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The secreted protein form of the α-klotho gene, S-klotho, is gaining popularity as a predictor of overall morbimortality, and its role in dialysis patients has been recently highlighted. However, physical performance -which can be assessed through practical field-tests- might be a more practical prognostic marker. The present study aimed to analyze the relationship between physical performance, plasma S-klotho and all-cause mortality in this population. 30 male hemodialysis patients (71 ± 9 years) participated in this prospective, cohort study. Their plasma S-klotho levels and physical performance (assessed by means of the 6-minute walk test [6MWT], handgrip strength, and the sit-to-stand test [STS]) were determined at baseline, and the incidence of mortality was assessed 18-month later. Lower S-klotho levels were associated with a worse performance in all physical tests (all p < 0.05). 12 participants died during the 18 months following baseline measurements. An increased mortality risk was observed in those patients with a worse performance in the STS (RR: 3.0 [95%CI: 1.01-8.95], p < 0.05), the handgrip test (RR: 3.0 [95%CI: 1.01-8.95], p < 0.05) and the 6MWT (RR: 5.0 [95%CI: 1.31-19.07], p < 0.01), being the latter the best predictor of mortality. By contrast, this relationship was not found for plasma S-klotho (RR: 1.6 [95%CI: 0.65-1.35], p > 0.05). In summary, low plasma S-klotho levels are related to impaired physical performance in male dialysis patients. However, physical performance appears as a better and more practical predictor of mortality in this patient population. Sin financiación 4.032 JCR (2020) Q2, 23/53 Geriatrics & Gerontology 1.173 SJR (2020) Q2, 16/35 Aging No data IDR 2020 UEM

ObjectivesTo assess the influence of muscle power and adiposity on all-cause mortality risk and to evaluate the ‘fat but powerful’ (F+P) (or ‘fat but fit’) paradox in older adults.MethodsA total of 2563 older adults (65‒91 years old) from the EXERNET multicentre study were included. Adiposity (body mass index (BMI), waist circumference, body fat percentage (BF%) and fat index), allometric and relative power (sit-to-stand muscle power test) and various covariates (age, sex, hypertension, smoking status and walking and sitting times per day) were registered at baseline. All-cause mortality was recorded during a median follow-up of 8.9 years. Participants were classified into four groups: lean and powerful (L+P), F+P, lean but weak and fat and weak (F+W). Cox proportional hazard regression models and adjusted HRs were calculated.ResultsAccording to BMI and waist circumference, all-cause mortality risk was reduced in the F+P (HR=0.55 and 0.63, p=0.044 and 0.049, respectively) and L+P (HR=0.57 and 0.58, p=0.043 and 0.025, respectively) groups. According to BF%, all-cause mortality decreased in the L+P group (HR=0.53; p=0.021), and a trend for a reduction was reported in the F+P group (HR=0.57; p=0.060). According to fat index, a survival benefit was only noted in the L+P group (HR=0.50; p=0.049). Higher levels of relative power reduced all-cause mortality risk among older people (HR=0.63 and 0.53, p=0.006 and 0.011, respectively).ConclusionPowerful older people exhibited a reduced 9-year all-cause mortality regardless of BMI, waist circumference and BF%. Obesity according to fat index blunted the survival benefits of being powerful.

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.

ObjectivesTo assess the influence of muscle power and adiposity on all-cause mortality risk and to evaluate the ‘fat but powerful’ (or ‘fat but fit’) paradox in older adults.MethodsA total of 2563 older adults (65‒91 years old) from the EXERNET Multi-center study were included. Adiposity (body mass index (BMI), waist circumference, body fat percentage (BF%) and fat index), allometric and relative power (sit-to-stand muscle power test) and various covariates (age, sex, hypertension, smoking status, and walking and sitting times per day) were registered at baseline. All-cause mortality was recorded during a median follow-up of 8.9 years. Participants were classified into four groups: lean and powerful (L+P), fat but powerful (F+P), lean but weak (L+W) and fat and weak (F+W). Cox proportional hazard regression models and adjusted hazard ratios (HR) were calculated.ResultsAccording to BMI and waist circumference, all-cause mortality risk was reduced in the F+P (HR=0.55 and 0.63, respectively; p≤0.049) and L+P (HR=0.57 and 0.58, respectively; p≤0.043) groups. According to BF%, all-cause mortality decreased in the L+P group (HR=0.53; p=0.021), and a trend for a reduction was reported in the F+P group (HR=0.57; p=0.060). According to fat index, a survival benefit was only noted in the L+P group (HR=0.50; p=0.049). Higher levels of relative power reduced all-cause mortality risk among older people (HR=0.63 and 0.53, respectively; p≤0.011).ConclusionPowerful older people exhibited a reduced 9-year all-cause mortality regardless of BMI, waist circumference and BF%. Obesity according to fat index blunted the survival benefits of being powerful.

