Hàbits d'activitat física/exercici físic, sedentarisme i alimentació en nens amb sobrepès/obesitat i les seves famílies. Programa Nereu

La tesi pretén analitzar la relació entre els hàbits d'activitat física/exercici físic, sedentarisme i alimentació en nens amb sobrepès/obesitat. En aquest sentit, s’han redactat 5 articles on s'han estudiat els hàbits actius, les conductes sedentàries i d'alimentació, la resposta a l'exercici físic agut al caminar a diferents pendents a nivell energètic. S'ha portat a terme una primera avaluació del Programa Nereu i finalment s’ha proposat l’avaluació de l'efectivitat del Programa Nereu, com a eina integral vinculada a la salut pública en l'àmbit de l'atenció pediàtrica per al tractament del sobrepès i l'obesitat infantil. En l’article 1.1 i 1.2, es va observar que practicar almenys 3 hores/setmana d’exercici físic es va associar amb menor prevalença de sobrepès i millor condició física. En l’article 2, a mateixes intensitats de treball a nivell energètic i de ventilació els valors eren superiors en els grups de nens/as amb obesitat en relació als de sobrepès. A l’article 3, els nens van augmentar el temps dedicat a activitats de moderada i alta intensitat i es va reduir l'IMC z-score i les conductes sedentàries. Finalment, s'ha proposat un protocol d'estudi com a proposta de futur.La tesis pretende analizar la relación entre los hábitos de actividad física/ejercicio físico, sedentarismo y alimentación en niños con sobrepeso/obesidad. En este sentido, se han redactado 5 artículos donde se han estudiado los hábitos activos, las conductas sedentarias y de alimentación, la respuesta al ejercicio físico agudo al andar a diferentes pendientes a nivel energético. Se ha llevado a cabo una primera evaluación del Programa Nereu y finalmente se ha propuesto la evaluación de la efectividad del Programa Nereu, como herramienta integral vinculada a la salud pública en el ámbito de la atención pediátrica para el tratamiento del sobrepeso y la obesidad infantil. En el artículo 1.1 y 1.2, se observó que practicar al menos 3 horas/semana de ejercicio físico se asoció con menor prevalencia de sobrepeso y mejor condición física. En el artículo 2, a mismas intensidades de trabajo a nivel energético y ventilación los valores eran superiores en los grupos de niños/as con obesidad en relación a los de sobrepeso. En el artículo 3, los niños aumentaron el tiempo dedicado a actividades de moderada y alta intensidad y se redujo el IMC z-score y las conductas sedentarias. Finalmente, se ha propuesto un protocolo de estudio como propuesta de futuro.The porpoise of the thesis was to analyze the relation between physical activity/exercise habits, sedentary behavior and foot intake in overweight/obesity children. In this sense, 5 articles have been written. Where, active habits, sedentary behavior or foot intake, the response to acute physical exercise in overweight and obese children when walking at different gradients at an energy expenditure level, an initial assessment of the Nereu Programme have been studied. Finally, a proposal has been put forward on the Nereu Programme as an integral tool linked to public health in the field of pediatric care in the treatment of childhood overweight and obesity. Article 1.1 and 1.2, practice at least 3 hours/week of physical activity was associated with lower prevalence of overweight and better physical condition. In Article 2, same intensities of work on an energetic and ventilation values were higher in the groups of obese children compared to overweight children. Article 3, children increased the time they spent in moderate and high intensity activities and in contrast, BMI z-scores and sedentary behaviors were reduced. Finally, a study protocol has been put forward as a proposal for the future

Valoració objectiva de l’activitat física en sessions d’exercici físic d’un programa multidisciplinari per al tractament de l’obesitat infantil

