Active and healthy life

Experts gathered at the Public University of Navarra (UPNA) have urged health and sports professionals to become ‘health agents’ by promoting physical activity among young people and pregnant women. Their goal is to improve the health and fitness of the population as a strategy to prevent non-communicable chronic diseases like obesity, heart disease or type 2 diabetes. A symposium was held by UPNA in Pamplona on Thursday 9 May to discuss exercise prescription as a way to improve health in all ages. Organised by the School of Medical Sciences and the Department of Medical Sciences, the event drew some 130 sports, health and biomedical experts.

Two UPNA researchers, who are also members of Navarrabiomed (the joint biomedical research centre of the Government of Navarra and the Public University of Navarra) and the Navarra Medical Research Institute (IdiSNA), delivered speeches: Mikel Izquierdo Redín, organiser the event, and Robinson Ramírez-Vélez. Mikel Izquierdo talked about strength training and the functions of the muscular system, ‘which a number of health professionals consider important for improving health and recovering from diseases linked with a sedentary lifestyle and population ageing, as well as for optimising sport performance after muscle injury.’ He debunked some of the myths created by pseudo-therapies in connection with strength training and improved muscle function. He said that muscle loss is not an inevitable outcome of ageing, as it can be prevented with proper training. He also observed that it is not true that children cannot do strength training exercises; on the contrary, they can, as long as they engage in controlled movements that are suitable for their age. He insisted that fitness ‘always’ offers benefits to patients who suffer from diseases such as type 2 diabetes and denied that the best muscle training is the one associated with extreme fatigue.

Finally, Izquierdo questioned the effectiveness and validity of the Kinesio Taping Method (which consists in applying elastic strips on muscles to treat pain), hypopressive techniques, electro stimulation suits and muscle roller sticks.

Health and pregnancy

Robinson Ramírez-Vélez said that, despite the efforts made to prevent non-communicable chronic disease, such as promoting healthy habits like physical exercise, a balanced diet, a good night’s sleep, quitting smoking and drinking, and so on, ‘we have failed to obtain the desired results.’ Studies reveal, he added, that ‘the mother’s state of health during pregnancy conditions to some extent the developing baby’s health later in life.’ He highlighted the importance of physical activity in children and adolescents – both aerobic exercise and resistance/strength training. Also, he insisted that health professionals should prescribe physical activity in all stages of life, even pregnancy.

The closing lecture was delivered by Antonio García-Hermoso, of Navarrabiomed and IdiSNA. He showed his disappointment in the fact that ‘Physical Education in school is not considered to be as important as subjects.’ He cited important international studies concluding that ‘exercise in youth is good for both physical and mental wellbeing.’ Finally, García-Hermoso recommended that ‘sports should be given the importance they deserve in primary, secondary and higher education.’

• JAMA Pediatrics, the journal of the American Pediatrics Association, has published the study results.

A group of researchers from Navarrabiomed and the Department of Health Sciences at the Universidad Pública de Navarra (UPNA) specializing in prescribing physical exercise to improve health and quality of life has published an article on the effects of increasing the quality and quantity of physical education (PE) classes on improving the health-related physical fitness and fundamental motor skills of young people (ages 3 to 18). The article was recently published in JAMA Pediatrics (Journal of the American Medical Association).

The study analyzed data from approximately 50,000 young people and concluded that qualitative strategies such as including games and activities involving a high level of cardiovascular and muscular work, as well as better methodological session planning could provide young people with healthy benefits in terms of fitness and fundamental motor skills.

In addition to Antonio García-Hermoso, Robinson Ramírez-Vélez, Alicia María Alonso-Martínez and Mikel Izquierdo Redín (who form part of Navarrabiomed, Idisna and UPNA), the article authors also include Miguel Ángel Pérez-Sousa (Universidad de Huelva) and Rodrigo Ramírez-Campillo (Universidad de Los Lagos, Osorno, Chile).

Exercise is necessary to improve physical fitness

The study researchers also point out that it is not always possible to increase the number of hours spent per week on exercise or PE classes during school hours and therefore recommend improving the efficiency of these sessions by using strategies such as high-intensity interval training (HIIT), and muscle strength, jumping or circuit training. However, the authors mention that, despite the benefits of these strategies during school hours, young people should also participate in more out-of-school physical activities based on their age group (i.e., 60 minutes a day of moderate to intense physical activity).