A Follow-up of vitamin B12 and lipids status is essential in older people, being closely related to non-communicable diseases. Their relationships with cognitive and physical status are not clear. The aim was to analyze the evolution of vitamin B12 and related parameters, lipid and hematological profiles, and their relationships with cognitive and physical status among institutionalized elderly. Sixty residents, ranged from 62 to 99, were evaluated. Biomarkers (vitamin B12 and related parameters, lipid and hematological profiles), functional capacity (handgrip, arm and leg strength), and cognitive status (Mini-Mental State Examination) were evaluated four times at 4-month intervals. At the beginning of the study, 63% and 70% of the sample showed abnormal homocysteine and folate values, respectively. At the end of the year, abnormal homocysteine increased to 68%, abnormal folate values decreased to 50%. Throughout the year, serum folate showed a significant increase (14.9 vs. 16.3 nmol/L), (p &lt, 0.05). Serum cobalamin (299 vs. 273 pmol/L). HDL-cholesterol (49.9 vs. 47.0 mg/dL) and triglyceride levels (102.4 vs. 123.2 mg/dL) showed a significant decrease and increase respectively in mean values (all p &lt, 0.05). Serum cobalamin and HDL-cholesterol were the most important biomarkers associated with cognitive function (both p &lt, 0.05). The most relevant biomarkers associated with poor physical strength depending on the body part analyzed were low concentrations of HDL-cholesterol, LDL-cholesterol, apolipoprotein A1, and albumin (all p &lt, 0.05). The evolution of lipid biomarkers, their significance with cognitive values, and association with handgrip, point to the importance of the handgrip measurement, a very simple test, as an important health marker. Both serum albumin and physical strength are important health markers in older people.

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.

Aging is associated with the impairment of health and functional capacity, and physical exercise seems to be an effective tool in frailty prevention and treatment. The purpose of this study was to present the methodology used in the EXERNET-Elder 3.0 project that aims to evaluate the immediate and residual effects and of a multicomponent exercise training program called Elder-fit on frailty, fitness, body composition and quality of life, and also to analyse a possible dietary intake interaction according to health and metabolic status. A total of 110 frail and pre-frail elders participated in this study and were divided into a control group (CG = 52) and an intervention group (IG = 58). The IG performed a supervised multicomponent exercise training program of 6 months and 3 days per week, which included strength, endurance, balance, coordination and flexibility exercises, while the CG continued with their usual daily activities. Both groups received four speeches about healthy habits along the project. Four evaluations were performed: at baseline, after 3 months of training, at the end of the training program (6 months) and 4 months after the program had ended to examine the effects of detraining. Evaluating the efficacy, safety and feasibility of this program will help to develop efficacious physical interventions against frailty. Further, protocols should be described accurately to allow exercise programs to be successfully replicated.

On behalf of the HELENA Study Group., The aim was to investigate whether there was an association between amino acid (AA) intake and physical fitness and if so, to assess whether this association was independent of carbohydrates intake. European adolescents (n = 1481, 12.5–17.5 years) were measured. Intake was assessed via two non-consecutive 24-h dietary recalls. Lower and upper limbs muscular fitness was assessed by standing long jump and handgrip strength tests, respectively. Cardiorespiratory fitness was assessed by the 20-m shuttle run test. Physical activity was objectively measured. Socioeconomic status was obtained via questionnaires. Lower limbs muscular fitness seems to be positively associated with tryptophan, histidine and methionine intake in boys, regardless of centre, age, socioeconomic status, physical activity and total energy intake (model 1). However, these associations disappeared once carbohydrates intake was controlled for (model 2). In girls, only proline intake seems to be positively associated with lower limbs muscular fitness (model 2) while cardiorespiratory fitness seems to be positively associated with leucine (model 1) and proline intake (models 1 and 2). None of the observed significant associations remained significant once multiple testing was controlled for. In conclusion, we failed to detect any associations between any of the evaluated AAs and physical fitness after taking into account the effect of multiple testing., The HELENA study took place with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT: 2005-007034).

