Physical activity, diabetes, obesity and cardiometabolic risk in Chile

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Formación de Profesorado y Educación, Departamento de Educación Física, Deporte y Motricidad Humana. Fecha de lectura: 29-01-2020El aumento en la esperanza de vida debido a la disminución en las tasas de mortalidad trae consigo un envejecimiento poblacional. Estos cambios demográficos, junto con la acumulación de estilos de vida poco saludables, están indisolublemente vinculados con un aumento de las enfermedades no transmisibles, principales responsables de la mortalidad a nivel mundial. Dentro de las enfermedades no transmisibles, las cardiovasculares son las que lideran el ranking, seguidas por los cánceres y enfermedades respiratorias. Sin embargo, todas las enfermedades no transmisibles, convergen en que la inactividad física, una glicemia elevada y el sobrepeso u obesidad, entre otras, son responsables del aumento de estas enfermedades, independiente del nivel socioeconómico del país. Los objetivos propuestos para esta tesis doctoral fueron: (i) examinar la asociación entre los niveles de actividad física y el control metabólico en pacientes con diabetes mellitus de dos hospitales públicos en Chile (artículo 1), (ii) examinar la asociación entre transporte activo y síndrome metabólico, y sus componentes en una muestra representativa nacional de adultos chilenos (artículo 2) y (iii) examinar las asociaciones y las reasignaciones teóricas de la conducta sedentaria y los contextos de actividad física con los indicadores de obesidad en una muestra representativa nacional de adultos chilenos (artículo 3). Estas investigaciones fueron llevadas a cabo en dos hospitales públicos con pacientes diabéticos tipo 1 (n=101) y tipo 2 (n=100) o utilizando datos de los participantes de la 2ª Encuesta Nacional de Salud Chilena 2009-2010 (n=5412). Los niveles de actividad física y conducta sedentaria fueron medidos por autoreporte con el Cuestionario Global de Actividad Física. El control metabólico fue examinado con la hemoglobina glicosilada, mientras que el colesterol, las lipoproteínas de baja densidad, las lipoproteínas alta densidad y los triglicéridos a través de métodos enzimáticos estandarizados. Por último, la composición corporal se evaluó mediante el índice de masa corporal y perímetro de cintura. Los principales resultados de esta tesis doctoral sugieren que: (i) la actividad física en tiempo libre se asocia con un mejor control metabólico; (ii) la actividad física de desplazamiento se asocia negativamente con el síndrome metabólico, los triglicéridos y el perímetro de cintura; (iii) la reasignación de tiempo en conducta sedentaria por actividad física en tiempo libre o de desplazamiento se asoció inversamente con los indicadores de obesidad. Los resultados de la presente tesis doctoral ponen de manifiesto que la promoción de la actividad física puede ser una estrategia coste-efectiva para la prevención y tratamiento de las enfermedades cardiometabólicas.Increase in life expectancy due to lower mortality rates brings along population ageing. These demographic changes summed with the accumulation of unhealthy lifestyles, are inextricably linked to an increase in non-communicable diseases, responsible for the majority of deaths worldwide. Among non-communicable diseases, cardiovascular diseases are the foremost prevalent, followed by cancers and respiratory diseases. However, all non-communicable diseases agree that physical inactivity, elevated blood glucose, overweight and obesity, among others, are responsible for the increase of these diseases, independent of the socioeconomic status of the country. The proposed aims for this doctoral thesis were: (i) to examine the association between leisure time physical activity and metabolic control, in adults with diabetes mellitus from two public hospitals in Chile (article 1), (ii) to examine the association between travel physical activity and prevalence of metabolic syndrome and its components in a national representative sample of Chilean adults (article 2), (iii) to examine independent associations and theoretical reallocations of sedentary behavior and physical activity domains with obesity indicators in a nationally representative sample from Chile (article 3). One of the studies was conducted in two public hospitals with diabetics type 1 (n=101) and type 2 (n=100), while the others analyzed data from the 2009-2010 Chilean National Health Survey (n=5412). Physical activity levels and sedentary behavior were measured with the Global Physical Activity Questionnaire. Metabolic control was assessed with glycated hemoglobin, while cholesterol, low-density lipoproteins, high-density lipoproteins and triglycerides with standardized enzymatic procedures. Lastly, body composition was measured with body mass index and waist circumference. Main results of this thesis suggest: (i) leisure time physical activity associates with a better metabolic control; (ii) active travel inversely associates with metabolic syndrome, triglycerides and waist circumference; (iii) theoretical reallocation of sedentary behavior with leisure time physical activity or active travel inversely associates with obesity indicators. The findings from the present doctoral thesis highlights that physical activity promotion could be a cost-effective strategy for the prevention and treatment of cardiometabolic diseases

