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Association of sedentary time and physical fitness with ideal cardiovascular health in perimenopausal women: The FLAMENCO project

      Highlights

      • Greater cardiorespiratory fitness is associated with a better cardiovascular profile in perimenopausal women.
      • Lower-body muscular strength is associated with a better cardiovascular profile in perimenopausal women.
      • In this population, >460 min/day of sedentary time and <−3 cm in the back-scratch test are suggestive of higher cardiovascular disease risk.

      Abstract

      Introduction

      Healthier lifestyle behaviours might be related to a lower cardiometabolic risk predisposed by menopause transition. The objectives of the study were: 1) to examine the association of sedentary time (ST) and physical fitness with “Ideal Cardiovascular Health” (ICH) in perimenopausal women, and 2) to determine the capacity of ST and physical fitness tests to discriminate between the presence or absence of ICH status in this population.

      Study design

      Observational cross-sectional study.

      Main outcome measures

      Sedentary time and different levels of physical activity were objectively assessed using triaxial accelerometry (on 7 consecutive days). Physical fitness was assessed with the Senior Fitness Test battery, handgrip strength, and sit-and-reach tests. ICH status was created from the cut-off values of several health behaviours (smoking, body mass index, physical activity, and diet) and classical cardiometabolic markers (plasma total cholesterol and fasting glucose, and blood pressure).

      Results

      A total of 122 perimenopausal women (52.6 ± 4.2 years old) participated in this study. After adjusting for covariates, perimenopausal women with ICH status spent less time in sedentary behaviours and had higher scores on the 6-min-walk, 30-s-chair-stand, and back-scratch tests than women with a non-ICH status (all, P≤.03). Cut-off values of <460 min/day in ST and ≥−3 cm on the back-scratch test were associated with around threefold higher odds (95% confidence interval 0.14-0.71 and 1.47–7.01, respectively, all P <.01) of having ICH status.

      Conclusion

      Reduced ST and greater cardiorespiratory fitness, upper-body flexibility, and lower-body muscular strength were associated with a better cardiovascular profile in perimenopausal women. Including ST and upper-body flexibility as complementary ICH metrics might facilitate early identification of perimenopausal women with a higher risk of cardiovascular disease. However, further studies evaluating the usefulness of these potential complementary diagnostic tools in perimenopausal women are warranted before they are implemented in clinical practice.

