influences future HRQoL in older adults who accordingly should try to remain fit to maintain an increased age-adjusted HRQoL

Relación entre el nivel educativo y la composición corporal en personas mayores no institucionalizadas: proyecto multi-céntrico EXERNET

Fundamentos: El nivel educacional se ha relacionado inversamente con la composición corporal, sin embargo esta asociación ha sido evidenciada mayoritariamente en población joven y adulta. El objetivo del presente estudio fue evaluar la relación entre la composición corporal de las personas mayores de 65 años y su nivel educativo, y determinar si tener un nivel educativo alto puede prevenir el riesgo de padecer sobrepeso, obesidad central o exceso de grasa durante la senectud. Métodos: El estudio se realizó entre los años 2008-2009, sobre una muestra representativa de personas mayores de España (n= 2,706; 629 varones, 2,077 mujeres; edad media 72,1 ± 5,3 años), pertenecientes al Proyecto Multi-céntrico EXERNET. La composición corporal se evaluó mediante bio-impedancia eléctrica. Se utilizó ANCOVA para determinar las diferencias entre grupos. La asociación entre el nivel educativo y el riesgo de padecer sobrepeso, obesidad central o exceso de grasa se analizó mediante regresión logística. Resultados: En el perímetro de cintura, los hombres y mujeres con mayor nivel de estudios presentaron 96,6 cm y 86,3 cm, respectivamente (p<0,05 y p<0,01, respectivamente). Las mujeres con menor nivel de estudios presentaron 29,5 kg de masa grasa total y 40,8% de masa grasa (p<0,05 y p<0,01, respectivamente). Los varones no presentaron diferencias en estas mediciones. Conclusiones: Poseer un bajo nivel de estudios aumenta las posibilidades de padecer sobrepeso y obesidad en las mujeres y de tener mayor perímetro de cintura en ambos sexos. OBJECTIVE: There is an inverse association between educational level and body composition; however this association has strongly focused in young and adults population. The aim of this study was to analyze the educational levels attained in overweight and obesity Spanish elderly and to investigate if there was a correlation between having a low educational level and the risk of having overweight, central obesity or excess fat mass during the aging process. METHODS: A representative sample of 2706 elderly (629 men and 2077 women; mean age of 72.1 ± 5.3 years) from Spain were assessed in the elderly EXERNET multi-center study between 2008 and 2009. Body composition was assessed in all subjects by bioelectrical impedance. ANCOVA was used to compare the averages between the groups. Logistic regression was used to calculate the association between educational level and the risk of having overweight, central fat or obesity. RESULTS: We observed significances between waist circumference and educational level in both sex (men 96.6 cm, women 86.3 cm); (p less than 0.05 and p less than 0.01, respective). There is an inverse association between the academic level, fat mass (29.5 kg) and percentage of body fat (40.8%) in women (p less than 0.05, p less than 0.01, respectively). No differences were observed in men. CONCLUSIONS: low educational level increases the possibility of having overweight or obesity in women and to have an increased waist circumference in both sexes

Physical Activity Patterns of the Spanish Population Are Mostly Determined by Sex and Age: Findings in the ANIBES Study

Background Representative data for the Spanish population regarding physical activity (PA) behaviors are scarce and seldom comparable due to methodological inconsistencies. Aim Our objectives were to describe the PA behavior by means of the standardized self-reported International Physical Activity Questionnaire (IPAQ) and to know the proportion of the Spanish population meeting and not meeting international PA recommendations. Material and Methods PA was assessed using the IPAQ in a representative sample of 2285 individuals (males, 50.4%) aged 9–75 years and living in municipalities of at least 2,000 inhabitants. Data were analyzed according to: age groups 9–12, 13–17, 18–64, and 65–75 years; sex; geographical distribution; locality size and educational levels. Results Mean total PA was 868.8±660.9 min/wk, mean vigorous PA 146.4±254.1 min/wk, and mean moderate PA 398.1±408.0 min/wk, showing significant differences between sexes (p<0.05). Children performed higher moderate-vigorous PA than adolescents and seniors (p<0.05), and adults than adolescents and seniors (p<0.05). Compared to recommendations, 36.2%of adults performed <150 min/week of moderate PA, 65.4% <75 min/week of vigorous PA and 27.0%did not perform any PA at all, presenting significant differences between sexes (p<0.05). A total of 55.4%of children and adolescents performed less than 420 min/week of MVPA, being higher in the later (62.6%) than in the former (48.4%). Highest non-compliance was observed in adolescent females (86.5%). Conclusion Sex and age are the main influencing factors on PA in the Spanish population. Males engage in more vigorous and light PA overall, whereas females perform more moderate PA. PA behavior differs between age groups and no clear lineal increase with age could be observed. Twenty-seven percent of adults and 55.4% of children and adolescents do not meet international PA recommendations. Identified target groups should be addressed to increase PA in the Spanish populationCoca-Cola Iberia through Spanish Nutrition Foundation (FEN)Coca-Cola Iberi