This study aims to examine the validity and reliability of the Elderly EXERNET Physical Activity Questionnaire (EEPAQ) in a sample of Spanish elderly population. A sample of 73 elderly successfully completed the EEPAQ and wore an accelerometer over 7 consecutive days. Test-retest reliability of the EEPAQ was assessed by having the participants answer the EEPAQ twice within 14 days. Criterion validity was assessed for the questionnaire against the accelerometer, as the gold standard. Results indicated that EEPAQ had adequate reliability measured by Intraclass correlation coefficient (ICC) (walking ICC=0.88; sitting ICC=0.68; household activities ICC=0.97), and good validity against the accelerometer. Walking had a significant (p

Older adults spend most of their waking hours performing sedentary activities. The influence of these lifestyle patterns on the physical fitness (PF) levels of this population has not yet been sufficiently investigated.The aim of the study was to examine whether sedentary behavior (SB) (h•d-1sitting) is associated with PF, and specifically to analyze whether sitting4 h•d-1 is associated with higher risk of having lower levels of fitness in seniors.EXERNET multi-center study.A representative sample of 3136 non-institutionalized elderly (aged 72.2±5.3 years), from 6 Regions of Spain were included in the study.PF was assessed using 8 different tests from the EXERNET battery. Lifestyle patterns were collected using a validated questionnaire. ANOVA was used to compare the groups according to the hours of sitting. Binary logistic regression was used to calculate the association between the SB and low levels of fitness.For both genders, those who spent sitting4 h•d-1 had lower levels of balance, agility, walking speed and aerobic endurance (p0.001). Sedentary men also had less strength of lower extremities (p0.05), whereas, sedentary women were less flexible in the lower extremities (p0.001). More than 4 h•d-1 sitting was associated, in men, to higher odds for having low strength (lower extremities), agility, flexibility (lower extremities) and aerobic endurance (p0.05); and in women, to higher risk of low balance, strength (lower and upper extremities), flexibility (lower extremities), agility, walking speed and aerobic endurance (p0.05).Seniors that sit4 h•d-1 have lower levels of fitness and this behavior is related with an increased risk of having low levels of PF in this population.

Objective: To assess the relationship between fitness levels and components, sitting time and health-related quality of life (HRQoL), over time among community-dwelling older adults. Methods: Three different sitting trajectories were calculated: (i) no change; (ii) decrease; and (iii) increase in ST, between baseline and follow-up. Fitness was assessed using the aerobic capacity, upper and lower limb strength, and total fitness. Participants were classified into higher (75th percentile or above) or lower (below 75th percentile) fitness levels, using the fitness tests. HRQoL scores at follow-up were compared to the three different sitting time trajectories within and across both the higher and the lower fitness groups for each of the three fitness indexes. Results: Greater HRQoL scores were observed in those participants that decreased their ST as compared with those increasing their sitting time over time for participants classified in the lower end of their aerobic capacity or total fitness index. No differences were detected in HRQoL scores in people classified in the higher fitness level group for any of the fitness indexes. Participants that increased or did not change their sitting time and who were classified in the higher fitness end of aerobic capacity and total fitness index self-reported higher HRQoL scores when compared with those in the lower fitness end. Conclusion: Increased sitting time over time is associated with poorer HRQoL in older adults. Higher fitness levels could help attenuate the negative impact of sitting over time.

[Purpose]: To examine the adherence to the Mediterranean dietary pattern (MDP) in metabolically healthy overweight or obese (MHO) and metabolically unhealthy obese (MUO) European adolescents., [Methods]: In this cross-sectional study, 137 overweight/obese adolescents aged 12–17 years old from the HELENA study were included. Height, weight, waist circumference and skinfold thickness were measured and body mass index and body fat percent were calculated. Systolic and diastolic blood pressure, glucose, HDL cholesterol, triglycerides and cardiorespiratory fitness (20 m shuttle run test) were measured. MHO and MUO phenotypes were categorized following the Jolliffe and Janssen criteria. Two non-consecutive 24 h recalls were used for dietary intake assessment and the adherence to the MDP was calculated using the Mediterranean dietary pattern score (MDP score) (range 0–9)., [Results]: A total of 45 (22 girls) adolescents (32.8%) were categorized as MHO. The adherence to the MDP was significantly higher in MHO than in MUO adolescents regardless of age, sex, body fat percentage, energy intake and center (MDP score: 4.6 ± 1.6 vs. 3.9 ± 1.5, p = 0.036), but this difference became non-significant after further adjustment for cardiorespiratory fitness. Participants who had a low adherence to the MDP (MDP score ≤ 4) had a higher likelihood of having MUO phenotype regardless of sex, age, energy intake, center and body fat percentage (OR 2.2; 95% CI 1.01–4.81, p = 0.048)., [Conclusions]: Adherence to the MDP might be beneficial to maintain metabolic health in overweight/obese adolescents, yet cardiorespiratory fitness seems to play a key role on the metabolic phenotype., The HELENA project was supported by the European Community Sixth RTD Framework Programme (contract FOODCT-2005-007034), by the Education Department of the Government of the Basque Country (PRE_2016_1_0057, PRE_2017_2_0224), by the Spanish Ministry of Science and Innovation (RYC-2011-09011), by the University of the Basque Country (GIU14/21), and by the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES). Furthermore, the current study was supported by the Spanish Ministry of Health (CIBERobn CB12/03/30038).