Antecedents. La inclusió d’exercici físic supervisat en les intervencions per al tractament de l’obesitat infantil és un dels factors que pot determinar la seva eficàcia. No obstant, malgrat que les sessions hagin estat planificades segons les recomanacions, la resposta real dels nens/nenes no sempre ha estat quantificada. La finalitat del treball va ser analitzar el grau de moviment i estimar la despesa energètica durant les sessions d’exercici físic d’una intervenció per al tractament de l’obesitat infantil. Mètode. Hi van participar 41 nens/nenes de 8 a 12 anys, obesos i poc actius, en els quals es va mesurar, mitjançant acceleròmetres, el grau de moviment global i el temps dedicat a diferents nivells d’intensitat d’esforç (sedentària, lleugera, moderada-vigorosa) i el patró de les conductes sedentàries i d’activitat física durant les sessions d’exercici físic de la intervenció. Resultats. Les sessions de 60 minuts de durada es caracteritzen per períodes curts de moderada-vigorosa intensitat interromputs per períodes curts de menor intensitat de moviment. Els participants van dedicar un 58,3% del temps a activitats de moderada-vigorosa intensitat, un 30% a activitats de lleugera intensitat i tan sols un 11.8% del temps a conductes sedentàries. Per al conjunt de les sessions, i en particular a les de futbol, la despesa energètica dels nens va ser superior a la de les nenes. Conclusions. El programa d’intervenció dóna l’oportunitat d’augmentar els minuts setmanals dedicats a activitat física de moderada i vigorosa intensitat i d’incrementar la despesa energètica.Background. The inclusion of supervised physical exercise in interventions for the management of childhood obesity is one of the factors that can determine their efficacy. However, even though physical exercise sessions are planned according to existing guidelines, the children’s actual response has not always been quantified. The aim of this study was to analyse the level of movement and estimate energy expenditure during the supervised physical exercise sessions of an intervention for the treatment of childhood obesity. Method. Forty-one 8-to-12-year-old low active and obese children participated in the study. The overall physical activity, the time spent in different levels of exertion (sedentary, light intensity (LPA) and moderateto-vigorous intensity (MVPA) physical activity) and the pattern of sedentary and physical activity behaviour during the supervised physical exercise sessions were objectively assessed using Actigraph accelerometers. Results. The 60-minutes sessions were characterised by short bouts of MVPA interspersed by short bouts of LPA. Participants spent 58.3% of the duration of the session in MVPA, 30% in LPA and only 11.8% in sedentary behaviour. For all the sessions, and in particular for the football ones, energy expenditure was greater in boys than girls. Conclusions. Multidisciplinary intervention offers the opportunity to increase the weekly time devoted to moderate-to-vigorous physical activity and to raise energy expenditure

Physical Activity Behavior, Aerobic Fitness and Quality of Life in School-Age Children

The aim of this article is to assess the differences in sedentary and physical activity behavior, physical fitness and quality of lifein school-age children according to their adiposity state (BMI-SD= Body Mass Index Standard deviation) and gender. 352 children participated in the study (11.99 ± 1.5 years). Children were assigned to a normal weight group (NW= Normal Weight) (n=175) or to an overweight/obese group (OW/OB= Overweight and Obese) (n=177). The percentage of OW/OB was significantly superior (p<0.05) in boys (55.4%) than in girls. Boys reported spending 2:19 h/week (sd= 2:33; p<0.01) watching TV and 3:21 h/week (4:28; p<0.001) more than girls practicing moderate-high intensity physical activity. In contrast, in weight groups differences appeared only at high intensity activities to which NW children devoted 52minuts/week (2:33; p<0.01) longer than OW/OB children. NW and OW/OB groups presented significant (p<0.05) differences in all the physical fitness tests, except for the medicine ball toss one. Children's involvement in at least three hours a week of physical activity were associated to a lower prevalence of overweight or obesity, and to higher physical fitness in children.The authors are grateful to all the schools, children and their families for their participation, to the colleagues in Programa Nereu (Lleida, Catalonia) for their valuable contributions and the IDIAP – Jordi Gol Foundation. This study was supported by a grant from the Institute of Physical Education of Catalonia (INEFC), University of Lleida, Spain, (PRE/2730/2012, de 4 de desembre, DOGC NÚM. 6272 – 12.12.2012

How Important is Focalizing on a Healthier Lunch at School?