Alarming low physical activity levels in Chilean adults with disabilities during COVID-19 pandemic: a representative national survey analysis

BackgroundPeople with disabilities usually face barriers to regularly engaging in physical activities. Estimating physical activity patterns are necessary to elaborate policies and strategies to facilitate active lifestyles, considering the particular access difficulties experienced by this population.PurposeThis study aimed (i) to describe the prevalence of physical activity levels and (ii) to examine the associations of physical activity levels with socio-demographic variables and type of disability in the 2020 Chilean National Physical Activity and Sports Habits in Populations with Disabilities (CNPASHPwD) survey during the coronavirus disease 19 (COVID-19) pandemic.MethodsCross-sectional data from 3,150 adults (18–99 years old), 59.8% female, were analyzed from November to December 2020. Self-reported age, gender, type of disability (i.e., physical, visual, hearing, intellectual, or mixed), socio-economic status, area and zone of residence, and physical activity levels (0 min/week, < 150 min/week, ≥ 150 min/week) were obtained.Results11.9% of the participants were classified as active (≥ 150 min/week), and 62.6% declared no involvement in physical activity. A larger proportion of females (61.7%) did not meet the current guidelines (≥ 150 min/week of physical activity) in comparison with males (p < 0.001). Participants with visual and hearing disabilities were more likely to be active than those with other types of disabilities. Those living in the central and southern regions of Chile were more likely to be physically active than those from the northern region. Also, older participants, women, and those from lower socio-economic statuses were less likely to meet the physical activity guidelines.ConclusionAlarmingly, nine out of ten participants were categorized as physically inactive, particularly women, older adults, and those with a low socioeconomic status. If the pandemic context moderated, the considerable prevalence of reduced physical activity levels deserves future exploration. Health promotion initiatives should consider these aspects, emphasizing inclusive environments and increasing opportunities to favor healthy behaviors, countering the COVID-19 effects

Mediation Role of Physical Fitness and Its Components on the Association Between Distribution-Related Fat Indicators and Adolescents' Cognitive Performance: Exploring the Influence of School Vulnerability. The Cogni-Action Project

Background: Physical fitness and fatness converge simultaneously modulating cognitive skills, which in turn, are associated with children and adolescents' socioeconomic background. However, both fitness components and fat mass localization are crucial for understanding its implication at the cognitive level. Objective: This study aimed to determine the mediation role of a global physical fitness score and its components on the association between different fatness indicators related to fat distribution and adolescents' cognitive performance, and simultaneously explore the influence of school vulnerability. Methods: In this study, 1,196 Chilean adolescents participated (aged 10-14; 50.7% boys). Cardiorespiratory fitness (CRF), muscular fitness (MF), and speed-agility fitness (SAF) were evaluated, and a global fitness score (GFS) was computed adjusted for age and sex (CRF + MF + SAF z-scores). Body mass index z-score (BMIz), sum-of-4-skinfolds (4SKF), and waist-to-height ratio (WHtR) were used as non-specific, peripheral, and central adiposity indicators, respectively. A global cognitive score was computed based on eight tasks, and the school vulnerability index (SVI) was registered as high, mid or low. A total of 24 mediation analyses were performed according to two models, adjusted for sex and peak high velocity (Model 1), and adding the school vulnerability index (SVI) in Model 2. The significance level was set at p < 0.05. Results: The fitness mediation role was different concerning the fatness indicators related to fat distribution analyzed. Even after controlling for SVI, CRF (22%), and SAF (29%), but not MF, mediated the association between BMIz and cognitive performance. Likewise, CRF, SAF and GFS, but not MF, mediated the association between WHtR and cognitive performance (38.6%, 31.9%, and 54.8%, respectively). No mediations were observed for 4SKF. Conclusion: The negative association between fatness and cognitive performance is mitigated by the level of adolescents' physical fitness, mainly CRF and SAF. This mediation role seems to be more consistent with a central fat indicator even in the presence of school vulnerability. Strategies promoting physical fitness would reduce the cognitive gap in children and adolescents related to obesity and school vulnerability.The ``Cogni-Action Project'' was supported by the National Commission for Scientific and Technological Research CONICYT/FONDECYT INICIACION 2016 grant no. 11160703. IE-C was supported by the Spanish Ministry of Science and Innovation (RYC2019-027287-I)

Physical activity and diabetes mortality in people with type 2 diabetes: a prospective cohort study of 0.5 million US people

