Barriers and facilitators for physical activity in rheumatic and musculoskeletal disease: a European-based survey.

Physical activity (PA) is a key strategy for improving symptoms in people with rheumatic and musculoskeletal diseases (RMDs). The aim of this study was to investigate and rank the importance of known barriers and facilitators for engaging in PA, from the perspective of people living with RMD. Five hundred thirty-three people with RMD responded to a survey (nine questions) disseminated by the People with Arthritis and Rheumatism (PARE) network of the European Alliance of Associations for Rheumatology (EULAR). The survey required participants to rank - based on their perceived importance - known PA barriers and facilitators from the literature, and specifically RMD symptoms as well as healthcare and community factors that may affect PA participation. Of the participants, 58% reported rheumatoid arthritis as their primary diagnosis, 89% were female, and 59% were between 51 and 70 years of age. Overall, participants reported fatigue (61.4%), pain (53.6%) and painful/swollen joints (50.6%) as the highest ranked barriers for engaging in PA. Conversely, less fatigue (66.8%) and pain (63.6%), and being able to do daily activities more easy (56.3%) were identified as the most important facilitators to PA. Three literature identified PA barriers, i.e., general health (78.8%), fitness (75.3%) and mental health (68.1%), were also ranked as being the most important for PA engagement. Symptoms of RMDs, such as pain and fatigue, seem to be considered the predominant barriers to PA by people with RMD; the same barriers are also the ones that they want to improve through increasing PA, suggesting a bi-directional relationship between these factors. Key Points • Symptoms of rheumatic and musculoskeletal disease (RMD) are the predominant barriers for lack of physical activity engagement. • RMD symptoms are the factors that people with RMDs want to improve when engaging in PA. • The barriers that stop people living with RMDs to do more PA are the ones that can be significantly improved through PA engagement.

The effects of exercise on cardiovascular disease risk factors and cardiovascular physiology in rheumatoid arthritis.

Cardiovascular disease (CVD) morbidity and mortality is highly prevalent in patients with rheumatoid arthritis (RA) with debilitating effects for the individual as well as significant healthcare impact. Current evidence demonstrates that engaging in aerobic and resistance exercise (i.e. structured physical activity) can significantly improve patient-reported and clinical index-assessed outcomes in RA. In addition to this, engagement in exercise programmes improves, in a dose-dependent manner, the risk of developing CVD as well as CVD symptoms and outcomes. The present narrative review uses evidence from systematic reviews and meta-analyses as well as controlled trials, to synthesize the current state-of-the-art on the potential effects of aerobic and resistance exercise on CVD risk factors as well as on cardiac and vascular function and structure in people with RA. Where there is a lack of evidence in RA to explain potential mechanisms, relevant studies from the general population are also discussed and linked to RA.

Genetic variation in Wnt/ß-catenin and ER signalling pathways in female and male elite dancers and its associations with low bone mineral density: a cross-section and longitudinal study.

The association of genetic polymorphisms with low bone mineral density in elite athletes have not been considered previously. The present study found that bone mass phenotypes in elite and pre-elite dancers are related to genetic variants at the Wnt/ß-catenin and ER pathways. INTRODUCTION: Some athletes (e.g. gymnasts, dancers, swimmers) are at increased risk for low bone mineral density (BMD) which, if untreated, can lead to osteoporosis. To investigate the association of genetic polymorphisms in the oestrogen receptor (ER) and the Wnt/ß-catenin signalling pathways with low BMD in elite and pre-elite dancers (impact sport athletes). METHODS: The study included three phases: (1) 151 elite and pre-elite dancers were screened for the presence of low BMD and traditional osteoporosis risk factors (low body weight, menstrual disturbances, low energy availability); (2) a genetic association study was conducted in 151 elite and pre-elite dancers and age- and sex- controls; (3) serum sclerostin was measured in 101 pre-elite dancers and age- and sex-matched controls within a 3-year period. RESULTS: Eighty dancers revealed low BMD: 56.3% had at least one traditional osteoporosis risk factor, whereas 28.6% did not display any risk factor (37.2% revealed traditional osteoporosis risk factors, but had normal BMD). Body weight, menstrual disturbances and energy availability did not fully predict bone mass acquisition. Instead, genetic polymorphisms in the ER and Wnt/ß-catenin pathways were found to be risk factors for low BMD in elite dancers. Sclerostin was significantly increased in dancers compared to controls during the 3-year follow-up (p < 0.05). CONCLUSIONS: Elite and pre-elite dancers demonstrate high prevalence of low BMD, which is likely related to genetic variants at the Wnt/ß-catenin and ER pathways and not to factors usually associated with BMD in athletes (body weight, menstrual disturbances, energy deficiency).