On behalf of the HELENA study group: et al., [Objectives]: To determine dietary patterns (DPs) and explain the highest variance of vitamin B6, folate, and B12 intake and related concentrations among European adolescents., [Methods]: A total of 2173 adolescents who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence study met the eligibility criteria for the vitamin B intake analysis (46% boys) and 586 adolescents for the biomarkers analysis (47% boys). Two non-consecutive, 24-h, dietary recalls were used to assess the mean intakes. Concentrations were measured by chromatography and immunoassay testing. A reduced rank regression was applied to elucidate the combined effect of food intake of vitamin B and related concentrations., [Results]: The identified DPs (one per vitamin B intake and biomarker and by sex) explained a variability between 34.2% and 23.7% of the vitamin B intake and between 17.2% and 7% of the biomarkers. In the reduced rank regression models, fish, eggs, cheese, whole milk and buttermilk intakes were loaded positively for vitamin B intake in both sexes; however, soft drinks and chocolate were loaded negatively. For the biomarkers, a higher variability was observed in the patterns in terms of food loads such as alcoholic drinks, sugars, and soft drinks. Some food items were loaded differently between intakes and biomarkers such as fish products, which was loaded positively for intakes but negatively for plasma folate in girls., [Conclusions]: The identified DPs explained up to 34.2% and 17.2% of the variability of the vitamin B intake and plasma concentrations, respectively, in European adolescents. Further studies are needed to elucidate the factors that determine such patterns., HELENA study received funding from the European Union’s Sixth RTD Framework Programme (Contract FOODCT-2005-007034). Additional support from the Spanish Ministry of Education (AGL2007-29784-E/ALI), Axis-Shield Diagnostics Ltd (Oslo, Norway), Abbot Científica S.A. (Spain). This analysis was also supported by the Spanish Ministry of Science and Innovation (JCI-2010-07055) with the contribution of the European Regional Development Fund (FEDER). The first author is supported by a grant from the Spanish Carlos III Health Institute: RD08/0072/0025 (Red SAMID: Maternal, Child Health and Development Research Network).

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.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.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 grater than 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 less than 0,05).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.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.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.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 mayor de 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 menor de 0,05).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.

To investigate the association between physical fitness, obesity, health related quality of life (HRQoL) and sleep disturbance in 463 community-dwelling older Spanish women (66-91 years of age).Cross-sectional study.Sleep disturbance was assessed with the Jenkins Sleep Scale. Active and sedentary behaviors were recorded by standardized questionnaires. HRQoL was assessed with the EuroQoL-5D. Anthropometric measurements were obtained using standardized techniques. Body fat was measured using bioelectrical impedance. Physical fitness was evaluated by a set of eight tests.Sleep disturbance was reported by 45.1% of women, being associated with higher body mass index (p 0.05) and waist circumference (p 0.01). Presence of insomnia was inversely associated with physical fitness. Women in the upper tertile of fitness index had 92.0% lower risk of sleep disturbance as compared to the lower tertile (p = 0.08), while women in the highest tertile of upper body strength had 76.4% lower risk of sleep disturbance as compared to the lower tertile (p 0.05). Women without sleep disturbance showed better HRQoL.Sleep disturbance was associated with central obesity, lower physical fitness and reduced HRQoL. Interventions involving weight management and improvement of physical fitness may contribute to better sleep quality in older women.

Aim The present cross-sectional study aimed at assessing muscle strength of hands, the dominant arm and legs in Spanish institutionalized elderly people according to sex, age and cognitive status. Methods A total of 153 elderly subjects (102 females, 51 males, mean age 83.6 ± 6.8 years) living in the region of Madrid were measured for handgrip strength (kg) with a Takei TKK 5101 digital dynamometer (range 5–100 kg, precision 0.1 kg), and arm and leg endurance strength (repetitions) according to the Rikli and Jones tests. Cognitive status was determined with the Mini-Mental State Examination (MMSE). Results The values for men and women were, respectively: 23.5 ± 7.3 kg and 11.6 ± 4.6 kg (right handgrip), 22.0 ± 7.8 kg and 10.7 ± 4.8 kg (left handgrip), 13 ± 5 and 10 ± 5 repetitions (arm strength), 8 ± 5 and 5 ± 4 repetitions (legs strength), and 21 ± 6 and 17 ± 7 (MMSE score). All parameters were significantly higher for men (P ≤ 0.01), but strength decline with age was less pronounced in women. In all MMSE groups, lower strength was associated with lower cognitive status. Conclusions Strength values were lower in older subjects in both sexes; this difference was higher in men than in women. Higher strength values were associated with better cognitive status, which was the most influencing variable, even more than sex and age. Geriatr Gerontol Int 2013; 13: 1026–1034.