They argue that PE classes also offer other benefits not specifically related to physical activity, such as helping young people develop socialization, teamwork and body language skills, and fostering healthy habits. Above all, the authors highlight the fact that improving physical fitness among school kids is a fundamental short- and long-term aspect of good health, given the high rates of obesity and physical inactivity among young people, which the authors refer to as “a public health problem that must be addressed by schools.”

Researchers from the Public University of Navarra (UPNA), Navarrabiomed and the Education Department of the Government of Navarra participated in a research project financed by the Navarra Education Department to create the first Physical Education Observatory for 3- to 6-year-old children in Navarra. They were Alicia Alonso, Mikel Izquierdo and Alazne Antón (UPNA), Antonio García-Hermoso and Robinson Ramírez-Vélez (Navarrabiomed), and Berta Villoslada and Berta Echavarri (CIP FP Lumbier-Education Department, Government of Navarra).

The Observatory is meant to promote physical activity in schoolchildren, reducing their screen time and adding relaxation time instead, as it has been shown that developing healthy habits in childhood is crucial to preventing cardiovascular disease in adult life. In order to achieve its goal, the Observatory will conduct a series of assessments in local schools, with children and their families, testing their fitness, measuring their sleep time and analysing all this information with them. The evaluation includes physical tests (jumping with both feet, speed/agility tests, etc.), body composition analysis (waist circumference, percentage of body fat and body mass index) and the use of personal electronic devices to measure the intensity of everyday activity and rest/sleep periods. In addition, the correlation will be established between fitness and school achievements.

The study is set to begin in Colegio Santa María la Real-Maristas Pamplona in October, then moving to Colegio Público San Juan de la Cadena. Finally, there will be a special teacher training module in CIP FP Lumbier, targeted at the students in the higher education training cycles (80), who will become assessors. This will be part of the module titled ‘Fitness testing and response to accidents’.

Throughout the process, school teachers will participate in measurements and evaluations, in an effort to introduce new trends, methods and formulas in children health assessment. According to the authors of the study, ‘the results might help understand why schoolchildren are gaining weight and their performance at school is worsening, with low levels of physical activity.’

Childhood as a critical period to develop healthy habits

‘Early childhood is a critical period for physical, social and cognitive development, to establish healthy behaviour patterns that can be kept into adulthood,’ the researchers say. Studies show that ‘regular participation in physical activities by pre-schoolers is essential for normal development and growth, with immediate and long-term benefits for physical and psychological wellbeing,’ they add. However, they explain, evidence for this age group is still relatively scarce as compared to the data available for children and adolescents aged 6 to 17.

Recently, the World Health Organisation (WHO) published new guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. According to these recommendations, children 3-5 years of age should spend at least 180 minutes in a variety of types of physical activities, of which at least 60 minutes is moderate- to vigorous-intensity activity. ‘Despite the benefits for health of regular physical activity, many pre-schoolers fail to meet these standards,’ the authors of the study state. The Observatory is aimed at improving results in this area.

The European network APTITUDE - Acting for Trans-Pyrenees Prevention of Dependency in Seniors – is gathering in Pamplona on Wednesday, 3 July for a scientific seminar that is expected to draw more than 200 experts in active ageing and frailty. The seminar will take place at the Tres Reyes Hotel in Pamplona, starting at 8.15am. In addition, there will be side workshops organised with the Navarra Red Cross for the general public, at Rincón de la Aduana and Paseo del Doctor Arazuri, starting at 10am.

These events were introduced this morning at the biomedical research centre Navarrabiomed, the network’s leading institution in Navarra, along with the Public University of Navarre (UPNA), the Navarra Hospital Complex (CHN) and the Navarra Red Cross. At the press conference were Nicolás Martínez Velilla, APTITUDE Coordinator in Navarra and Head of the Geriatrics Unit at CHN, Juan José San Martín Baquedano, Coordinator of the Navarra Red Cross, and Jorge Marín Vidondo, Project Manager at Navarrabiomed.