Leg-Length in Relation to Selected Ballet Performance Indicators.

It is unclear whether the modern ballet body stereotype of long limbs is advantageous in dance performance. Therefore, we investigated the relationship between leg-length and selected dance movements representative of power, dexterity, and range of motion in ballet dancers at different competence levels. METHODS: The total of 10 recreational, 24 vocational, and 10 professional ballerinas volunteered. They were subjected to: a) lower limb-length measurements, b) power tests (vertical jump-sautés and unilateral countermovement jump-temps levé), c) dexterity tests (tendus and double battement frappes), and d) flexibility tests (lateral active and passive-développé à la seconde). RESULTS: For power, regression analyses revealed negative leg-length relationships in recreational dancers (p<0.05) and positive leg-length relationships in vocational dancers (p<0.05). We also found negative relationships between leg-length and dexterity in the vocational group (p=0.01). No significant predictions of leg-length on power, dexterity, and range of motion were found in professional dancers. Multiple comparisons revealed significant differences between groups only for dexterity (p<0.01) and range of motion (p<0.01). CONCLUSION: Based on selected movements representative of power, dexterity, and range of motion, the present exploratory data indicate that lower limb length is not a determinative criterion for ballet success. Further studies should investigate whether body stereotypes, such as long limbs, are linked to dance injuries.

Bone mineral density in vocational and professional ballet dancers.

According to existing literature, bone health in ballet dancers is controversial. We have verified that, compared to controls, young female and male vocational ballet dancers have lower bone mineral density (BMD) at both impact and non-impact sites, whereas female professional ballet dancers have lower BMD only at non-impact sites. INTRODUCTION: The aims of this study were to (a) assess bone mineral density (BMD) in vocational (VBD) and professional (PBD) ballet dancers and (b) investigate its association with body mass (BM), fat mass (FM), lean mass (LM), maturation and menarche. METHODS: The total of 152 VBD (13 ± 2.3 years; 112 girls, 40 boys) and 96 controls (14 ± 2.1 years; 56 girls, 40 boys) and 184 PBD (28 ± 8.5 years; 129 females, 55 males) and 160 controls (27 ± 9.5 years; 110 female, 50 males) were assessed at the lumbar spine (LS), femoral neck (FN), forearm and total body by dual-energy X-ray absorptiometry. Maturation and menarche were assessed via questionnaires. RESULTS: VBD revealed lower unadjusted BMD at all anatomical sites compared to controls (p < 0.001); following adjustments for Tanner stage and gynaecological age, female VBD showed similar BMD values at impact sites. However, no factors were found to explain the lower adjusted BMD values in VBD (female and male) at the forearm (non-impact site), nor for the lower adjusted BMD values in male VBD at the FN. Compared to controls, female PBD showed higher unadjusted and adjusted BMD for potential associated factors at the FN (impact site) (p < 0.001) and lower adjusted at the forearm (p < 0.001). Male PBD did not reveal lower BMD than controls at any site. CONCLUSIONS: Both females and males VBD have lower BMD at impact and non-impact sites compared to control, whereas this is only the case at non-impact site in female PBD. Maturation seems to explain the lower BMD at impact sites in female VBD.

