Background:A shift from self-reports to wearable sensors for global physical activity(PA)surveillance has been recommended.The conventional use of a generic cut-point to assess moderate-to-vigorous PA(MVPA)is problema...Background:A shift from self-reports to wearable sensors for global physical activity(PA)surveillance has been recommended.The conventional use of a generic cut-point to assess moderate-to-vigorous PA(MVPA)is problematic as these cut-points are often derived from non-representative samples under non-ecological laboratory conditions.This study aimed to develop age-and sex-(age-sex)specific cut-points for MVPA based on population-standardized values as a feasible approach to assess the adherence to PA guidelines and to investigate its associations with all-cause mortality.Methods:A total of 7601 participants(20-85+years)were drawn from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Surveys(NHANES).Minutes per week of MVPA were assessed with a hip-worn accelerometer.Counts per minute(CPM)were used to define an age-sex specific target intensity,representing the intensity each person should be able to reach based on their age and sex.Age-sex specific MVPA cut-points were defined as any activity above 40%of the target intensity.These population-and free-living-based age-sex specific cut-points overcome many of the limitations of the standard generic cut-point approach.For comparison,we also calculated MVPA with a generic cut-point of 1952 CPM.Both approaches were compared for assessing adherence to PA guidelines and association of MVPA with allcause mortality(ascertained through December 2015).Results:Both approaches indicated that 37%of the sample met the 150+min/week guideline.The generic cut-point approach showed a trend to inactivity with age,which was less pronounced using the age-sex specific cut-points.Overall mortality rates were comparable using generic cutpoint(hazard ratio(HR)=0.61,95%confidence interval(95%CI):0.50-0.73)or age-sex specific cut-points(HR=0.57,95%CI:0.50-0.66)for the entire sample.The generic cut-point method revealed an age-and sex-related gap in the benefits of achieving 150+min/week of MVPA,with older adults showing an 18%greater reduction in mortality rates than younger adults,and a larger difference in women than in men.This disparity disappeared when using age-sex specific cut-points.Conclusion:Our findings underscore the value of age-sex specific cut-points for global PA surveillance.MVPA defined with age-sex specific thresholds was associated with all-cause mortality and the dose-response was similar for all ages and sexes.This aligns with the single recommendation of accumulating 150+min/week MVPA for all adults,irrespective of age and sex.This study serves as a proof of concept to develop this methodology for PA surveillance over more advanced open-source acceleration metrics and other national and international cohorts.展开更多
Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and wide...Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.展开更多
Background:Cardiorespiratory fitness(CRF)is a powerful health marker recommended by the American Heart Association as a clinical vital sign.Comparing the predictive validity of objectively measured CRF(the"gold s...Background:Cardiorespiratory fitness(CRF)is a powerful health marker recommended by the American Heart Association as a clinical vital sign.Comparing the predictive validity of objectively measured CRF(the"gold standara")and estimated CRF is clinically relevant because estimated CRF is more feasible.Our objective was to meta-analyze cohort studies to compare the associations of objectively measured,exerciseestimated,and non-exercise-estimated CRF with all-cause and cardiovascular disease(CVD)mortality in adults.Methods:Systematic searches were conducted in 9 databases(MEDLINE,SPORTDiscus,Embase,Scopus,PsycINFO,Web of Science,PubMed,CINAHL,and the Cochrane Library)up to April 11,2024.We included full-text refereed cohort studies published in English that quantified the association(using risk estimates with 95%confidence intervals(95%CIs))of objectively measured,exercise-estimated,and non-exercise-estimated CRF with all-cause and CVD mortality in adults.CRF was expressed as metabolic equivalents(METs)of task.Pooled relative risks(RR)for all-cause and CVD mortality per 1-MET(3.5 mL/kg/min)higher level of CRF were quantified using random-effects models.Results:Forty-two studies representing 35 cohorts and 3,813,484 observations(81%male)(362,771 all-cause and 56,471 CVD deaths)were included.The pooled RRs for all-cause and CVD mortality per higher MET were 0.86(95%CI:0.83-0.88)and 0.84(95%CI:0.80-0.87),respectively.For both all-cause and CVD mortality,there were no statistically significant differences in RR per higher MET between objectively measured(RR range:0.86-0.90)and maximal exercise-estimated(RR range:0.85-0.86),submaximal exercise-estimated(RR range:0.91-0.94),and non-exercise-estimated CRF(RR range:0.81-0.85).Conclusion:Objectively measured and estimated CRF showed similar dose-response associations for all-cause and CVD mortality in adults.Estimated CRF could provide a practical and robust alternative to objectively measured CRF for assessing mortality risk across diverse populations.Our findings underscore the health-related benefits of higher CRF and advocate for its integration into clinical practice to enhance risk stratification.展开更多