Martínez Velilla said the seminar would be the third APTITUDE meeting – and the first to take place in Pamplona. It will gather primary health care professionals and representatives of hospitals and research centres, universities, nursing homes and businesses from Occitanie in France, Catalonia and Navarra in Spain, and Andorra.
At the seminar, experts will discuss the concept of intrinsic capacity in older individuals – that is, the set of physical and mental skills an individual can apply at any given moment, plus the functional capacity, which is the way in which an individual relates to and interacts with the environment – proposed by the World Health Organisation (WHO). Also, they will talk about the multi-component training offered by the project, targeted at health and social care practitioners working with frail seniors, so that they can prescribe the adequate physical activity routines, make cognitive stimulation interventions, give healthy diet guidelines, make psycho-social interventions, etc.

Keynote speakers include Norman Lazarus and Stephen Harridge, from King’s College London, who have broad experience in physical activity, anti-ageing and muscle deterioration in geriatric care and other sectors, like aerospace, where they have worked with NASA.

Open workshops

On Wednesday, between 10am and 2pm, there will be open workshops at Rincón de la Aduana and Paseo del Doctor Arazuri, Pamplona. Under the title ‘Active, healthy seniors/Tailerrak: Adineko aktibo eta osasuntsuak’, they are targeted at people over 65, but they can also be of interest to caretakers, relatives or volunteers. The workshops are free and no prior registration is required.

In addition, there will be APTITUDE-Red Cross Tents, hosting functional assessment, cognitive stimulation and adapted leisure activities for the elderly, giving information about support devices and healthy habits, and giving out supplementary material with workout routines.

Ageing and functional decline

According to INE data from 2018, the population of Navarra amounts to 647,219 people, 19.5 per cent are 65 or above. The region has one of the longest life expectancies in Europe: 86.6 years for women and 81 years for men. However, the quality of life varies: whereas women tend to live longer lives, they become more dependent than men after 65.

According to the World Health Organisation, the main causes of mild or severe disability in old age are sensory impairment, back or neck pain, chronic obstructive pulmonary disease (COPD), depression, falls, diabetes mellitus, dementia and osteoarthritis. Moreover, more than 50 per cent of the elderly suffer from a combination of illnesses and take three to five medicines together.

Initiatives like APTITUDE advocate a change of paradigm in elderly care. Caretakers should face the challenge of setting illness aside to focus on functional capacity and its maintenance or improvement. APTITUDE promotes healthy habits, physical activity and cross-generational, adapted leisure both in urban centres and rural environments, in an effort to combat loneliness, depopulation in rural areas and the stereotypes associated with ageing.

About APTITUDE

APTITUDE was established in 2018 as a three-year network to foster cross-border cooperation in four regions (Occitanie, Catalonia, Navarra and Andorra) by building its own local networks with a total budget of 2 million Euro.
The APTITUDE project, which includes the APTITUDE network in Navarra, gets 65 per cent of its funds from the European Regional Development Fund (ERDF), through the Interreg V-A Spain-France-Andorra (POCTEFA) cooperation programme, aimed at the development of cross-border economic, social and environmental action by means of joint strategies to promote sustainable territorial development.

APTITUDE partners:

Gérontopôle - Centre Hospitalier Universitaire (CHU) de Toulouse
Fundació Salut i Envelliment - Universitat Autònoma de Barcelona (UAB)
Servei Andorrà d’Atenció Sanitària
Complejo Hospitalario de Navarra (CHN) - Navarrabiomed

More information: www.aptitude-net.com

Photo: From left to right: Jorge Marín (Navarrabiomed), Nicolás Martínez (CHN-Navarrabiomed) and Juan José San Martín (Navarra Red Cross).

Professionals at the Navarra Hospital Complex (CHN) from the Public University of Navarra (UPNA) and Navarrabiomed are participating in the establishment of a European network for preventing old-age dependency and promoting active ageing. Hospitals and research centres from France, Spain (Navarra and Catalonia) and Andorra are part of this project, named APTITUDE (Acting for Trans-Pyrenees Prevention of Dependency in Seniors). As announced today, the network in Navarra is being coordinated by Navarrabiomed-Miguel Servet Foundation.