      Keywords

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      References

        • Perk J.
        • De Backer G.
        • Gohlke H.
        • Graham I.
        • Reiner Z.
        • Verschuren W.M.M.
        • Albus C.
        • Benlian P.
        • Boysen G.
        • Cifkova R.
        • Deaton C.
        • Ebrahim S.
        • Fisher M.
        • Germano G.
        • Hobbs R.
        • Hoes A.
        • Karadeniz S.
        • Mezzani A.
        • Prescott E.
        • Ryden L.
        • Scherer M.
        • Syvanne M.
        • Reimer W.
        • Vrints C.
        • Wood D.
        • Zamorano J.L.
        • Zannad F.
        • P. European Assoc Cardiovascular
        European Guidelines on cardiovascular disease prevention in clinical practice (version 2012).
        Eur. Heart J. 2012; 33 (1635-U130)
        • El Khoudary S.R.
        • Shields K.J.
        • Janssen I.
        • Hanley C.
        • Budoff M.J.
        • Barinas-Mitchell E.
        • Everson-Rose S.A.
        • Powell L.H.
        • Matthews K.A.
        Cardiovascular fat, menopause, and sex hormones in women: the SWAN cardiovascular fat ancillary study.
        J. Clin. Endocrinol. Metab. 2015; 100: 3304-3312
        • Kapoor E.
        • Collazo-Clavell M.L.
        • Faubion S.S.
        Weight gain in women at midlife: a concise review of the pathophysiology and strategies for management.
        Mayo Clin. Proc. 2017; 92: 1552-1558
        • Lloyd-Jones D.M.
        • Hong Y.L.
        • Labarthe D.
        • Mozaffarian D.
        • Appel L.J.
        • Van Horn L.
        • Greenlund K.
        • Daniels S.
        • Nichol G.
        • Tomaselli G.F.
        • Arnett D.K.
        • Fonarow G.C.
        • Ho P.M.
        • Lauer M.S.
        • Masoudi F.A.
        • Robertson R.M.
        • Roger V.
        • Schwamm L.H.
        • Sorlie P.
        • Yancy C.W.
        • Rosamond W.D.
        • P. Amer Heart Assoc Strategic
        Defining and setting national goals for cardiovascular health promotion and disease reduction the American Heart Association's strategic impact goal through 2020 and beyond.
        Circulation. 2010; 121: 586-613
        • Kruse N.T.
        • Scheuermann B.W.
        Cardiovascular responses to skeletal muscle stretching: "Stretching" the truth or a new exercise paradigm for cardiovascular medicine?.
        Sports Med. 2017;
        • Artero E.G.
        • Lee D.C.
        • Lavie C.J.
        • Espana-Romero V.
        • Sui X.M.
        • Church T.S.
        • Blair S.N.
        Effects of muscular strength on cardiovascular risk factors and prognosis.
        J. Cardiopulm. Rehabil. Prev. 2012; 32: 351-358
        • Lee D.C.
        • Artero E.G.
        • Sui X.M.
        • Blair S.N.
        Mortality trends in the general population: the importance of cardiorespiratory fitness.
        J. Psychopharmacol. 2010; 24: 27-35
        • Aparicio V.A.
        • Carbonell-Baeza A.
        • Senhaji M.
        • Martin S.
        • Camiletti-Moiron D.
        • Aranda P.
        Usefulness of fitness testing to establish metabolic syndrome in perimenopausal Moroccan women.
        Eur. J. Cardiovasc. Nurs. 2014; 13: 524-531
        • Gregorio-Arenas E.
        • Ruiz-Cabello P.
        • Camiletti-Moiron D.
        • Moratalla-Cecilia N.
        • Aranda P.
        • Lopez-Jurado M.
        • Llopis J.
        • Aparicio V.A.
        The associations between physical fitness and cardiometabolic risk and body-size phenotypes in perimenopausal women.
        Maturitas. 2016; 92: 162-167
        • Healy G.N.
        • Wijndaele K.
        • Dunstan D.W.
        • Shaw J.E.
        • Salmon J.
        • Zimmet P.Z.
        • Owen N.
        Objectively measured sedentary time, physical activity, and metabolic risk the australian diabetes, obesity and lifestyle study (AusDiab).
        Diabetes Care. 2008; 31: 369-371
        • Carbonell-Baeza A.
        • Soriano-Maldonado A.
        • Gallo F.J.
        • del Amo M.P.L.
        • Ruiz-Cabello P.
        • Andrade A.
        • Borges-Cosic M.
        • Peces-Rama A.R.
        • Spacirova Z.
        • Alvarez-Gallardo I.C.
        • Garcia-Mochon L.
        • Segura-Jimenez V.
        • Estevez-Lopez F.