Background:Physicalfitness in childhood and adolescence is associated with a variety of health outcomes and is a powerful marker of current and future health.However,inconsistencies in tests and protocols limit interna...Background:Physicalfitness in childhood and adolescence is associated with a variety of health outcomes and is a powerful marker of current and future health.However,inconsistencies in tests and protocols limit international monitoring and surveillance.The objective of the study was to seek international consensus on a proposed,evidence-informed,Youth Fitness International Test(YFIT)battery and protocols for health monitoring and surveillance in children and adolescents aged 618 years.Methods:We conducted an international modified Delphi study to evaluate the level of agreement with a proposed,evidence-based,YFIT of core health-relatedfitness tests and protocols to be used worldwide in 6-to 18-year-olds.This proposal was based on previous European and North American projects that systematically reviewed the existing evidence to identify the most valid,reliable,health-related,safe,and feasiblefitness tests to be used in children and adolescents aged 618 years.We designed a single-panel modified Delphi study and invited 216 experts from all around the world to answer this Delphi survey,of whom one-third are from low-to-middle income countries and one-third are women.Four experts were involved in the piloting of the survey and did not participate in the main Delphi study to avoid bias.We pre-defined an agreement of 80%among the expert participants to achieve consensus.Results:We obtained a high response rate(78%)with a total of 169fitness experts from 50 countries and territories,including 63 women and 61 experts from low-or middle-income countries/territories.Consensus(>85%agreement)was achieved for all proposed tests and protocols,supporting the YFIT battery,which includes weight and height(to compute body mass index as a proxy of body size/composition),the 20-m shuttle run(cardiorespiratoryfitness),handgrip strength,and standing long jump(muscularfitness).Conclusion:This study contributes to standardizingfitness tests and protocols used for research,monitoring,and surveillance across the world,which will allow for future data pooling and the development of international and regional sex-and age-specific reference values,health-related cut-points,and a global picture offitness among children and adolescents.展开更多
Background Low-intensity resistance training(LI-RT)combined with blood flow restriction(BFR)is an alternative to traditional moderate-high-intensity resistance training to increase strength and muscle mass.However,the...Background Low-intensity resistance training(LI-RT)combined with blood flow restriction(BFR)is an alternative to traditional moderate-high-intensity resistance training to increase strength and muscle mass.However,the evidence about the efficacy of this novel training method to increase strength and muscle mass in healthy and older adults with patholo-gies is limited.Furthermore,the possible risk and adverse effects with BFR training methodology in older adults should be considered.Objectives(1)To summarize the current evidence on training with BFR strategies in older adults aiming to improve strength and to increase muscle mass;and(2)to provide recommendations for resistance and aerobic training with BFR in older adults based on the studies reviewed.Methods Studies that investigated the chronic responses to resistance training or aerobic training with BFR related to strength and muscle mass changes in older adults were identified.Two independent researchers conducted the search in PubMed,Web of Science,and Google Scholar databases from their inception up to November 1,2018.Results Seventeen out of 35 studies,which performed resistance or aerobic training with BFR in older adults focused on strength and muscle mass outcomes,were included in this review.Studies performing resistance and aerobic train-ing with BFR found better improvements in strength and higher increase in muscle mass compared to non-BFR groups that performed the same training protocol.High-intensity resistance training(HI-RT)without BFR provided greater improvements in strength and a similar increase in muscle mass compared to light-intensity resistance training(LI-RT)with BFR.Conclusions Current evidence suggests that LI-RT and/or aerobic training with BFR improves strength and increases muscle mass in older people.Light-intensity training without BFR would normally not obtain such benefits.Therefore,LI-RT and aerobic training with BFR is an alternative to traditional methods to improve strength and by way of an increase in muscle mass,which are important in the elderly who have progressive muscle atrophy and are at higher risk of falls.展开更多
基金supported in part by the intramural research programs at the National Institute on Aging and National Cancer Institute(USA)supported by the Spanish Ministry of Science,Innovation and Universities under Beatriz Galindo's 2022 fellowship program(BG22/00075).