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.

Backgroud Several lifestyle-related behaviors are associated with cardiovascular health outcomes in adolescents. To examine the associations between clustered lifestyle-related behaviors and blood pressure (BP) levels in adolescents. Methods Participants were recruited by multistage random cluster in two cross-sectional studies; one conducted in 2006 and 2007 in ten cities from nine European countries: Athens and Heraklion in Greece, Dortmund in Germany, Ghent in Belgium, Lille in France, Pecs in Hungary, Rome in Italy, Stockholm in Sweden, Vienna in Austria, and Zaragoza in Spain; and another conducted in 2007 one city in Brazil (Maringa/PR). Systolic BP (SBP) and diastolic BP (DBP) (outcomes) and clustered behaviors (weekly consumption of fruits and vegetables, weekly consumption of sugar-sweetened beverages, sleep duration, screen time and physical activity) were analyzed. Results The Healthy Eating cluster was negatively associated with DBP in European girls, β = − 2.46 (− 4.62; − 0.30), and with SBP in Brazilian boys, β = − 2.79 (− 3.10; − 0.15). Furthermore, the Unhealthy Eating cluster was associated with increased SBP in European girls, β = 4.54 (1.29; 7.79), and in Brazilian boys, β = 4.10 (0.80; 7.40). Conclusion The Healthy Eating cluster was associated with lower blood pressure, whereas the Unhealthy Eating cluster was associated with increased SBP in adolescents.

Coupled with the growth of the older population, an increase in the prevalence of overweight and obesity in this age group has occurred in the last decades. The main aims of the present study were (i) to provide an updated prevalence of overweight and obesity in a representative sample of the Spanish elderly population; (ii) to calculate the prevalence of sarcopenic obesity (SO) and (iii) to analyse the relationships between adiposity measurements and lifestyle. A cross-sectional study was carried out in a sample of 3136 persons representative of the non-institutionalized population ≥65 years of age. Anthropometric measurements were obtained using standardized techniques and equipment. Overall, 84% of the population can be categorized as overweight and/or obese. The present study indicates that 67% of the Spanish elderly population has an increased percentage of fat mass and more than 56% suffer from central obesity. Moreover, SO is present in 15% of the Spanish elderly population. Finally, a strong relationship between both physically active and sedentary lifestyles and the level of adiposity was found. Prevalence of overweight and obesity among elderly people in Spain is very high and is still increasing. Lifestyle seems to be a determinant factor in the development of obesity among elderly people.

To investigate the associations between body composition, fitness level, and urinary incontinence (UI) in 471 non-institutionalized women ≥ 65 years of age.Cross-sectional study.UI was assessed using the International Consultation on Incontinence Questionnaire Short-Form and a specific severity UI item. Anthropometric measurements were obtained using standardized techniques and equipment. Body fat percentage (BF%) was measured by bioelectrical impedance. Physical fitness (PF) was evaluated by a set of 8 tests and a fitness index (FI) was calculated. Active and sedentary behaviors were recorded by standardized questionnaires.UI was reported in 28.5% of the participants. Women with UI showed higher values of body mass index (BMI), BF% and waist circumference (WC) (all p0.05) compared to urinary continent women, whereas there was a lower fitness index (FI) level in women with UI (p=0.08). Among all fitness capacities, upper body flexibility showed the closest relationship with UI. UI risk increased by 87.0% [95% confidence intervals (1.01-3.17)] in obese women compared to the normal group, according to the BF% while no significant results were found when PF, WC and BMI were included in the model. Mean sitting and walking time per day were 4.3±1.4 and 1.8±0.9 h/d, respectively.UI was associated with an excess of fat mass and poor PF, especially upper-body flexibility.