Functional responses of uremic single skeletal muscle fibers to redox imbalances.

BACKGROUND: The exact causes of skeletal muscle weakness in chronic kidney disease (CKD) remain unknown with uremic toxicity and redox imbalances being implicated. To understand whether uremic muscle has acquired any sensitivity to acute redox changes we examined the effects of redox disturbances on force generation capacity. METHODS: Permeabilized single psoas fibers (N =37) from surgically induced CKD (UREM) and sham-operated (CON) rabbits were exposed to an oxidizing (10 mM Hydrogen Peroxide, H2O2) and/or a reducing [10 mM Dithiothreitol (DTT)] agent, in a blind design, in two sets of experiments examining: A) the acute effect of the addition of H2O2 on maximal (pCa 4.4) isometric force of actively contracting fibers and the effect of incubation in DTT on subsequent re-activation and force recovery (N =9 CON; N =9 UREM fibers); B) the effect of incubation in H2O2 on both submaximal (pCa 6.2) and maximal (pCa 4.4) calcium activated isometric force generation (N =9 CON; N =10 UREM fibers). RESULTS: Based on cross-sectional area (CSA) calculations, a 14 % atrophy in UREM fibers was revealed; thus forces were evaluated in absolute values and corrected for CSA (specific force) values. A) Addition of H2O2 during activation did not significantly affect force generation in any group or the pool of fibers. Incubation in DTT did not affect the CON fibers but caused a 12 % maximal isometric force decrease in UREM fibers (both in absolute force p =0.024, and specific force, p =0.027). B) Incubation in H2O2 during relaxation lowered subsequent maximal (but not submaximal) isometric forces in the Pool of fibers by 3.5 % (for absolute force p =0.033, for specific force p =0.019) but not in the fiber groups separately. CONCLUSIONS: Force generation capacity of CON and UREM fibers is affected by oxidation similarly. However, DTT significantly lowered force in UREM muscle fibers. This may indicate that at baseline UREM muscle could have already been at a more reduced redox state than physiological. This observation warrants further investigation as it could be linked to disease-induced effects. HIPPOKRATIA 2017, 21(1): 3-7.

Exercise and exposure to heat following bovine colostrum supplementation: a review of gastrointestinal and immune function.

Colostrum is the first milk produced by mammalian mothers and is essential for the health and survival of the newborn. Bovine colostrum (BC) has greater concentrations of the bioactive components (i.e. immune and growth factors) than those found in human colostrum. As a result, BC supplementation has been recently adopted by many sport competitors as a means of enhancing immune function as well as improving performance. Improvements in physical performance associated with BC supplementation may stem from the ability of BC to maintain gastrointestinal (GI) integrity by decreasing GI permeability. During exercise in the heat, blood flow to the GI tract is reduced that leads to endotoxin leakage into circulation. Endotoxins, such as lipopolysaccharide, can trigger an inflammatory cascade leading to physiological strain that, in turn, increases heat storage and decreases time to exhaustion. GI permeability is lessened during passive heat stress following BC supplementation, but the influence of BC supplementation on GI function during exercise heat stress remains to be determined. The implications of endotoxemia during exercise in the heat is a matter of growing importance and warrants further study given the global increase in ambient temperatures during sport competitions.

A single bout of downhill running transiently increases HOMA-IR without altering adipokine response in healthy adult women.