The three-year cross-border project will develop local networks in France, Navarra, Catalonia and Andorra. The project has been assigned a 2-million-Euro budget, with 1 million going to Spain (and 400,000 to Navarra). 65 per cent of the funds are being contributed by the European Regional Development Fund (ERDF) through the Interreg V-A Spain programme.

Through training programmes, awareness-raising activities and scientific evidence, the project is aimed at improving the quality of life of elderly people, encouraging the adoption of healthy habits and reducing the loss of functional autonomy, as explained by Antonio Merino Díaz de Cerio, CHN Managing Director, and Nicolás Martínez Velilla, Head of the Geriatrics Department, researcher at the Geriatrics Unit in Navarrabiomed and leader of APTITUDE in Navarra. In the words of Martínez Velilla, ‘the primary goal of the network is to prevent old-age dependency by trying to mitigate frailty in the elderly population.’

Antonio Merino stressed the importance of this type of European projects where protocols, good practices and procedures are shared for the benefit of all the participating institutions and society at large.

Specific actions by APTITUDE Navarra

Álvaro Casas Herrero, geriatrician at CHN and President of the Spanish Geriatrics Society, and Maite Soria Sarnago, Nursing Director at CHN, announced the actions to be undertaken in our community in the forthcoming months.

On Tuesday, 20 November, the project will be presented at a talk in the function room of the School of Medical Sciences, titled ‘Active and healthy seniors: Keys for adopting healthy habits’. The talk will start at 4pm and finish at 6.30pm. Admission is free, but there will be a limited number of seats available. It will also be streamed on the Navarrabiomed YouTube channel.

At the event, the leaders of the project will talk about healthy habits and good practices for improving the quality of life of old people. The President of Club Atlético Osasuna, Luis Sabalza Iriarte, will talk about ‘Working beyond retirement age’. He will share experiences from his career in the Club.

In addition, three strategic actions will take place in the upcoming months in Navarra. Firstly, a cross-border record will be established of people aged 65 and over who are interested in getting information or taking part in gerontechnology and clinical research programmes.

Simultaneously, Clinical and Innovation Research Travelling Teams will be established where professionals specialising in various medical fields will transfer clinical and research practice to urban and rural areas, thus ensuring broader penetration and larger participation for the population. The teams will be made of doctors, nurses, physiotherapists and occupational therapists.

Also, a database will be created with data provided voluntarily by frail old people and old adults with memory disorders, which will be used to design research projects involving all the centres participating in the project.

Lastly, the members of the project will participate in the validation of a new concept, ‘intrinsic capacity’, as defined by the World Health Organisation (WHO), which might be used in the clinical assessment of old people.

Recently published studies

The actions framed within the project are in line with the conclusions drawn in a study published recently in JAMA Internal Medicine, the peer-reviewed medical journal of the American Medical Association.

Professor Mikel Izquierdo Redín, Director of the Department of Medical Sciences at UPNA and senior researcher from the Physical Exercise and Frailty Research Unit at Navarrabiomed, presented a study that shows that a tailored physical activity plan for in-patients aged 75 or older reduces functional decline. The clinical trial consisted in a three-year follow-up of 370 patients in the Geriatrics Service of CHN.

The study reveals that preadmission health and functional status can indicate the risk of functional decline associated with hospitalisation. This clinical sign might be negatively affected by bed rest during hospitalisation.

Simultaneously, the team is participating in the DIABFRAIL LATAM European project, funded by the European Commission in the context of the Horizon 2020 European research project. DIABFRAIL LATAM focuses on pre-frail and frail old people with diabetes in Latin America. At present, 40 per cent of people aged 65 and older are affected by diabetes.

The project’s goal is to implement a treatment model in Colombia, Chile, Mexico, Peru and Argentina, consisting of physical exercise, education and a nutrition plan, plus blood sugar level and blood pressure goals adjusted to old adults with diabetes, who are particularly vulnerable as a result of their frailty. More than 1000 pre-frail and frail old people with type 2 diabetes are taking part in the clinical trial.

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