The aim is to assess the differences in frequency of school lunches, the adherence to the Mediterranean diet, sport practice and the parents’ educational level in school-age children according to their weight status. 352 school-age children recruited from schools in Catalonia participated (11.99 ± 1.5 years). Body weight status groups were grouped as follows: overweight and obese (OW/OB; n=175) versus normal weight (NW(Normal Weight); n=177). The percentage of NW children who had school lunches on weekdays was significantly (p <0.001) higher than the percentage of peer children with OW/OB. The percentage of OW/OB(Overweight and Obese) children who reported to practice structured sport was significantly lower (p<0.05) than in the NW children group and the mean time spent on it as well (2.05 ± 2.36 vs. 2.99 ± 3.03 hours/week; p<0.001, respectively). No differences were found in the parental studies or the Mediterranean diet variable between groups. The results support the role of the educator at school and it is suggested that a healthy and regulated food supply could favor lower adiposity in children. Promoting physical exercise at school could also help with the degree of obesity.The authors are grateful to all the schools, children and their families for their participation, to the colleagues in Programa Nereu (Lleida, Catalonia) for their valuable contributions and the IDIAP – Jordi Gol Foundation. This study was supported by a grant from the Institute of Physical Education of Catalonia (INEFC), University of Lleida, Spain, (PRE/2730/2012, de 4 de desembre, DOGC NÚM. 6272 – 12.12.2012

Effectiveness of a Multi-Component Intervention for Overweight and Obese Children (Nereu Program): A Randomized Controlled Trial

Introduction: Treatment of childhood obesity is a complex challenge for primary health care professionals. Objectives: To evaluate the effectiveness of the Nereu Program in improving anthropometric parameters, physical activity and sedentary behaviours, and dietary intake. Methods: Randomized, controlled, multicentre clinical trial comparing Nereu Program and usual counselling group interventions in primary care settings. The 8-month study recruited 113 children aged 6 to 12 years with overweight/obesity. Before recruitment, eligible participants were randomly allocated to an intensive, family-based multi-component behavioural intervention (Nereu Program group) or usual advice from their paediatrician on healthy eating and physical activity. Anthropometric parameters, objectively measured sedentary and physical activity behaviours, and dietary intake were evaluated pre- and post-intervention. Results: At the end of the study period, both groups achieved a similar decrease in body mass index (BMIsd) compared to baseline. Nereu Program participants (n = 54) showed greater increases in moderate-intense physical activity (+6.27% vs. -0.61%, p<0.001) and daily fruit servings (+0.62 vs. +0.13, p<0.026), and decreased daily soft drinks consumption (-0.26 vs. -0.02, p<0.047), respectively, compared to the counselling group (n = 59). Conclusions: At the end of the 8-month intervention, participants in the Nereu Program group showed improvement in physical activity and dietary behaviours, compared to the counselling group

Evaluation of a family intervention programme for the treatment of overweight and obese children (Nereu Programme): a randomized clinical trial study protocol