PURPOSE: Eccentric exercise-induced muscle damage may cause marked alterations in insulin sensitivity. However, it is not entirely known whether such alterations are also related to changes in adipokine levels. The aim of this study was to investigate the effects of muscle damage due to downhill running on inflammation, insulin sensitivity and selected adipokines related to insulin regulation (adiponectin, visfatin, resistin). METHODS: Data were collected from 12 healthy adult women. Each subject participated in two trials, 4 weeks apart. The first trial was reserved for resting measurements only (control trial), while the second trial involved a 45-min exercise (-15 % slope, ~60 % of VO2max) intervention (exercise trial). Insulin sensitivity (HOMA), creatine kinase activity (CK), delayed onset muscle soreness (DOMS), tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), glucose, insulin, adiponectin, resistin, and visfatin were assessed pre-exercise and 1, 2, 3, and 4 days post-exercise and during the same time points in the control trial. RESULTS: Analyses revealed that CK, DOMS, TNF-α, IL-6, insulin and HOMA significantly increased (p < 0.05) throughout recovery (days 1-4). Adiponectin and visfatin remained unchanged, while resistin significantly increased (p < 0.05) only 2 days post-exercise. Visfatin was negatively correlated with HOMA at days 1 and 4 of recovery. CONCLUSION: Although muscle damage due to downhill running caused a decline of insulin sensitivity, this response was not associated with the changes in adipokine levels.

No adverse effects of statins on muscle function and health-related parameters in the elderly: an exercise study.

The aim of the present study was to investigate the effects of a repeated bout of eccentric exercise on health-related parameters and muscle performance on subjects undergoing atorvastatin therapy. Twenty-eight elderly men participated in the investigation and were assigned either in a control (n = 14) or in a statin therapy group (n = 14). All participants performed two isokinetic eccentric exercise bouts separated by 3 weeks. Muscle damage indices, resting energy expenditure, substrate metabolism, lipid and lipoprotein profile, as well as insulin sensitivity, were evaluated before and after eccentric. No differences in muscle function were observed between the two groups either at rest or after exercise. Eccentric exercise increased resting energy expenditure, increased fat oxidation, improved lipid profile, and increased insulin resistance 2 days after both eccentric exercise bouts. However, these changes appeared to lesser extent after the second bout. No differences were observed in the responses in the health-related parameters in the control and in the statin therapy group. Eccentric exercise affected similarly the control and the atorvastatin-treated individuals. The present results indicate that atorvastatin-treated elderly individuals may participate in various physical activities, even high-intensity muscle-damaging activities, without negative impact on muscle function and adaptation.

Time motion and video analysis of classical ballet and contemporary dance performance.

Video analysis has become a useful tool in the preparation for sport performance and its use has highlighted the different physiological demands of seemingly similar sports and playing positions. The aim of the current study was to examine the performance differences between classical ballet and contemporary dance. In total 93 dance performances (48 ballet and 45 contemporary) were analysed for exercise intensity, changes in direction and specific discrete skills (e. g., jumps, lifts). Results revealed significant differences between the 2 dance forms for exercise intensity (p<0.001), changes in direction (p<0.001) and discrete skills (p<0.05) with gender differences noted in the latter (p<0.05). Ballet was characterised by longer periods at rest (38 s x min(-1)) and high to very high exercise intensities (9 s x min(-1)), whilst contemporary dance featured more continuous moderate exercise intensities (27 s x min(-1)). These differences have implications on the energy systems utilised during performance with ballet potentially stressing the anaerobic system more than contemporary dance. The observed high rates in the discrete skills in ballet (5 jumps x min(-1); 2 lifts x min(-1)) can cause local muscular damage, particularly in relatively weaker individuals. In conclusion, classical ballet and contemporary dance performances are as significantly different in the underlying physical demands placed on their performers as the artistic aspects of the choreography.

Hypermobility and dance: a review.

Joint hypermobility is defined as an excessive range of motion. Although the dance profession has often promoted hypermobility for aesthetic reasons, there is a belief amongst health professionals that potential risks associated with the condition may have been overlooked. The aims of this review were to examine the epidemiology of joint hypermobility in dancers; the effects on fatigue and bone health; the injury profile of hypermobile dancers; and the use of the Beighton score as a diagnostic tool. Depending on the criteria used, epidemiological studies suggest that hypermobility among dancers can be as high as 44%, especially in students. As hypermobility has been linked to fatigue in the general population, the hypermobile dancer should be careful given the association between fatigue and aetiology of injury in dance. Similarly, in light of research encouraging dancers to become fitter, this recommendation may not be appropriate for hypermobile dancers. In addition, the Beighton score used in most dance related studies may not be an appropriate measure of hypermobility in these populations. More research is necessary into this area to ascertain the reasons for the attrition rate from student to soloist/principal level and whether it is linked to dance health and injury issues.