The objective measurement of human movement and the quantification of energy expenditure due to physical activity is an identified need in both research and the clinical setting. Validated and well-defined reference methods (double labelled water, direct calorimetry, indirect calorimetry) are expensive and mostly limited to the laboratory setting. Therefore, in the last years, several objective measurement devices have been developed which are appropriate for field studies and clinical settings. There is no gold standard among them, as all have limitations. Pedometers are small, non-expensive, count the steps taken and give information on total physical activity, but not about physical activity patterns and behaviour. Accelerometers are expensive, save information about frequency and intensity of physical activity, but not about type of physical activity. Both pedometers and accelerometers only save information about lower body movement, but reliability about the estimation of energy expenditure is limited. Heart rate monitoring relates intensity to energy expenditure, but gives no information about physical activity. GPS watches are portable, relatively inexpensive, non-invasive and provide distance, speed, and elevation with exact time and location, but are maybe limited for the assessment of brief higher speed movement and energy expenditure. Combined motion sensors combine accelerometry with the measurement of physiological variables and share advantages of single devices and are more precise. Manufacturer software which applies activity-specific algorithms for the calculation of energy expenditure can affect energy expenditure results. Most of the devices estimate energy expenditure more accurately at light to moderate intensities; underestimation increases at very light and higher intensity activities.La medición objetiva del movimiento humano y la cuantificación del gasto energético debido a la actividad física es una necesidad identificada tanto en investigación como en clínica. Los métodos de referencia validados y bien definidos (el agua doblemente marcada, la calorimetría directa, la calorimetría indirecta) son caros y prácticamente se limitan a la investigación en el laboratorio. Por lo tanto, en los últimos años, se han desarrollado diferentes dispositivos de medición objetiva que son apropiados para los estudios de campo y clínicos. No hay ningún estándar de oro entre ellos, ya que todos tienen limitaciones. Los podómetros son ligeros, poco costosos, cuentan los pasos y aportan información sobre la actividad física total, pero no sobre el comportamiento y los patrones de actividad física. Los acelerómetros son caros, aportan información sobre patrón, frecuencia e intensidad de la actividad física, pero no sobre el tipo de actividad física. Los podómetros y acelerómetros únicamente recogen información sobre el movimiento del movimiento corporal, pero la validez en la estimación del gasto energético es limitada. La monitorización de la frecuencia cardíaca relaciona intensidad del ejercicio con gasto de energía, pero no aporta información sobre la actividad física. Los dispositivos GPS son portátiles, relativamente asequibles, no invasivos y recogen distancia, velocidad y elevación con hora y lugar exactos, pero quizás estén limitados para la evaluación de movimientos cortos de alta intensidad y elevado gasto energético. Los dispositivos de última generación combinan acelerometría con la medición de variables fisiológicas, comparten las ventajas de los dispositivos individuales y son más precisos. Para el cálculo del gasto energético se aplican algoritmos específicos de la actividad incluidos en el software del fabricante que pueden afectar a los resultados. La mayoría de los dispositivos estiman con mayor precisión el gasto energético a intensidades ligeras y moderadas, pero subestiman el gasto a intensidades muy ligeras y de mayor intensidad.

Traditionally, biomarkers have been of interest in sports in order to measure performance, progress in training and for identifying overtraining. During the last years, growing interest is set on biomarkers aiming at evaluating health-related aspects which can be modulated by regular physical activity and sport. The value or concentration of a biomarker depends on many factors, as the training status of the subject, the degree of fatigue and the type, intensity and duration of exercise, apart from age and sex. Most of the biomarkers are measured in blood, urine and saliva. One of the main limitations for biochemical biomarkers is that reference values for blood concentration of biomarkers specifically adapted to physically active people and athletes are lacking. Concentrations can differ widely from normal reference ranges. Therefore, it is important to adapt reference values as much as possible and to control each subject regularly, in order to establish his/her own reference scale. Other useful biomarkers are body composition (specifically muscle mass, fat mass, weight), physical fitness (cardiovascular capacity, strength, agility, flexibility), heart rate and blood pressure. Depending on the aim, one or several biomarkers should be measured. It may differ if it is for research purpose, for the follow up of training or to prevent risks. For this review, we will get deeper into the biomarkers used to identify the degree of physical fitness, chronic stress, overtraining, cardiovascular risk, oxidative stress and inflammation.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.

The aim of this study was to analyze the usefulness of different fitness test to detect the risk of sarcopenic obesity (SO) in octogenarian people.306 subjects (76 men, 230 women) with a mean age of 82.5 ± 2.3 years from the Multi-center EXERNET Project sample fulfilled the inclusion criteria. Body composition was assessed in all subjects by bioelectrical impedance. Four groups were created based on the percentage of fat mass and muscle mass: 1) normal, 2) high fat mass, 3) low muscle mass and 4) SO. Physical fitness was assessed using 8 different tests modified from the batteries “Senior Fitness Test” and Eurofit (EXERNET battery). The risk of suffering SO depending on the fitness level was studied by logistic regression.Among the studied physical fitness tests, those that better predicted the risk of SO were leg strength, arm strength, agility, walking speed and balance in men; 95% CI [(0.606-0.957) (0.496-0.882), (0.020-2.014), (0.17-1.39), (0.913-1.002), all p0.05, except balance test (p = 0.07)] and balance test and agility in women; (95% CI [(0.928-1.002) (0.983-1.408), (both p = 0.07)].Adequate levels of physical fitness are associated with a lower risk of SO. Some easy fitness tests seem to be useful for the detection of SO in those cases where the body-composition required methods for diagnosis are not available.Objetivo: El objetivo de este estudio fue analizar la utilidad de diferentes test de condición física para detectar el riesgo de sufrir obesidad sarcopénica (OS) en octogenarios. Métodos: 306 sujetos (76 hombres, 230 mujeres) con una media de edad de 82,5±2,3 años, del total de la muestra del Proyecto Multi-céntrico EXERNET cumplieron con los criterios de inclusión. La composición corporal se evaluó en todos los sujetos mediante impedancia bioeléctrica. Se crearon 4 grupos basados en el porcentaje de masa grasa y masa muscular: 1) normal, 2) elevada masa grasa, 3) baja masa muscular y 4) OS. La condición física fue evaluada utilizando 8 test diferentes adaptados de las baterías “Senior Fitness Test” y “Eurofit” (batería EXERNET). La probabilidad de padecer OS en función del nivel de condición física se estudió mediante regresión logística. Resultados: Entre las pruebas de condición física estudiadas, los test que mejor predecían el riesgo de sufrir OS fueron la falta de fuerza de piernas, fuerza de brazos, agilidad, velocidad y equilibrio en hombres; 95% CI [(0,606-0,957); (0,496-0,882); (1,116-3,636); (1,060-1,825); (0,913-1,002); todos p.

