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The university stage is a critical developmental period for young adults, where lifestyles can determine future health. A cross-sectional study including 481 college students was conducted, with the following objectives: 1) to examine the prevalence of risk of developing eating disorders in college students, 2) to assess differences in obesity and physical fitness in those with and without risk of eating disorders, and 3) to determine whether cardiorespiratory fitness, muscular fitness or fat mass were associated with the risk of eating disorders. We measured fat mass percentage (by densitometry), risk of feeding or eating disorders (by SCOFF questionnaire), cardiorespiratory fitness levels and a muscular fitness index. The prevalence of risk of eating disorders in women (32.4%) was higher than in men (17.4%) (p

Flash glucose monitoring (FGM) systems have been suggested to have clinical beneficial effects in patients with diabetes mellitus, although their improvements in terms of quality of life (QoL) and patients’ satisfaction are not always addressed or are considered a secondary outcome. Thus, the aim of this meta-review is to establish the benefits of FGM in terms of patients’ satisfaction and QoL in both type 1 and type 2 diabetes patients using evidence from past systematic reviews and meta-analyses. Major databases were searched for systematic reviews (with or without meta-analyses) that assessed the satisfaction or QoL of type 1 or 2 diabetes patients using FGM compared with other glucose monitoring systems. The quality of the included systematic reviews was addressed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. Six systematic reviews (including two meta-analyses) were included in the meta-review. Evidence suggests that FGM systems seem to improve patients’ satisfaction and QoL compared with self-monitoring of blood glucose, although the high variability in the measurement tools, the clinical significance and the quality of the systematic reviews included do not allow us to state FGM benefits with any certainty. Further research, including high-quality randomised clinical trials, differentiating the needs of both type 1 and type 2 diabetes patients and focusing on psychosocial benefits for these patients is needed to optimise clinical decisions between patients and professionals by developing the right health technology assessment for FGM systems.

Background: Mobile health (mHealth) is currently among the supporting elements that may contribute to an improvement in health markers by helping people adopt healthier lifestyles. mHealth interventions have been widely reported to achieve greater weight loss than other approaches, but their effect on body composition remains unclear. Objective: This study aimed to assess the short-term (3 months) effectiveness of a mobile app and a smart band for losing weight and changing body composition in sedentary Spanish adults who are overweight or obese. Methods: A randomized controlled, multicenter clinical trial was conducted involving the participation of 440 subjects from primary care centers, with 231 subjects in the intervention group (IG; counselling with smartphone app and smart band) and 209 in the control group (CG; counselling only). Both groups were counselled about healthy diet and physical activity. For the 3-month intervention period, the IG was trained to use a smartphone app that involved self-monitoring and tailored feedback, as well as a smart band that recorded daily physical activity (Mi Band 2, Xiaomi). Body composition was measured using the InBody 230 bioimpedance device (InBody Co., Ltd), and physical activity was measured using the International Physical Activity Questionnaire. Results: The mHealth intervention produced a greater loss of body weight (-1.97 kg, 95% CI -2.39 to -1.54) relative to standard counselling at 3 months (-1.13 kg, 95% CI -1.56 to -0.69). Comparing groups, the IG achieved a weight loss of 0.84 kg more than the CG at 3 months. The IG showed a decrease in body fat mass (BFM; -1.84 kg, 95% CI -2.48 to -1.20), percentage of body fat (PBF; -1.22%, 95% CI -1.82% to 0.62%), and BMI (-0.77 kg/m(2), 95% CI -0.96 to 0.57). No significant changes were observed in any of these parameters in men; among women, there was a significant decrease in BMI in the IG compared with the CG. When subjects were grouped according to baseline BMI, the overweight group experienced a change in BFM of -1.18 kg (95% CI -2.30 to -0.06) and BMI of -0.47 kg/m(2) (95% CI -0.80 to -0.13), whereas the obese group only experienced a change in BMI of -0.53 kg/m(2) (95% CI -0.86 to -0.19). When the data were analyzed according to physical activity, the moderate-vigorous physical activity group showed significant changes in BFM of -1.03 kg (95% CI -1.74 to -0.33), PBF of -0.76% (95% CI -1.32% to -0.20%), and BMI of -0.5 kg/m(2) (95% CI -0.83 to -0.19). Conclusions: The results from this multicenter, randomized controlled clinical trial study show that compared with standard counselling alone, adding a self-reported app and a smart band obtained beneficial results in terms of weight loss and a reduction in BFM and PBF in female subjects with a BMI less than 30 kg/m(2) and a moderate-vigorous physical activity level. Nevertheless, further studies are needed to ensure that this profile benefits more than others from this intervention and to investigate modifications of this intervention to achieve a global effect. Trial Registration: Clinicaltrials.gov NCT03175614; https://clinicaltrials.gov/ct2/show/NCT03175614. International Registered Report Identifier (IRRID): RR2-10.1097/MD.0000000000009633, This study was funded by the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III, and co-funded by the European Union (ERDF/ESF, Investing in your future) (RD12/0005/0001, RD16/0007/0003, RD16/0007/0005, RD16/0007/0008, RD16/0007/0009 and PI16/00101, PI16/00952, PI16/00765, PI16/00659, PI16/00421, PI16/00170, FI17/00040). Gerencia Regional de Salud de Castilla y Leon (GRS 1277/B/16) also collaborated in the funding of this study. They played no role in the study design, data analysis, reporting results, or decision to submit the manuscript for publication.