Effects of exercise and physical activity on depression.

INTRODUCTION: Depression is a very prevalent mental disorder affecting 340 million people globally and is projected to become the leading cause of disability and the second leading contributor to the global burden of disease by the year 2020. AIM: In this paper, we review the evidence published to date in order to determine whether exercise and physical activity can be used as therapeutic means for acute and chronic depression. Topics covered include the definition, classification criteria and treatment of depression, the link between ß-endorphin and exercise, the efficacy of exercise and physical activity as treatments for depression, properties of exercise stimuli used in intervention programs, as well as the efficacy of exercise and physical activity for treating depression in diseased individuals. CONCLUSIONS: The presented evidence suggests that exercise and physical activity have beneficial effects on depression symptoms that are comparable to those of antidepressant treatments.

Effect of leg length on ROM, VJ and leg dexterity in dance.

We investigated the associations between leg length and specific ballet movements in different skill groups. Volunteers were from an undergraduate dance programme (n=18), a pre-professional school (n=43) and from an elite classical ballet company (n=45). Individual data were collected for anthropometry, vertical jump, leg dexterity, and leg active and passive ROM. ANCOVA identified both main effects as significant with regard to vertical jump (gender P<0.001 and skill P=0.017); leg length was also identified as a significant covariate (P=0.023). Analysis of leg dexterity identified no significant effects with gender, skill or leg length. Active and passive range of motion noted gender (P=0.001) and skill (P<0.001) differences. Leg length was found to be negatively associated with both active and passive ROM (P=0.002). In conclusion, the present data highlight the diverse and conflicting effects of leg length on fundamental ballet skills. The longer legs that benefit vertical jump have a negative influence on range of motion and leg dexterity except for highly skilled dancers, who through skill, seem to have overcome the effects of some of these dichotomies.

What predicts obesity in patients with rheumatoid arthritis? An investigation of the interactions between lifestyle and inflammation.

OBJECTIVE: To assess whether physical activity, diet or inflammation is a more important determinant of body mass index (BMI) and body fat (BF) in patients with rheumatoid arthritis (RA). METHODS: A total of 150 RA patients (102 female) were assessed for BMI and BF. Their habitual physical activity was assessed with the international physical activity questionnaire (IPAQ) and their energy intake with a 3-day food diary. Pro-inflammatory cytokines (interleukins, IL-1 and IL-6, and tumor necrosis factor-alpha), erythrocyte sedimentation rate, C-reactive protein, disease activity score-28 and physical function (Health Assessment Questionnaire-HAQ) were also measured. RESULTS: BMI correlated inversely with IPAQ (r=-0.511, P=0.000) and positively with energy intake (r=0.331, P=0.016) and HAQ (r=0.133, P=0.042). BF correlated inversely with IPAQ (r=-0.575, P=0.000) and positively with HAQ (r=0.201, P=0.037). Normal weight patients were more physically active compared with those who were either overweight (P=0.006) or obese (P=0.000). Underweight patients consumed significantly fewer calories compared with other patients (P<0.05 in all cases). Cytokines or HAQ did not differ between weight groups. IPAQ was the sole predictor of obesity, whereas energy intake was the sole predictor of underweight. CONCLUSIONS: Inflammation does not seem to influence BMI and BF in RA. As in the general population, high levels of habitual physical activity associate with low BMI and BF in RA. Energy intake is a major determinant of being underweight in those who consume fewer calories. Further research is needed to investigate the suitability of exercise and diet modalities, and their effects on the body composition of RA patients.