        • Camiletti-Moiron D.
        • Martin-Martin J.J.
        • Aranda P.
        • Delgado-Fernandez M.
        • Aparicio V.A.
        Cost-effectiveness of an exercise intervention program in perimenopausal women: the Fitness League Against MENopause COst (FLAMENCO) randomized controlled trial.
        BMC Public Health. 2015; 15: 11
        • Kupperman H.S.
        • Blatt M.H.G.
        • Wiesbader H.
        • Filler W.
        Comparative clinical evaluation of estrogenic preparations by the menopausal and amenorrheal indices.
        J. Clin. Endocrinol. Metab. 1953; 13: 688-703
        • Aparicio V.A.
        • Borges-Cosic M.
        • Ruiz-Cabello P.
        • Coll-Risco I.
        • Acosta-Manzano P.
        Association of objectively measured physical activity and physical fitness with menopause symptoms.
        Flamenco Project. 2017; 20: 456-461
        • Aguilar-Farias N.
        • Brown W.J.
        • Peeters G.
        ActiGraph GT3X+cut-points for identifying sedentary behaviour in older adults in free-living environments.
        J. Sci. Med. Sport. 2014; 17: 293-299
        • Rikli R.E.
        • Jones C.J.
        Development and validation of a functional fitness test for community-residing older adults.
        J. Aging Phys. Act. 1999; 7: 129-161
        • Ruiz-Ruiz J.
        • Mesa J.L.M.
        • Gutiérrez A.
        • Castillo M.J.
        Hand size influences optimal grip span in women but not in men.
        J. Hand Surg. 2002; 27: 897-901
        • Rodriguez F.A.
        • Gusi N.
        • Valenzuela A.
        • Nacher S.
        • Nogues J.
        • Marina M.
        Evaluation of health-related fitness in adults (I): background and protocols of the AFISAL-INEFC battery.
        Apunts Educacion Fisica y Deportes. 1998; 52 ([in Spanish]): 54-76
        • Ritchie C.
        • Trost S.G.
        • Brown W.
        • Armit C.
        Reliability and validity of physical fitness field tests for adults aged 55 to 70 years.
        J. Sci. Med. Sport. 2005; 8: 61-70
        • Crapo R.O.
        • Casaburi R.
        • Coates A.L.
        • Enright P.L.
        • MacIntyre N.R.
        • McKay R.T.
        • Johnson D.
        • Wanger J.S.
        • Zeballos R.J.
        • Bittner V.
        • Mottram C.
        • Comm A.T.S.
        ATS statement: guidelines for the six-minute walk test.
        Am. J. Respir. Crit. Care Med. 2002; 166: 111-117
        • Carbonell-Baeza A.
        • Alvarez-Gallardo I.C.
        • Segura-Jimenez V.
        • Castro-Pinero J.
        • Ruiz J.R.
        • Delgado-Fernandez M.
        • Aparicio V.A.
        Reliability and feasibility of physical fitness tests in female fibromyalgia patients.
        Int. J. Sports Med. 2015; 36: 157-162
        • Aparicio V.A.
        • Segura-Jimenez V.
        • Alvarez-Gallardo I.C.
        • Soriano-Maldonado A.
        • Castro-Pinero J.
        • Delgado-Fernandez M.
        • Carbonell-Baeza A.
        Fitness testing in the fibromyalgia diagnosis: the al-Andalus project.
        Med. Sci. Sports Exerc. 2015; 47: 451-459
        • Aparicio V.A.
        • Ruiz-Cabello P.
        • Borges-Cosic M.
        • Andrade A.
        • Coll-Risco I.
        • Acosta-Manzano P.
        • Soriano-Maldonado A.
        Association of physical fitness, body composition, cardiometabolic markers and adherence to the Mediterranean diet with bone mineral density in perimenopausal women. The FLAMENCO project.
        J. Sports Sci. 2017; 35: 880-887
        • Thacker E.L.
        • Gillett S.R.
        • Wadley V.G.
        • Unverzagt F.W.
        • Judd S.E.
        • McClure L.A.
        • Howard V.J.
        • Cushman M.
        The American Heart Association life’s simple 7 and incident cognitive impairment: the Reasons for geographic and racial differences in stroke (REGARDS) study.
        J. Am. Heart Assoc. 2014; 3: 9
        • Ruiz-Cabello P.
        • Coll-Risco I.
        • Acosta-Manzano P.
        • Borges-Cosic M.
        • Gallo-Vallejo F.J.
        • Aranda P.
        • Lopez-Jurado M.
        • Aparicio V.A.
        Influence of the degree of adherence to the Mediterranean diet on the cardiometabolic risk in peri and menopausal women.
        The Flamenco project, Nutr Metab Carbiovasc Dis. 2017; 27: 217-224