Background: Obesity is mainly attributed to environmental factors. In developed countries, the time spent on physical activity tasks is decreasing, whereas sedentary behaviour patterns are increasing. The purpose of the intervention is to evaluate the effectiveness of an intensive family-based behavioural multicomponent intervention (Nereu programme) and compared it to counselling intervention such as a health centre intervention programme for the management of children"s obesity. Methods/Design: The study design is a randomized controlled multicenter clinical trial using two types of interventions: Nereu and Counselling. The Nereu programme is an 8-month intensive family-based multi-component behavioural intervention. This programme is based on a multidisciplinary intervention consisting of 4 components: physical activity sessions for children, family theoretical and practical sessions for parents, behaviour strategy sessions involving both, parents and children, and lastly, weekend extra activities for all. Counselling is offered to the family in the form of a monthly physical health and eating habits session. Participants will be recruited according the following criteria: 6 to 12 year-old-children, referred from their paediatricians due to overweight or obesity according the International Obesity Task Force criteria and with a sedentary profile (less than 2 hours per week of physical activity), they must live in or near the municipality of Lleida (Spain) and their healthcare paediatric unit must have previously accepted to cooperate with this study. The following variables will be evaluated: a) cardiovascular risk factors (anthropometric parameters, blood test and blood pressure), b) sedentary and physical activity behaviour and dietary intake, c) psychological aspects d) health related quality of life (HRQOL), e) cost-effectiveness of the intervention in relation to HRQOL. These variables will be then be evaluated 4 times longitudinally: at baseline, at the end of the intervention (8 months later), 6 and 12 months after the intervention. We have considered necessary to recruit 100 children and divide them in 2 groups of 50 to detect the differences between the groups. Discussion: This trial will provide new evidence for the long-term effects of childhood obesity management, as well as help to know the impact of the present intervention as a health intervention tool for healthcare centres. Trial registration: ClinicalTrials.gov, NCT01878994This research is partially funded by the Instituto de Salud Carlos III in Spain, from the Ministry of Economy and Competitiveness with the expedient number PI12/02220, the Diputació de Lleida, the Department of Health of the Generalitat de Catalunya and the City Council of Lleida “La Paeria - Ajuntament de Lleida”. This research was supported by the Institute of Physical Education of Catalonia (INEFC), University of Lleida, Spain, (VCP/3570/2010, de 29 d’octubre, DOGC NÚM. 5753 – 11.11.2010; VCP/28/2009, 14 of January, DOGC NÚM. 5302 – 22/01/1999)

Physical activity/physical exercise, sedentary behaviours and nutrition in children with overweight/obesity and their families. Nereu Programme

La tesi pretén analitzar la relació entre els hàbits d'activitat física/exercici físic, sedentarisme i alimentació en nens amb sobrepès/obesitat. En aquest sentit, s’han redactat 5 articles on s'han estudiat els hàbits actius, les conductes sedentàries i d'alimentació, la resposta a l'exercici físic agut al caminar a diferents pendents a nivell energètic. S'ha portat a terme una primera avaluació del Programa Nereu i finalment s’ha proposat l’avaluació de l'efectivitat del Programa Nereu, com a eina integral vinculada a la salut pública en l'àmbit de l'atenció pediàtrica per al tractament del sobrepès i l'obesitat infantil. En l’article 1.1 i 1.2, es va observar que practicar almenys 3 hores/setmana d’exercici físic es va associar amb menor prevalença de sobrepès i millor condició física. En l’article 2, a mateixes intensitats de treball a nivell energètic i de ventilació els valors eren superiors en els grups de nens/as amb obesitat en relació als de sobrepès. A l’article 3, els nens van augmentar el temps dedicat a activitats de moderada i alta intensitat i es va reduir l'IMC z-score i les conductes sedentàries. Finalment, s'ha proposat un protocol d'estudi com a proposta de futur.La tesis pretende analizar la relación entre los hábitos de actividad física/ejercicio físico, sedentarismo y alimentación en niños con sobrepeso/obesidad. En este sentido, se han redactado 5 artículos donde se han estudiado los hábitos activos, las conductas sedentarias y de alimentación, la respuesta al ejercicio físico agudo al andar a diferentes pendientes a nivel energético. Se ha llevado a cabo una primera evaluación del Programa Nereu y finalmente se ha propuesto la evaluación de la efectividad del Programa Nereu, como herramienta integral vinculada a la salud pública en el ámbito de la atención pediátrica para el tratamiento del sobrepeso y la obesidad infantil. En el artículo 1.1 y 1.2, se observó que practicar al menos 3 horas/semana de ejercicio físico se asoció con menor prevalencia de sobrepeso y mejor condición física. En el artículo 2, a mismas intensidades de trabajo a nivel energético y ventilación los valores eran superiores en los grupos de niños/as con obesidad en relación a los de sobrepeso. En el artículo 3, los niños aumentaron el tiempo dedicado a actividades de moderada y alta intensidad y se redujo el IMC z-score y las conductas sedentarias. Finalmente, se ha propuesto un protocolo de estudio como propuesta de futuro.The porpoise of the thesis was to analyze the relation between physical activity/exercise habits, sedentary behavior and foot intake in overweight/obesity children. In this sense, 5 articles have been written. Where, active habits, sedentary behavior or foot intake, the response to acute physical exercise in overweight and obese children when walking at different gradients at an energy expenditure level, an initial assessment of the Nereu Programme have been studied. Finally, a proposal has been put forward on the Nereu Programme as an integral tool linked to public health in the field of pediatric care in the treatment of childhood overweight and obesity. Article 1.1 and 1.2, practice at least 3 hours/week of physical activity was associated with lower prevalence of overweight and better physical condition. In Article 2, same intensities of work on an energetic and ventilation values were higher in the groups of obese children compared to overweight children. Article 3, children increased the time they spent in moderate and high intensity activities and in contrast, BMI z-scores and sedentary behaviors were reduced. Finally, a study protocol has been put forward as a proposal for the future