Beneficial changes in energy expenditure and lipid profile after eccentric exercise in overweight and lean women.

The aim was to compare lean and overweight females in regard to the effects of eccentric exercise on muscle damage indices, resting energy expenditure (REE) and respiratory quotient (RQ) as well as blood lipid and lipoprotein profile. Lean and overweight females (deviated by their body mass index) performed an eccentric exercise session. Muscle damage, energy cost and lipid profile were assessed pre-exercise and up to 72 h post-exercise. After eccentric exercise (i) muscle damage indices were affected more in the overweight subjects compared with the lean subjects; (ii) the elevation of absolute and relative REE was larger and more prolonged in the overweight group compared with the lean group; (iii) after 24 h, RQ had significantly declined, with the overweight subjects exhibiting a larger reduction compared with the lean group; and (iv) the blood lipid profile was favorably modified, with the overweight group exhibiting more favorable responses compared with the lean group. The differences between the lean and the overweight subjects may be partly due to the fact that overweight individuals experienced greater muscle damage than lean individuals. Eccentric exercise may be a promising lifestyle factor to combat obesity and dyslipidemias.

Submaximal fatigue and recovery in boys and men.

We examined the effects of a sustained submaximal isometric contraction on fatigue and recovery rates in untrained prepubescent boys and men. Fifteen prepubescent boys and 15 men executed an isometric plantar flexion at 20% of their maximal voluntary contraction for 10 min. During the fatigue protocol, surface electromyogram of the soleus, medial gastrocnemius, and tibialis anterior muscles were obtained. Following the fatigue protocol, maximal voluntary contraction data were also obtained every 3 min throughout a 15-min recovery period. During the fatigue protocol, agonist and antagonist surface electromyogram increased gradually to a similar extent in both groups. Following fatigue, torque and surface electromyogram during a maximal voluntary contraction decreased compared to pre-fatigue values and recovered in a similar manner in both groups. However, boys showed faster recovery in torque and surface electromyogram during the third minute of recovery period. It is concluded that a low-intensity sustained isometric fatigue protocol induces similar fatigue levels in boys and men. However, there is evidence that boys can recover faster than men.

Fitness in contemporary dance: a systematic review.

It has been suggested that dancers are less fit compared to other athletes. However, the majority of studies make their arguments based on data deriving mainly from ballet. Therefore, the aim of the current review was to investigate: a) aerobic and anaerobic fitness, muscular strength and body composition characteristics in contemporary dancers of different levels, and b) whether supplementary exercise interventions, in addition to normal dance training, further improves contemporary dance performance. Three databases (Medline, Cochrane and the Cumulative Index to Nursing & Allied Health research database) were searched to identify publications regarding the main fitness components of contemporary professional and student dancers. At a professional level, it appears that contemporary dancers demonstrate higher maximal oxygen uptake and higher scores in muscular endurance than ballet dancers. However, contemporary dance students are equally fit compared to their ballet counterparts and their body composition is also very similar. Only two studies have investigated the effects of supplementary exercise training on aspects of dance performance. Further research is needed in order to confirm preliminary data, which suggest that the implementation of additional fitness training is beneficial for contemporary dance students to achieve a better performance outcome.

Associations of obesity with modifiable risk factors for the development of cardiovascular disease in patients with rheumatoid arthritis.