Background The objective of this study was to analyse the secular trends in body composition variables and weight status among Spanish schoolchildren from 1992 to 2017, and to examine the persistence in the same weight status category from 2013 to 2017 of the birth cohort in 2007–08. Methods The data for the prevalence/trend analysis were taken from cross-sectional analyses conducted in 1992 (n = 308), 1996 (n = 307), 1998 (n = 275), 2004 (n = 1119), 2010 (n = 912), 2013 (n = 352) and 2017 (n = 275) using similar procedure methods among schoolchildren (aged 4–6 y and 8–11 years) from 22 public schools in the province of Cuenca, Spain. The data for the longitudinal analysis were obtained from cross-sectional analyses of measurements gathered in 2013 and 2017 in the same cohort of children (n = 275) born in 2007 and 2008. Weight, height, body fat percentage (by electronic bioimpedance) and waist circumference were measured by trained personnel. Weight status was defined according to the BMI cut-offs proposed by the International obesity task force (IOTF) criteria. Results In schoolchildren, the overall prevalence of thinness increased from 5.9% in 1992 to 14.5% in 2017, P Conclusions The child obesity epidemic in Spain has remained relatively stable over the last two decades. However, the prevalence of thinness shows a worrying upward trend.

High blood pressure levels are among the most important cardiovascular disease risk factors and are influenced by physical fitness and body composition. However, the degree to which obesity may attenuate or modify the beneficial effects of physical fitness on blood pressure levels in young adults is uncertain. Thus, the aim of this study was to analyze whether body composition is a mediator between cardiorespiratory fitness (CRF) and blood pressure levels in young adults. This work was a cross-sectional study involving first-year college students (n=386) at the University Campus of Cuenca (Spain). We measured weight, height, waist circumference, fat mass percentage (by densitometry), systolic and diastolic blood pressure and CRF levels (by a 20 m shuttle run test). Partial correlation coefficients were estimated to examine the relationships among adiposity variables, CRF and blood pressure variables, controlling for age and sex. ANCOVA models were conducted to explore differences in blood pressure levels across adiposity and CRF categories. Hayes’s PROCESS macro was used for the simple mediation analysis. The indirect effect and Sobel test were significant (P

The aim of this review was to determine the relationship between dairy product consumption and arterial stiffness, measured by pulse wave velocity (PWV). We systematically searched the Medline, Embase and Web of Science databases until 30 January 2019 for cross-sectional data from studies addressing the association between dairy product consumption and PWV. This study was registered with PROSPERO (CRD42018110528). Both the inverse-variance fixed effects method and the DerSimonian and Laird method were used to compute pooled estimates of effect size (ES) and the respective 95% confidence intervals (CIs). Seven studies were included in the meta-analysis, with a total of 16,443 patients. Total dairy product (ES = -0.03; 95% CI [-0.04, -0.01]) and cheese (ES = -0.04; 95% CI [-0.07, -0.01]) consumption were weak, but significantly associated with lower PWV levels. Conversely, milk intake showed no significant association with PWV (ES = 0.02; 95% CI [-0.01, 0.05]). Heterogeneity in the ES was not important for the three groups of dairy products assessed. This systematic review and meta-analysis of seven studies found no detrimental effects of dairy product consumption on arterial stiffness measured by PWV. Due to the scarcity of studies, further investigations are warranted to clarify the role of dairy products on arterial stiffness