Erratum to: Foods contributing to vitamin B6, folate, and vitamin B12 intakes and biomarkers status in European adolescents: The HELENA study : The HELENA study (Eur J Nutr, 10.1007/s00394-016-1221-1)

Objectives To examine the independent and combined association of physical activity (PA) and sedentary behavior (SB) on both systolic (SBP) and diastolic blood pressure (DBP) in adolescents from two observational studies. Methods Participants from two cross-sectional studies, one conducted in Europe (n = 3,308; HELENA study) and the other in Brazil (n = 991; BRACAH study), were selected by complex sampling. Systolic and diastolic blood pressure (outcomes), PA and SB, both independently and combined, and potential confounders were analyzed. Associations were examined by multilevel linear regression. Results Performing the recommended amount of PA (≥60 min/d) attenuated the effect of SB on DBP in BRACAH study girls and in boys from both studies. In contrast, PA did not attenuate the effects of SB on the SBP of girls in the HELENA study. The combination of less than recommended levels of PA with 2–4 h/d of sedentary behavior was found to be associated with increased SBP in boys from both studies. Conclusions Meeting current PA recommendations could mediate the association between SB and DBP in both sexes. In boys, the joint effect of low levels of PA and excessive sedentary activity increases SBP levels. Longitudinal studies are required to confirm these findings., The HELENA Study takes place with the financial support of the European Community Sixth RTD Framework Programme (contract FOOD-CT-2005-007034).

9 páginas,1 figura, 4 tablas, BACKGROUND/OBJECTIVES: To assess dietary patterns (DPs) in European adolescents and to examine their relationship with several indicators of sedentary behaviour. SUBJECTS/METHODS: A multinational cross-sectional study was carried out in 2202 adolescents (45.4% boys) aged 12.5¿17.5 years. A self-reported questionnaire with information on sedentary behaviours, separately for weekdays and weekend days, and two non-consecutive 24 h-recalls were used. Principal component analysis was used to obtain DPs, and linear regression examined the association between DPs scores and sedentary behaviour. RESULTS: Four DPs for boys (`plant based¿, `snacking¿, `breakfast¿ and `health conscious¿) and five DPs for girls (`confectionary and snacking¿, `plant based¿, `breakfast¿, `animal protein¿ and `health conscious¿) were obtained. Boys who spent 44 h/day watching television (TV) had lower adherence to the `plant based¿, `breakfast¿ and `health conscious¿ DPs, and higher adherence to the `snacking¿ DP. Higher computer use and internet use for recreational reason were associated with higher adherence to the `snacking¿ DP. In girls, TV viewing and using internet for recreational reasons for 44 h/day was associated with higher adherence to the `confectionary and snacking¿ and lower adherence with `health conscious¿ DP. Also, studying between 2 and 4 h during weekend days was associated with lower adherence to the `snacking¿ and with higher adherence to the `plant based¿ and `breakfast¿ DPs. CONCLUSION: Adolescents¿ DPs are related with the time spent in several sedentary behaviours. Such findings may help to generate interventions focusing on decreasing unhealthy dietary habits and specific sedentary behaviours.