Aim To examine the association between physical activity and the cause of death with the greatest risk related to type 2 diabetes mellitus (T2DM) in a large population-based cohort representative of the general US adult population. Methods A total of 41,726 adults suffering from T2DM (age 62 ± 14 years) and 459,660 adults without diabetes (age 46 ± 18 years) who participated in the National Health Interview Survey from 1997 to 2014 were included in this prospective cohort study. Self-reported moderate-to-vigorous physical activity (MVPA) was categorized into inactive, insufficiently active, active and very active. Mortality data was obtained from the National Death Index. Cox regression models adjusted for potential confounders were performed to estimate hazard ratio (HR) and 95% confidence interval (CI). Results Diabetes mortality cause showed the highest relative risk of death among adults with T2DM compared to adults without diabetes (HR 5.72 [3.15;10.39]). There was a non-linear inverse dose-response association between MVPA and diabetes mortality among adults with T2DM, up to a plateau in risk reduction at approximately 500 min/week. Any level of activity was inversely associated with a significantly lower risk of diabetes mortality compared with being inactive (insufficiently active HR 0.71[0.54;0.97], active HR 0.68 [0.49;0.95], very active HR 0.44 [0.32;0.60]). Compared to adults without diabetes, the risk of diabetes mortality decreased from HR 7.38 [4.00;13.58] for inactive people with T2DM to HR 3.34 [1.76;6.32] for very active people with T2DM. Conclusions Higher levels of MVPA were associated with lower risk of diabetes mortality among adults with T2DM

A healthy lifestyle attenuates the effect of polypharmacy on total and cardiovascular mortality: a national prospective cohort study

This work examines whether the increased all-cause and cardiovascular disease (CVD) mortality associated with polypharmacy could be offset by a healthy lifestyle. We included a prospective cohort of 3,925 individuals representative of the Spanish population aged ≥60 years, who were recruited in 2000–2001 and followed up through 2014. Polypharmacy was defined as treatment with ≥5 medications. The following lifestyle behaviors were considered healthy: not smoking, eating a healthy diet, being physically active, moderate alcohol consumption, low sitting time, and adequate sleep duration. Individuals were classified into three lifestyle categories s: unfavorable (0–2), intermediate (3–4) favorable (5–6). Over a median 13.8-y follow-up, 1,822 all-cause and 675 CVD deaths occurred. Among individuals with polypharmacy, intermediate and favorable lifestyles were associated with an all-cause mortality reduction (95% confidence interval [CI]) of 47% (34–58%) and 54% (37–66%), respectively; 37% (9–56%) and 60% (33–76%) for CVD death, respectively. The theoretical adjusted hazard ratio (95%CI) associated with replacing 1 medication with 1 healthy lifestyle behavior was 0.73 (0.66–0.81) for all-cause death and 0.69 (0.59–0.82) for CVD death. The theoretical adjusted hazard ratio (95%CI) for all-cause and CVD mortality associated with simply reducing 1 medication was 0.88 (0.83–0.94) and 0.83 (0.76–0.91), respectively. Hence, adherence to a healthy lifestyle behavior can reduce mortality risk associated with polypharmacy in older adults.This work was supported by FIS grants 16/609 and 13/0288 (Instituto de Salud Carlos III, State Secretary of R + D + I and FEDER/FSE), MINECO R + D + I grant (DEP2013-47786-R), the FRAILOMIC Initiative (European Union FP7-HEALTH-2012-Proposal No. 305483-2), and the ATHLOS project (European project H2020- Project ID:635316

A comparative study between traditional and sports school uniforms on cardiorespiratory and muscular fitness and waist-height-to-ratio in adolescents

BackgroundImproving health of children and adolescents is crucial for their overall development. Therefore, it is essential to explore factors that may influence their health at both the public health and school system levels.ObjectiveThis study compares physical fitness components and waist-height-to-ratio (WHtR) in adolescents according to school uniforms, namely the traditional uniform (i.e., shirt and school necktie in boys and skirt and blouse in girls) and the sports uniform (i.e., polo shirts or t-shirts and sport or short trousers). Additionally, it seeks to investigate potential differences in these measures based on sex and school type (i.e., public, subsidized, and private).MethodsThis cross-sectional study used data from the Chilean national learning outcome assessment system (SIMCE)–2014 and involved 8,030 adolescents. Cardiorespiratory fitness (CRF) and muscular fitness (MF) were measured. WHtR was assessed as a health cardiovascular indicator. Mixed models and ANCOVA were performed to compare uniform types, adjusting for multiple covariates. value of p and effect size (ES) was used to establish significant results.ResultsOverall, sports uniforms (SU) were linked to higher CRF (p &lt; 0.001) than the traditional uniform (TU). Boys from private schools wearing SU presented higher CRF (p = 0.016; ES = 0.37), and a positive trend was observed for MF (p = 0.645; ES = 0.21). In subsidized, a trend was found in CRF (p = 0.005; ES = 0.16). Girls wearing SU from private schools showed a positive trend in CRF (p = 0.167; ES = 0.28). Trends in WHtR were found in both sexes from private (p = 0.555; ES = 0.24; p = 0.444; ES = 0.25, respectively).ConclusionWearing SU seems a promissory alternative to promote healthy physical fitness and body composition at the educational level. However, the relationship between higher physical activity and CRF, MF, and lower WHtR due to SU must be verified. Finally, when deciding to implement this measure, special attention must be paid to boys from public schools and girls from all types of schools