文摘Background:A shift from self-reports to wearable sensors for global physical activity(PA)surveillance has been recommended.The conventional use of a generic cut-point to assess moderate-to-vigorous PA(MVPA)is problematic as these cut-points are often derived from non-representative samples under non-ecological laboratory conditions.This study aimed to develop age-and sex-(age-sex)specific cut-points for MVPA based on population-standardized values as a feasible approach to assess the adherence to PA guidelines and to investigate its associations with all-cause mortality.Methods:A total of 7601 participants(20-85+years)were drawn from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Surveys(NHANES).Minutes per week of MVPA were assessed with a hip-worn accelerometer.Counts per minute(CPM)were used to define an age-sex specific target intensity,representing the intensity each person should be able to reach based on their age and sex.Age-sex specific MVPA cut-points were defined as any activity above 40%of the target intensity.These population-and free-living-based age-sex specific cut-points overcome many of the limitations of the standard generic cut-point approach.For comparison,we also calculated MVPA with a generic cut-point of 1952 CPM.Both approaches were compared for assessing adherence to PA guidelines and association of MVPA with allcause mortality(ascertained through December 2015).Results:Both approaches indicated that 37%of the sample met the 150+min/week guideline.The generic cut-point approach showed a trend to inactivity with age,which was less pronounced using the age-sex specific cut-points.Overall mortality rates were comparable using generic cutpoint(hazard ratio(HR)=0.61,95%confidence interval(95%CI):0.50-0.73)or age-sex specific cut-points(HR=0.57,95%CI:0.50-0.66)for the entire sample.The generic cut-point method revealed an age-and sex-related gap in the benefits of achieving 150+min/week of MVPA,with older adults showing an 18%greater reduction in mortality rates than younger adults,and a larger difference in women than in men.This disparity disappeared when using age-sex specific cut-points.Conclusion:Our findings underscore the value of age-sex specific cut-points for global PA surveillance.MVPA defined with age-sex specific thresholds was associated with all-cause mortality and the dose-response was similar for all ages and sexes.This aligns with the single recommendation of accumulating 150+min/week MVPA for all adults,irrespective of age and sex.This study serves as a proof of concept to develop this methodology for PA surveillance over more advanced open-source acceleration metrics and other national and international cohorts.
基金supported by European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement(No.101028929)BJFis supported by National Heart Foundation of Australia Postdoc-toral Fellowship(No.106588)+1 种基金BG is supported by Australian Government Research Training Program ScholarshipDPLis supported by Clive Kearon Award,McMaster University.Additional funding information can be found in Supplemen-tary Funding.
文摘Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.
基金supported by a grant from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska Curie(Grant agreement No.101028929)supported by an Investigator Grant from the Medical Research Future Fund(MRF1193862)supported by an Australian Government Research Training Program Scholarship.
文摘Background:Cardiorespiratory fitness(CRF)is a powerful health marker recommended by the American Heart Association as a clinical vital sign.Comparing the predictive validity of objectively measured CRF(the"gold standara")and estimated CRF is clinically relevant because estimated CRF is more feasible.Our objective was to meta-analyze cohort studies to compare the associations of objectively measured,exerciseestimated,and non-exercise-estimated CRF with all-cause and cardiovascular disease(CVD)mortality in adults.Methods:Systematic searches were conducted in 9 databases(MEDLINE,SPORTDiscus,Embase,Scopus,PsycINFO,Web of Science,PubMed,CINAHL,and the Cochrane Library)up to April 11,2024.We included full-text refereed cohort studies published in English that quantified the association(using risk estimates with 95%confidence intervals(95%CIs))of objectively measured,exercise-estimated,and non-exercise-estimated CRF with all-cause and CVD mortality in adults.CRF was expressed as metabolic equivalents(METs)of task.Pooled relative risks(RR)for all-cause and CVD mortality per 1-MET(3.5 mL/kg/min)higher level of CRF were quantified using random-effects models.Results:Forty-two studies representing 35 cohorts and 3,813,484 observations(81%male)(362,771 all-cause and 56,471 CVD deaths)were included.The pooled RRs for all-cause and CVD mortality per higher MET were 0.86(95%CI:0.83-0.88)and 0.84(95%CI:0.80-0.87),respectively.For both all-cause and CVD mortality,there were no statistically significant differences in RR per higher MET between objectively measured(RR range:0.86-0.90)and maximal exercise-estimated(RR range:0.85-0.86),submaximal exercise-estimated(RR range:0.91-0.94),and non-exercise-estimated CRF(RR range:0.81-0.85).Conclusion:Objectively measured and estimated CRF showed similar dose-response associations for all-cause and CVD mortality in adults.Estimated CRF could provide a practical and robust alternative to objectively measured CRF for assessing mortality risk across diverse populations.Our findings underscore the health-related benefits of higher CRF and advocate for its integration into clinical practice to enhance risk stratification.
基金supported by the Grant PID2020-120249RB-I00PID2023-148404OB-100funded by MCIN/AEI/10.13039/501100011033+4 种基金by the Andalusian Government(Junta de Andalucía,Plan Andaluz de Investigación,ref.P20_00124)by the Erasmus+Sport Programme of the European Union within the project FitBack4Literacy(No.101089829)Additional support is provided by the University of Granada,Plan Propio de Inves-tigación,Units of ExcellenceUnit of Excellence on Exercise,Nutrition and Health(UCEENS)by theCIBERobn Physiopa-thology of Obesity and Nutrition,and by the Spanish Network in Exercise and Health,EXERNET Network(RED2022-134800-Tand EXP_99828).