Intervenció multidisciplinària i no competitiva en l’àmbit de la salut pública per al tractament del sedentarisme, el sobrepès i l’obesitat infantil: Programa Nereu

L’objectiu de l’estudi va ser avaluar si el Programa Nereu té un impacte favorable en l’activitat física (AF), les conductes sedentàries i el grau d’obesitat en nens poc actius amb sobrepès i obesitat com a eina d’intervenció en salut pública per al tractament de l’obesitat infantil. El disseny de l’estudi va ser prospectiu longitudinal amb posttest als 9 mesos i va consistir en AF per a nenes i nens amb components conductuals, sessions d’hàbits saludables per als pares i estratègies de comportament per a ambdós. Hi van participar vuitanta-sis nens (10,65 ± 2 anys) poc actius i amb sobrepès o obesitat, segons els criteris de l’International Obesity Task Force (IOTF), i els seus pares. AF, conductes sedentàries i adipositat es van mesurar a l’inici del programa i 9 mesos després de la intervenció. En finalitzar-la, els subjectes de l’estudi van indicar que dedicaven més temps (p < 0,01) a activitats d’intensitat moderada (2,4 ± 5,3 h · semana–1) i alta intensitat (3,1 ± 1,62 h · semana–1) i menys temps (p < 0,001) en activitats sedentàries (5,4 ± 6,3 h · setmana–1). La puntuació z de l’IMC es va reduir en 0,2 ± 0,29 unitats (p < 0,001). Aquests resultats mostren un canvi positiu en els hàbits d’AF, en les conductes sedentàries i en la puntuació z de l’IMC en les nenes i els nens sedentaris poc actius amb sobrepès i obesitat. Aquesta intervenció podria ser una eina interessant en salut pública per al tractament de l’obesitat infantil. No obstant això, futurs estudis han d’aclarir aquestes associacions.The aim was to evaluate if the Nereu Programme would favourably impact on physical activity (PA), sedentary behaviour and adiposity in low active overweight and obese children as a public health intervention tool for the management of children’s obesity. The design was a longitudinal prospective study with post-test at 9 months, consisted of PA for children with behavioural components, family behavioural sessions for parents and behaviour strategies for both. Eighty-six (10.65 ± 2 years) low active and overweight or obese children according the International Obesity Task Force (IOTF) Criteria and their parents participated. PA, sedentary behaviours and adiposity were collected at baseline and 9 months after the intervention. The children reported more time (p < 0.01) on moderate (2.4 ± 5.3 h·week-1) and high (3.1 ± 1.62 h · week-1) intensity PA and less time (p < 0.001) on sedentary activities (5.4 ± 6.3 h · week-1). BMI z-score was reduced by 0.2 ± 0.29 units (p < 0.001). These results may induce a positive change in PA, sedentary behaviours and BMI z-score in low active overweight and obese children. This intervention could be an interesting public health intervention tool for the management of children’s obesity. However, future studies should clarify these associations