        • Sasaki J.E.
        • John D.
        • Freedson P.S.
        Validation and comparison of ActiGraph activity monitors.
        J. Sci. Med. Sport. 2011; 14: 411-416
        • Panagiotakos D.B.
        • Pitsavos C.
        • Stefanadis C.
        Dietary patterns: a Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk.
        Nutr. Metab. Carbiovasc. Dis. 2006; 16: 559-568
        • Ruiz J.R.
        • Huybrechts I.
        • Cuenca-Garcia M.
        • Artero E.G.
        • Labayen I.
        • Meirhaeghe A.
        • Vicente-Rodriguez G.
        • Polito A.
        • Manios Y.
        • Gonzalez-Gross M.
        • Marcos A.
        • Widhalm K.
        • Molnar D.
        • Kafatos A.
        • Sjostrom M.
        • Moreno L.A.
        • Castillo M.J.
        • Ortega F.B.
        • Grp H.S.
        Cardiorespiratory fitness and ideal cardiovascular health in European adolescents.
        Heart. 2015; 101: 766-773
        • Nakagawa S.
        • Cuthill I.C.
        Effect size, confidence interval and statistical significance: a practical guide for biologists.
        Biol. Rev. 2007; 82: 591-605
        • Bernaards C.M.
        • Twisk J.W.R.
        • Van Mechelen W.
        • Snel J.
        • Kemper H.C.G.
        A longitudinal study on smoking in relationship to fitness and heart rate response.
        Med. Sci. Sports Exerc. 2003; 35: 793-800
        • Bibiloni M.D.
        • Julibert A.
        • Argelich E.
        • Aparicio-Ugarriza R.
        • Palacios G.
        • Pons A.
        • Gonzalez-Gross M.
        • Tur J.A.
        Western and mediterranean dietary patterns and physical activity and fitness among spanish older adults.
        Nutrients. 2017; 9: 14
        • Loyen A.
        • Verloigne M.
        • Van Hecke L.
        • Hendriksen I.
        • Lakerveld J.
        • Steene-Johannessen J.
        • Koster A.
        • Donnelly A.
        • Ekelund U.
        • Deforche B.
        • De Bourdeaudhuij I.
        • Brug J.
        • van der Ploeg H.P.
        • Consortium D.
        Variation in population levels of sedentary time in European adults according to cross-European studies: a systematic literature review within DEDIPAC.
        Int. J. Behav. Nutr. Phys. Act. 2016; 13: 11
        • Matthews C.E.
        • George S.M.
        • Moore S.C.
        • Bowles H.R.
        • Blair A.
        • Park Y.
        • Troiano R.P.
        • Hollenbeck A.
        • Schatzkin A.
        Amount of time spent in sedentary behaviors and cause-specific mortality in US adults.
        Am. J. Clin. Nutr. 2012; 95: 437-445
        • Segura-Jimenez V.
        • Alvarez-Gallardo I.C.
        • Estevez-Lopez F.
        • Soriano-Maldonado A.
        • Delgado-Fernandez M.
        • Ortega F.B.
        • Aparicio V.A.
        • Carbonell-Baeza A.
        • Mota J.
        • Silva P.
        • Ruiz J.R.
        Differences in sedentary time and physical activity between female patients with fibromyalgia and healthy controls: the al-Andalus project.
        Arthritis Rheumatol. (Hoboken, N.J.). 2015; 67: 3047-3057
        • Knaeps S.
        • Lefevre J.
        • Wijtzes A.
        • Charlier R.
        • Mertens E.
        • Bourgois J.G.
        Independent associations between sedentary time, moderate-to-vigorous physical activity, cardiorespiratory fitness and cardio-metabolic health: a cross-sectional study.
        PLoS One. 2016; 11: 13
        • Hamilton M.T.
        • Hamilton D.G.
        • Zderic T.W.
        Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease.
        Diabetes. 2007; 56: 2655-2667
        • Despres J.P.
        • Lemieux I.
        Abdominal obesity and metabolic syndrome.
        Nature. 2006; 444: 881-887
        • Wolfe R.R.
        The underappreciated role of muscle in health and disease.
        Am. J. Clin. Nutr. 2006; 84: 475-482
        • Chang K.V.
        • Hung C.Y.
        • Li C.M.
        • Lin Y.H.
        • Wang T.G.
        • Tsai K.S.
        • Han D.S.
        Reduced flexibility associated with metabolic syndrome in community-dwelling elders.
        PLoS One. 2015; 10: 11
        • Alder E.
        The Blatt-Kupperman menopausal index: a critique.
        Maturitas. 1998; 29: 19-24