文摘Background:Physicalfitness in childhood and adolescence is associated with a variety of health outcomes and is a powerful marker of current and future health.However,inconsistencies in tests and protocols limit international monitoring and surveillance.The objective of the study was to seek international consensus on a proposed,evidence-informed,Youth Fitness International Test(YFIT)battery and protocols for health monitoring and surveillance in children and adolescents aged 618 years.Methods:We conducted an international modified Delphi study to evaluate the level of agreement with a proposed,evidence-based,YFIT of core health-relatedfitness tests and protocols to be used worldwide in 6-to 18-year-olds.This proposal was based on previous European and North American projects that systematically reviewed the existing evidence to identify the most valid,reliable,health-related,safe,and feasiblefitness tests to be used in children and adolescents aged 618 years.We designed a single-panel modified Delphi study and invited 216 experts from all around the world to answer this Delphi survey,of whom one-third are from low-to-middle income countries and one-third are women.Four experts were involved in the piloting of the survey and did not participate in the main Delphi study to avoid bias.We pre-defined an agreement of 80%among the expert participants to achieve consensus.Results:We obtained a high response rate(78%)with a total of 169fitness experts from 50 countries and territories,including 63 women and 61 experts from low-or middle-income countries/territories.Consensus(>85%agreement)was achieved for all proposed tests and protocols,supporting the YFIT battery,which includes weight and height(to compute body mass index as a proxy of body size/composition),the 20-m shuttle run(cardiorespiratoryfitness),handgrip strength,and standing long jump(muscularfitness).Conclusion:This study contributes to standardizingfitness tests and protocols used for research,monitoring,and surveillance across the world,which will allow for future data pooling and the development of international and regional sex-and age-specific reference values,health-related cut-points,and a global picture offitness among children and adolescents.
基金supported by a grant from the Spanish Ministry of Economy,Industry and Competitiveness(BES-2014-068829)supported by the Spanish Min istry of Education,Culture and Sport(FPU 16/02760,FPU15/02645,and FPU14/06837,respectively)+7 种基金supported by a grant from the Spanish Ministry of Science,Innovation and Universities(RYC-2011-09011)supported by a grant from the Alicia Kop lowitz Foundationsupported by the National Operational Programme on Youth EmploymentAdditional support was obtained from the Scientific Excellence Unit on Exercise and Health(UCEES)EXERNET Research Network on Exercise and Health in Spe-cial Populations(DEP2005-00046/ACTI)funded by the University of Granada,Research and Knowledge Transfer Fund 2016,Excellence actions:Scientific Units of Excel-lenceUnit of Excellence on Exercise and Health(UCEES)by the Andalusian Regional Government,Consejeria de Conocimiento,Investigacion y Universidades and European Regional Development Fund(ERDF),ref.SOMM17/6107/UGR.
文摘Background Low-intensity resistance training(LI-RT)combined with blood flow restriction(BFR)is an alternative to traditional moderate-high-intensity resistance training to increase strength and muscle mass.However,the evidence about the efficacy of this novel training method to increase strength and muscle mass in healthy and older adults with patholo-gies is limited.Furthermore,the possible risk and adverse effects with BFR training methodology in older adults should be considered.Objectives(1)To summarize the current evidence on training with BFR strategies in older adults aiming to improve strength and to increase muscle mass;and(2)to provide recommendations for resistance and aerobic training with BFR in older adults based on the studies reviewed.Methods Studies that investigated the chronic responses to resistance training or aerobic training with BFR related to strength and muscle mass changes in older adults were identified.Two independent researchers conducted the search in PubMed,Web of Science,and Google Scholar databases from their inception up to November 1,2018.Results Seventeen out of 35 studies,which performed resistance or aerobic training with BFR in older adults focused on strength and muscle mass outcomes,were included in this review.Studies performing resistance and aerobic train-ing with BFR found better improvements in strength and higher increase in muscle mass compared to non-BFR groups that performed the same training protocol.High-intensity resistance training(HI-RT)without BFR provided greater improvements in strength and a similar increase in muscle mass compared to light-intensity resistance training(LI-RT)with BFR.Conclusions Current evidence suggests that LI-RT and/or aerobic training with BFR improves strength and increases muscle mass in older people.Light-intensity training without BFR would normally not obtain such benefits.Therefore,LI-RT and aerobic training with BFR is an alternative to traditional methods to improve strength and by way of an increase in muscle mass,which are important in the elderly who have progressive muscle atrophy and are at higher risk of falls.