OBJECTIVES: To assess the association of body mass index (BMI) with modifiable cardiovascular disease (CVD) risk factors in patients with rheumatoid arthritis (RA). METHODS: BMI, disease activity, selected CVD risk factors and CVD medication were assessed in 378 (276 women) patients with RA. Patients exceeding accepted thresholds in >or=3 CVD risk factors were classified as having the metabolic syndrome (MetS). RESULTS: BMI independently associated with hypertension (OR = 1.28 (95% CI = 1.22 to 1.34); p = 0.001), high-density lipoprotein (OR = 1.10 (95% CI = 1.06 to 1.15); p = 0.025), insulin resistance (OR = 1.13 (95% CI = 1.08 to 1.18); p = 0.000) and MetS (OR = 1.15 (95% CI = 1.08 to 1.21); p = 0.000). In multivariable analyses, BMI had the strongest associations with CVD risk factors (F(1-354) = 8.663, p = 0.000), and this was followed by lipid-lowering treatment (F(1-354) = 7.651, p = 0.000), age (F(1-354) = 7.541, p = 0.000), antihypertensive treatment (F(1-354) = 4.997, p = 0.000) and gender (F(1-354) = 4.707, p = 0.000). Prevalence of hypertension (p = 0.004), insulin resistance (p = 0.005) and MetS (p = 0.000) was significantly different between patients with RA who were normal, overweight and obese, and BMI differed significantly according to the number of risk factors present (p = 0.000). CONCLUSIONS: Increasing BMI associates with increased CVD risk independently of many confounders. RA-specific BMI cut-off points better identify patients with RA at increased CVD risk. Weight-loss regimens should be developed and applied in order to reduce CVD in patients with RA.

Rheumatoid cachexia and cardiovascular disease.

OBJECTIVE: It has been frequently stated that rheumatoid cachexia (RC) associates with increased cardiovascular risk; however, no studies to date have investigated this. The aim of this study was to investigate the association of RC with multiple novel and classical cardiovascular disease (CVD) risk factors and the presence of established CVD in rheumatoid arthritis (RA). METHODS: A total of 34 RA patients with RC (RA+RC) were identified from a database of 400 RA patients using published RC criteria and compared to the remaining patients (RA-RC) who did not fulfil RC criteria. All patients were assessed for fat and fat-free mass, albumin (indicator of catabolism), disease activity/severity, novel and classical risk CVD factors and established CVD. RESULTS: Fat-free mass (kg) and albumin (g/L) were significantly decreased in RA+RC vs. RA-RC patients: 37.3(33.9-41.6) vs. 45.9(41.2-55.5), p<0.001 and 39.6 + or - 6.7 vs. 42.4 + or - 4.9, p=0.001). Percent body fat was not significantly different. No significant differences were detected in either the classical or novel CVD risk factors, 10-year CVD risk or the prevalence of established CVD. CONCLUSIONS: RC does not appear to be associated with worse CVD profile in RA patients, but this needs to be confirmed in prospective studies.

Longitudinal preventive-screening cutoffs for metabolic syndrome in adolescents.

OBJECTIVE: To detect metabolic risk factor cutoff points in adolescence for the diagnosis of metabolic syndrome that develops at the age of 17 years (MS17). DESIGN: This study adopted a 6-year design incorporating four data collection time points (TPs). Volunteers were assessed prospectively at the ages of 12, 13, 14 and 17. PARTICIPANTS: A total of 210, 204, 198 and 187 schoolchildren volunteered at the first (TP(1)=12 years old), second (TP2=13 years old), third (TP3=14 years old) and fourth (TP4=17 years old) data collection TP, respectively. MEASUREMENTS: At each data collection TP, anthropometrical, biological and lifestyle data were obtained. Identical protocols were used for each assessment conducted by the same trained investigators. RESULTS: A total of 12% of the participants were diagnosed with MS17, the majority of them being boys (P<0.05). The prevalence of the syndrome increased directly with the degree of obesity. Using body mass index (BMI), adiposity and/or aerobic fitness levels in both genders, MS17 could be correctly diagnosed as early as TP1. No such cutoff points were found for high-density lipoprotein cholesterol, triglycerides, blood pressure and fasting plasma glucose levels. CONCLUSION: With respect to the data presented, it has been established that the calculated longitudinal preventive-screening cutoffs allow successful diagnosis of metabolic syndrome in adolescents using BMI, adiposity or aerobic fitness levels in both sexes. Adoption of such pediatric guidelines may help mitigate future increase in the prevalence of metabolic syndrome.