Clinical and Ambulatory Gait Speed in Older Adults: Associations With Several Physical, Mental, and Cognitive Health Outcomes

Background: Although clinical gait speed may indicate health and well-being in older adults, there is a lack of studies comparing clinical tests with ambulatory gait speed with regard to several health outcomes. Objective: The objective of this study was to examine the associations of clinical gait speed, measured by the 2.44-m walk test and the ambulatory gait speed with several physical, mental, and cognitive health outcomes in older adults. Design: A cross-sectional design was used. Methods: The study population comprised 432 high-functioning, community-dwelling older adults (287 women) aged between 65 and 92 years. Clinical and ambulatory gait speeds were measured using the 2.44-m walk test and a portable gait analysis device, respectively. Multiple linear regressions were used to examine the association of clinical and ambulatory gait speeds with several health outcomes (body mass index, waist circumference, systolic and diastolic blood pressure, chronic conditions, self-rated health, exhaustion, upper- and lower-body strength, physical and mental health status, cognitive status, and self-rated cognitive status). Results: The results showed that the average gait speed for clinical and ambulatory measures cannot be directly compared. Clinical gait speed was associated with 7 health outcomes, and the ambulatory gait speed was associated with 6 health outcomes. The significant associations between measures of gait speed and the health outcomes converged in 5 of the 13 health outcomes studied; however, the strength of associations was singly different between measures. Limitations: The short monitoring time, the inability to distinguish between the ambulatory gait speed inside the home and outdoor gait speed, and the under-representative sample are limitations of the study. Conclusion: The results indicated differences in the number and strength of associations between clinical and ambulatory gait speed. Both measures have construct validity because they have been associated with physical and health outcomes; however, they may have different predictive validity. Further research should be conducted to compare their predictive validity in longitudinal design

Could Physical Fitness Be Considered as a Protective Social Factor Associated with Bridging the Cognitive Gap Related to School Vulnerability in Adolescents? The Cogni-Action Project

Carlos Cristi-Montero received funding for the Cogni-Action Project from the National Commission for Scientific and Technological Research CONICYT/FONDECYT INICIACION 2016 grant No. 11160703 (Chile), and the National Research and Development Agency (ANID) from Chile-2019, Postdoctoral Grant No. 74200071.The first aim was to compare differences between school vulnerability groups, fitness levels, and their combination in adolescent cognitive performance. The second aim was to determine the mediation role of fitness in the association between school vulnerability and cognitive performance. A total of 912 Chilean adolescents aged 10–14 years participated in this study. The school vulnerability index (SVI) assigned by the Chilean Government was categorized into high-, mid-, or low-SVI. Adolescents were classified as fit or unfit according to their global fitness z-score computed from their cardiorespiratory (CRF), muscular (MF), and speed/agility fitness (SAF) adjusted for age and sex. A global cognitive scorewas estimated through eight tasks based on a neurocognitive battery. Covariance and mediation analyses were performed, adjusted for sex, schools, body mass index, and peak high velocity. Independent analyses showed that the higher SVI, the lower the cognitive performance (F(6,905) = 18.5; p < 0.001). Conversely, fit adolescents presented a higher cognitive performance than their unfit peers (F(5,906) = 8.93; p < 0.001). The combined analysis found cognitive differences between fit and unfit adolescents in both the high- and mid-SVI levels (Cohen’s d = 0.32). No differences were found between fit participants belonging to higher SVI groups and unfit participants belonging to lower SVI groups. Mediation percentages of 9.0%, 5.6%, 7.1%, and 2.8% were observed for the global fitness score, CRF, MF, and SAF, respectively. The mediation effect was significant between lowwith mid-high-SVI levels but not between mid- and high-SVI levels. These findings suggest that an adequate physical fitness level should be deemed a protective social factor associated with bridging the cognitive gap linked to school vulnerability in adolescents. This favourable influence seems to be most significant in adolescents belonging to a more adverse social background.National Commission for Scientific and Technological Research CONICYT/FONDECYT INICIACION (Chile) 11160703National Research and Development Agency (ANID) from Chile 7420007