Background: Evidence supports the relationship between pre-pregnancy body mass index (BMI) and gestational diabetes mellitus (GDM). However, the association between interpregnancy weight change (IPWC) and GDM in the subsequent pregnancy has been studied less. The purpose of this study was to conduct a systematic review and meta-analysis to synthesize evidence on the association between IPWC and GDM in the subsequent pregnancy. Methods: MEDLINE, EMBASE, Cochrane Library and Web of Science were searched from inception through 16 September 2019. The most adjusted relative risk (RR) or odds ratios (OR) and their corresponding 95% confidence intervals (CIs) reported by studies included were used. The ‘no weight change’ category defined by each study was used as the reference category. Findings: 13 articles were included in this systematic review and meta-analyses with a total sample of 529.080 women. The analyses showed higher risk of GDM in the subsequent pregnancy among women with interpregnancy weigh gain (OR = 1.56; 95% CI: 1.30-1.83; I2 = 82.30%; p =

ObjectiveTo test a physical activity intervention (MOVI-KIDS) on obesity indicators, physical fitness and blood pressure (BP) in children.MethodsA crossover randomised cluster trial was conducted, which comprised 1434 children (4–7 years old) from 21 schools in the provinces of Cuenca and Ciudad Real in the Castilla-La Mancha region of Spain. The intervention consisted of three 60 min sessions/week on weekdays between October 2013 and May 2014. Changes in anthropometric variables, physical fitness and BP parameters were measured. The analyses used were mixed regression models to adjust for baseline covariates under cluster randomisation.ResultsThere was no significant improvement in overweight/obesity with the intervention compared with the control group in both sexes. Further, the intervention did not alter other adiposity indicators or BP parameters. Improvements in cardiorespiratory fitness were seen in girls (1.19; 95% CI 0.31 to 2.08; p=0.008), but not in boys. Finally, there was an improvement in velocity/agility in both girls (−2.51 s; 95% CI −3.98 to −1.05; p=0.001) and boys (−2.35 s; 95% CI −3.71 to −0.98; p=0.001), and in muscular strength in both girls (0.66; 95% CI 0.03 to 1.28; p=0.038) and boys (1.26; 95% CI 0.03 to 1.28; pConclusionMOVI-KIDS was not successful in reducing the adiposity and maintained BP levels at previous healthy values in children. The intervention, however, showed significant improvements in cardiorespiratory fitness in girls, and muscular strength and velocity/agility in boys and girls.Trial registration numberNCT01971840; Post-results.

Objective. The aim of the study was to analyze the relationship between moderate-to-vigorous physical activity (MVPA) and insulin resistance (IR) in Spanish adults and to examine whether this relationship is mediated by abdominal obesity (waist circumference —WC). Methods. The cross-sectional study included 1162 healthy subjects belonging to the EVIDENT study (mean age 55.0±13.3 years; 61.8%women) from six different Spanish provinces. Moderate-to-vigorous physical activiity (MVPA) was measured objectively over 7 days using Actigraph accelerometers, collecting data in 60-second epochs, and retaining respondents with ≥4 valid days for the analysis. The homeostasis model of assessment (HOMA-IR) was used to determine IR, and its individual components – fasting glucose and insulin – were determined using standard protocols. Linear regressionmodelswere fitted according to Baron and Kenny's procedures for mediation analysis. Results. Fasting insulin and HOMA-IR levels were significantly worse in adults who spent fewer minutes in MVPA (first quartile ≤ 30.1 and 22.7 min/day in men and women, respectively) after adjusting for age, sex, smoking habits, drinking habits, accelerometer wear time, sedentary time, and Mediterranean diet adherence. However,when WC was added to the ANCOVA models as a covariate, the effects disappeared.Mediation analysis reported that WC acts as a fullmediator in the relationship between MVPA and IR (HOMA-IR and fasting insulin). Conclusion. These findings show that WC plays a pivotal role in the relationship between MVPA and IR, and therefore highlights that decreasing abdominal obesity might be considered as an intermediate outcome for evaluating interventions aimed at preventing diabetes mellitus., The Evident Group