The present cross-sectional study aimed at assessing muscle strength of hands, the dominant arm and legs in Spanish institutionalized elderly people according to sex, age and cognitive status.A total of 153 elderly subjects (102 females, 51 males, mean age 83.6 ± 6.8 years) living in the region of Madrid were measured for handgrip strength (kg) with a Takei TKK 5101 digital dynamometer (range 5-100 kg, precision 0.1 kg), and arm and leg endurance strength (repetitions) according to the Rikli and Jones tests. Cognitive status was determined with the Mini-Mental State Examination (MMSE).The values for men and women were, respectively: 23.5 ± 7.3 kg and 11.6 ± 4.6 kg (right handgrip), 22.0 ± 7.8 kg and 10.7 ± 4.8 kg (left handgrip), 13 ± 5 and 10 ± 5 repetitions (arm strength), 8 ± 5 and 5 ± 4 repetitions (legs strength), and 21 ± 6 and 17 ± 7 (MMSE score). All parameters were significantly higher for men (P ≤ 0.01), but strength decline with age was less pronounced in women. In all MMSE groups, lower strength was associated with lower cognitive status.Strength values were lower in older subjects in both sexes; this difference was higher in men than in women. Higher strength values were associated with better cognitive status, which was the most influencing variable, even more than sex and age.

Background: Cobalamin deficiency is a common problem in the elderly. There is no consensus about adequate doses for supplementation. Subjects/Methods: We performed an intervention study in order to establish the efficacy of a supplement providing 500 µg cyanocobalamin for four weeks in sixty-four institutionalized elderly residents, over 60 years of age, in Madrid (Spain). Before and after treatment, concentrations of serum cobalamin, serum holotranscobalamin, serum total homocysteine, and serum and red blood cell folate were analyzed. Clusters were built according to the initial cobalamin status and differences in the effect of supplementation were checked using a general linear model for repeated measures. Results: Cobalamin and holotranscobalamin increased highly significantly from 308 to 558 pmol/L and from 54 to 96 pmol/L (p < 0.001) in the whole study group as well as in each subgroup (clustered by initial cobalamin levels, all p < 0.01), with the highest relative change in the subgroup with the lowest initial cobalamin values. Total homocysteine decreased from 15 to 13 µmol/l, p < 0.001). Only the change of cobalamin (F = 4.61, p < 0.01), but not of holotranscobalamin nor total homocysteine, depended on the initial serum cobalamin status. Conclusions: A supplementation with an oral supplement solution of 500 µg cyanocobalamin daily for only four weeks, a shorter period than that found in former studies, may be considered suitable in institutionalized elderly.

a b s t r a c t Introduction: Obesity, defined as an excess of total body fat, is a matter of concern all over the world, and its prevalence is still increasing among elderly people. Objectives: To examine whether sedentary behaviour (hours sitting per day) is associated with higher risk of central obesity, overweight-obesity and overfat in a representative sample of non-institutionalized Spanish elderly population and if so, whether hours walking per day modified this association. Study design: A cross-sectional study in a sample of 3136 people ≥65 years of age. Main outcomes measures: Anthropometric measurements were obtained using standardized techniques and equipment. Active and sedentary behaviours were recorded by questionnaire. Results: For both men and women, the higher prevalence of overweight-obesity, central obesity and overfat was found in those who spent sitting more than 4 h per day and walk less than 1 h, compared with those who spent sitting less than 4 h per day and walk more than 1 h (all p < 0.001, except for central obesity in women). In men, more than 4 h sitting per day was associated with 1.7-fold higher odds of having central obesity compared with those sitting less than 4 h per day (p < 0.01). In women, this sedentary behaviour increased the risk of overweight-obesity and overfat by 1.5 and 1.4, respectively (p < 0.01). Age or time spent walking did not significantly change these results. Conclusion: Sitting time increases the risk of overweight-obesity and overfat in women and the risk of central obesity in men, independently of walking time. © 2012 Elsevier Ireland Ltd. All rights reserved.

Background: Physical fitness is gaining in importance in all population groups, including elderly, but data are still scarce. The aim of this study was to report gender and age specific physical fitness levels in non-institutionalized Spanish elderly. Methods: A representative sample of 3136 elderly (≥65 y), 724 men and 2412 women, from 6 Regions of Spain: Madrid, Aragon, Castilla y Leon, Castilla-La Mancha, Extremadura and Canarias were assessed in the elderly EXERNET multi-center study between 2008 and 2009. The authors assessed static balance, muscular strength, flexibility, agility, walking speed and cardiorespiratory fitness using eight different fitness tests: one leg balance, chair stand, arm curl, chair sit-and-reach, back scratch, 8-foot up-and-go, 30-m walk, and 6 min walk tests. Results: The authors derived gender and age-specific normative values for physical fitness in the non-institutionalized Spanish elderly. The figures showed greater physical fitness in the elderly men than in women, except for the flexibility test, and a trend toward decreased physical fitness in both genders as their age increased. Conclusions: The normative values hereby provided will enable evaluation and correct interpretation of independent non-institutionalized Spanish elderly fitness status.