Growing evidence has accumulated in recent years showing that movement behaviors have important implications for health in children, especially for cardiovascular health, whose risk factors could track from childhood to adulthood. However, these findings are mixed and inconsistent in children. The aim of this study was to examine the relationship between different movement behaviors (sedentary behavior, physical activity and sleep duration) and cardiometabolic risk in schoolchildren. The study shows cross-sectional results of baseline measurement from 146 Spanish schoolchildren, aged 8-to-11 years old, participating in the MOVI-2 study. Movement behaviors were determined using accelerometry combined with self-reported sleep time. Cardiometabolic risk was assessed using a validated metabolic syndrome index. Logistic regression analysis showed that higher levels of vigorous physical activity (OR = 0.110, p = 0.004) and sleeping more than 9 hours (OR = 0.269, p = 0.015) could be protective factors against metabolic syndrome risk in children. ANCOVA analysis showed associations between vigorous physical activity and waist circumference (p < 0.001), and sleep time with insulin resistance (p = 0.017) and lipid profile (p = 0.035). No association was observed between light and moderate physical activity, sedentary behavior and metabolic syndrome (index and components). No statistically significant differences were found for blood pressure and any of the movement behaviors. Our data suggest that both the amount of vigorous physical activity accumulated and sleep duration are independently associated with higher cardiometabolic risk in children.

To assess the effectiveness of insulin glargine 300 ui/ml (Gla-300) compared with insulin glargine 100 ui/ml (Gla-100) on reducing nocturnal hypoglycemia and improving glycemic control in type 1 and type 2 diabetes patients. We systematically searched in Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials until July 4th, 2018. This study was registered with PROSPERO (CRD42017080134). We included randomized clinical trials comparing Gla-300 versus Gla-100 reporting the rate ratio or number of events of nocturnal hypoglycemia and HbA1c levels percentage or mmol/mol−1. The main outcome was the incidence rate ratio (RR) of nocturnal hypoglycemia events. The heterogeneity of results across studies was assessed using the I2 statistic. Fixed- and random-effect models were used to estimate pooled RRs. Nine studies were included in the meta-analysis, including 3977 adult patients. Compared with Gla-100, the use of Gla-300 reduced confirmed nocturnal hypoglycemia [RR = 0.81 (0.69, 0.95)] and clinically significant nocturnal hypoglycemia [RR = 0.75 (0.63, 0.91)]. Reductions in clinically significant nocturnal hypoglycemia events [RR = 0.64 (0.42, 0.97)] in type 1 diabetes patients were found. A small decrease in HbA1c levels in favor of Gla-300 in the pooled sample was identified [ES = − 0.08 (95% CI − 0.14, − 0.01)]. The best current evidence indicates that Gla-300 reduces the incidence of nocturnal hypoglycemia with slight improvements in glycemic control compared with Gla-100 in both type 1 and type 2 diabetes adult patients.

To analyze the independent relationship between the risk of eating disorders and bone health and to examine whether this relationship is mediated by body composition and cardiorespiratory fitness (CRF). In this cross-sectional study, bone-related variables, lean mass, fat mass (by DXA), risk of eating disorders (SCOFF questionnaire), height, weight, waist circumference and CRF were measured in 487 university students aged 18–30 years from the University of Castilla-La Mancha, Spain. ANCOVA models were estimated to test mean differences in bone mass categorized by body composition, CRF or risk of eating disorders. Subsequently, linear regression models were fitted according to Baron and Kenny’s procedures for mediation analysis. The marginal estimated mean ± SE values of total body bone mineral density for the categories “no risk of eating disorders” and “risk of eating disorders” were 1.239 ± 0.126

We estimated the prevalence of underweight, overweight and obesity of children and adolescents from Castilla-La Mancha region (Spain), applying the new International Obesity Task Force (IOTF) 2012 criteria, and analysed differences in physical fitness components in relation to weight status. The sample was 2,330 schoolchildren aged 6–17 years. We measured height and weight, calculated body mass index (BMI) and assessed physical fitness using four tests included in the EUROFIT battery. Differences in physical fitness components across BMI categories, by sex, were calculated using ANOVA models. In children aged 6–11 years, 4.9 % were underweight, 26.7 % overweight and 11.0 % obese; in adolescents aged 12–17 years, 6.4 % were underweight, 16.7 % overweight and 5.8 % obese. Overall, overweight and obesity were associated with worse physical fitness but students in the underweight category did not score worse than their normal weight counterparts on fitness tests. Conclusion: Childhood obesity in Spain remains a public health problem. Our results show low physical fitness levels in overweight/obese children and adolescents and low levels of handgrip strength in underweight adolescents compared with normal weight subjects. Exercise programmes must be tailored to the specific needs of the subjects according to the different weight status.

The association between diet and obesity has been widely studied and it continues to be controversial; however, the extent to which cardiorespiratory fitness (CRF) acts as a confounder or mediator in this relation has not been analyzed. The aim of this study is to examine if the relation between diet and obesity is mediated by CRF. In this cross-sectional study, fat mass (by electronic bioimpedance) was measured in 320 schoolchildren, aged 9–11 years. Diet was measured through two computerised 24-h dietary recalls and CRF was assessed by the 20-m shuttle run test. Simple mediation analyses were fitted. CRF acts as a partial mediator in the negative relationship between dietary factors (energy intake/weight, carbohydrate intake/weight, protein intake/weight, and fat intake/weight) and fat mass. The percentage of mediation ranged from 24.3 to 33.2%. Thus, Spanish schoolchildren with higher levels of energy and macronutrients intake had lower adiposity levels, especially when they had good levels of CRF.

Sleep seems to have a significant influence on the metabolic syndrome (MetS). However, results in this association are still inconsistent in children. The aim of this study was to examine the influence of sleep characteristics in the MetS (index and factors) in Spanish children. Cross-sectional study including a sample of 210 children aged 8-to-11-years belonging to 20 schools from the province of Cuenca, Spain was conducted. Cardiometabolic risk and actigraphy sleep patterns were determined and analysed using correlation coefficients, ANCOVA models and a propensity score derivation model. Overall, children in the lower time in bed category and those who went to bed later (> 23:15h) showed worse values in the cardiometabolic profile and risk index. Differences were observed when the total time in bed was below 9h 15mins. Our study shows that short sleep duration could be a risk factor for cardiometabolic risk in children, and bedtime may independently influence this risk. In addition, our data suggests that children's sleep hygiene should be incorporated in parenting educational programs.

ObjectiveMuscular fitness levels have been associated with cardiometabolic risk in children, although whether body weight acts as a confounder or as an intermediate variable in this relationship remains controversial. The aim of this study was to examine whether the association between muscular fitness and cardiometabolic risk factors is mediated by body mass index (BMI).Design and methodsCross-sectional study using a sample of 1158 schoolchildren aged 8-11 years from the province of Cuenca, Spain. We measured anthropometrics and biochemical variables and we calculated a muscular fitness index as the sum of z-scores of handgrip dynamometry/weight and standing long jump, and we estimated a previously validated cardiometabolic risk index (CMRI). Linear regression models were fitted for mediation analysis to assess whether the association between muscular fitness and cardiometabolic risk was mediated by BMI.ResultsChildren with normal weight (NW) had a better cardiometabolic risk profile than their overweight (OW) or obese (OB) peers after controlling for muscular fitness. Marginal estimated mean ± SE values for NW, OW and OB categories of CMRI were -0.75 ± 0.06 < 0.84 ± 0.10 < 2.18 ± 0.16 in boys and -0.73 ± 0.06 < 0.96 ± 0.10 < 2.71 ± 0.17 in girls, both p < 0.001. Children with higher levels of muscular fitness had a better cardiometabolic risk profile (CMRI marginal estimated mean ± SE 1.04 ± 0.13 > 0.05 ± 0.09 >-1.16 ± 0.13 for lower, middle and upper quartiles of muscular fitness in boys and 1.01 ± 0.16 > 0.10 ± 0.09 > -1.02 ± 0.15 in girls, both p < 0.001), but differences disappeared when controlling for BMI. BMI acted as a full mediator between muscular fitness and most cardiometabolic risk factors (Sobel test z = -11.44 for boys; z = -11.83 for girls; p < 0.001 in CMRI mediation model) and as a partial mediator in the case of waist circumference (Sobel test z=-14.86 for boys; z=-14.51 for girls; pConclusionsBMI mediates the association between muscular fitness and cardiometabolic risk in schoolchildren. Overall, good muscular fitness is associated with lower cardiometabolic risk, but particularly when accompanied by normal weight.

Background The prevalence of high blood pressure in children is increasing worldwide, largely, but not entirely, driven by the concurrent childhood obesity epidemic. The aims of this study were to examine the prevalence of prehypertension and hypertension in 4-to-6-year-old Spanish schoolchildren, and to evaluate the association between different blood pressure (BP) components with different adiposity indicators. Methods Cross-sectional study including a sample of 1.604 schoolchildren aged 4-to-6-years belonging to 21 schools from the provinces of Ciudad Real and Cuenca, Spain. We measured height, weight, body mass index (BMI), fat mass percentage (%FM), triceps skinfold thickness (TST), waist circumference (WC), systolic and diastolic BP, mean arterial pressure and pulse pressure. Results The estimates of prevalence of prehypertension and hypertension were 12.3% and 18.2%, respectively. In both sexes, adiposity indicators were positively and significantly associated with all BP components (p

OBJECTIVE The relationship between cardiorespiratory fitness (CRF) and metabolic syndrome (MetS) is well known, although the extent to which body weight may act as a confounder or mediator in this relationship is uncertain. The aim of this study was to examine whether the association between CRF and cardiometabolic risk factors is mediated by BMI. RESEARCH DESIGN AND METHODS A cross-sectional study including 1,158 schoolchildren aged 8–11 years from the province of Cuenca, Spain, was undertaken. We measured height, weight, waist circumference (WC), blood pressure, fasting plasma lipid profile and insulin, and CRF (20-m shuttle run test). A validated cardiometabolic risk index was estimated by summing standardized z scores of WC, log triglyceride-to-HDL cholesterol ratio (TG/HDL-c), mean arterial pressure (MAP), and log fasting insulin. To assess whether the association between CRF and cardiometabolic risk was mediated by BMI, linear regression models were fitted according to Baron and Kenny procedures for mediation analysis. RESULTS In girls, BMI acts as a full mediator in the relationship between CRF and cardiometabolic risk factors, with the exception of log TG/HDL-c ratio. In boys, BMI acts as a full mediator in the relationship between CRF and both log TG/HDL-c ratio and MAP, and as a partial mediator in the relationship between CRF and cardiometabolic risk factors. CONCLUSIONS BMI mediates the association between CRF and MetS in schoolchildren. Overall, good levels of CRF are associated with lower cardiometabolic risk, particularly when accompanied by weight reduction.

The prevention of obesity and improvement of academic achievement in children are concerns of industrialized societies. Obesity has been associated with psychological disorders, including attention deficit hyperactivity disorder, whose prevalence has been estimated at 6.8 % in Spanish children and adolescents. It is known that physical activity is positively related to academic achievement and negatively related to the risk of obesity in children. However, studies to test the effectiveness of physical activity interventions in improving academic achievement in preschool children are scarce and have some weaknesses that threaten their validity. Moreover, very few studies have examined their effectiveness in improving symptoms of attention deficit hyperactivity disorder. This paper outlines a two-year multidimensional preschool intervention (Movi-Kids) aimed at preventing obesity and improving academic achievement in children with or without attention deficit hyperactivity disorder. Twenty-one schools from Ciudad Real and Cuenca, Spain, were randomized to intervention and control groups. In the first academic year, children in the third grade of preschool and the first grade of primary school in the intervention group received the Movi-Kids intervention. In the second academic year, schools were crossed over to the other group. The intervention included children, parents and teachers, and the school environment, and consisted of: (i) three hour-long sessions of recreational non-competitive physical activity after school, weekly, (ii) educational materials for parents and teachers addressing sedentary lifestyle risks and (iii) playground modifications to promote physical activity during breaks. Primary outcome measures of this study were academic achievement (intelligence, cognition, memory, attention and perception), assessed by the Battery of General and Differential Aptitudes, and adiposity measures (body mass index, waist circumference, triceps skinfold thickness and body fat percentage). Secondary outcome measures were: attention deficit hyperactivity disorder risk, motor skills, health-related quality of life and sleep quality. These variables will all be measured in both groups at baseline and at the end of the first and second academic years. It seems reasonable that an intervention to promote physical activity based on playground games will be useful for simultaneously improving academic achievement and controlling obesity. ClinicalTrials.gov NCT01971827 .