Damián Pereira-Payo

This chapter analyzes the integration of health variables into contemporary Physical Education, with a focus on physical literacy and students’ holistic well-being. It examines the shift from subjective methods to objective measurement technologies, such as accelerometers, heart rate (HR) monitors, and positioning systems, which act as precise educational biomarkers. The text emphasizes the importance of physical health as a biological basis for cognitive development and academic performance and explores the link between aerobic capacity and brain plasticity. Furthermore, it provides an interpretative framework for key variables such as moderate-to-vigorous physical activity (MVPA), sedentary time, and HR, emphasizing their pedagogical value in workload management and fostering autonomy. The teacher’s role in bridging the gap between technological data and students’ health literacy is also discussed, as is the transformation of figures into practical knowledge. Finally, it discusses practical applications such as session monitoring, motivational feedback, and the ethical considerations necessary for the equitable use of wearables. This work guides researchers and teachers toward critically using technology to optimize health in school settings.

Background/Objectives: Informal caregivers of older adults are a high-burden population for psychological problems, yet evidence on the relationship between physical activity (PA) and mental health in this population is still limited. The aim of this work is to examine the association between PA status and self-reported mental health indicators (psychological distress and the number of poor mental health days) among caregivers of older adults. Methods: This cross-sectional study used data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS) caregiver module. The analytical sample included 1785 informal caregivers of older adults whose care recipients’ main condition was old age/infirmity/frailty or Alzheimer’s disease, dementia, or another cognitive impairment disorder. Physical activity was classified into three groups: meeting both aerobic and muscle-strengthening recommendations, reporting some PA but not meeting both recommendations, and being inactive. The self-reported mental health indicators were psychological distress (≥14 poor mental health days in the past 30 days) and the number of poor mental health days. Survey-weighted logistic regression and quasi-Poisson regression models were fitted, adjusting for sociodemographic, health-related, and caregiving-related covariates. Results: The weighted prevalence of psychological distress was 18.8%, and the mean of poor mental health days was 5.99 days in the previous 30 days. The weighted prevalence of psychological distress was 16.3% among caregivers meeting both recommendations, 18.2% among those reporting some PA, and 23.2% among inactive caregivers; however, differences across PA groups were not statistically significant. The weighted mean number of poor mental health days was 5.5, 6.2, and 6.1 days, respectively, with no significant differences across PA groups. In adjusted logistic regression models, physically inactive caregivers had higher odds of psychological distress than those meeting both activity recommendations (OR = 3.10, 95% CI: 1.58–6.09; p = 0.001). In adjusted quasi-Poisson models, physically inactive caregivers also reported more poor mental health days (RR = 1.51, 95% CI: 1.08–2.10; p = 0.016) compared to those who met both recommendations. No significant differences were observed for caregivers who met only aerobic recommendations or only muscle-strengthening recommendations, or had insufficient physical activity relative to the reference group. Conclusions: In this survey-weighted BRFSS caregiver-module sample from participating US jurisdictions, physical inactivity was associated with poorer self-reported mental health indicators among caregivers of older adults. These findings suggest that physical inactivity may help identify caregivers at higher risk of poorer self-reported mental health, although longitudinal and intervention studies are needed to clarify directionality and causality.

Aim: Breast cancer remains the most common cancer among women and is linked to persistent frailty symptoms such as fatigue, falls, and dizziness, which impact survivors’ quality of life. Regular moderate or vigorous physical activity can reduce these symptoms. The aim of this research was to analyze the association between the frequency of moderate and vigorous physical activity and the presence and number of frailty symptoms in European women aged 50–85 years with a history of breast cancer. Subject and methods: This cross-sectional study used data from Wave 9 of the Survey of Health, Ageing and Retirement in Europe (SHARE). A total of 794 women aged 50–85 with a diagnosis of breast cancer were selected. Sociodemographic, biopsychosocial, and lifestyle variables (frequency of moderate and vigorous physical activity) were analyzed. Frailty symptoms included falls, fear of falling, dizziness/fainting, and fatigue. Chi-square tests and Cramér’s V were used to assess associations between physical activity frequency and frailty symptoms. Multivariate binary logistic regression and Poisson regression were used to identify predictors of the presence of frailty and their number of frailty symptoms. Results: A total of 61% of the participants reported at least one frailty symptom, with fatigue (43%) being the most common. Moderate and vigorous physical activity were significantly associated with the presence and number of frailty symptoms ( p < 0.001). Women who engaged in physical activity more than once a week showed a lower prevalence of all symptoms. Depression (odds ratio [OR] = 4.01), long-term illness (OR = 2.84), and never or rarely performing vigorous physical activity (OR = 1.93) were the strongest predictors of having at least one frailty symptom. Poisson regression confirmed these factors, along with never or rarely performing moderate physical activity, age, loneliness, and body mass index (BMI), as significantly associated with a higher number of symptoms. Conclusion: Lower frequencies of moderate and vigorous physical activity are significantly associated with higher prevalence and number of frailty symptoms among breast cancer survivors aged 50–85. Promoting safe and tailored physical activity in this population, while addressing specific barriers such as kinesiophobia, may reduce frailty burden and improve long-term outcomes.

Serotonin is a neurotransmitter that plays a crucial role in mood regulation and has several health-related functions in humans. Physical exercise (PE) has been proposed as a potential non-pharmacological strategy to modulate serotonin levels. Objective: This systematic review and meta-analysis aimed to investigate the effect of PE on circulating serotonin concentrations. Methods: Following PRISMA guidelines, a systematic search was conducted in PubMed, Web of Science, and Scopus, identifying 938 records. Randomized controlled trials with a PE intervention group and a non-PE usual care control group that meet the inclusion criteria were selected. Data were synthesized using a random-effects meta-analysis with standardized mean differences (SMD), and sensitivity analyses were performed using alternative pre–post correlation assumptions (r = 0.6–0.9). Study quality was assessed using the PEDro scale. Results: Five randomized controlled trials comprising 116 participants, all of them females, were included. The pooled analysis showed a non-significant effect of PE on circulating serotonin levels (SMD 1.48; p = 0.135; 95% CI −0.46 to 3.42), with extremely high heterogeneity (I² = 94.63%). Sensitivity analyses produced similar non-significant results and consistently high heterogeneity, indicating robustness of the original model. Methodological quality ranged from acceptable to good (PEDro scores 4–7). Conclusions: Current evidence, derived exclusively from female participants, does not support a significant effect of PE on serum or plasma serotonin levels. The substantial heterogeneity among studies and the generally moderate methodological quality limit the strength of the conclusions and generalizability of the conclusions. Further, high-quality randomized controlled trials with standardized measurement protocols are needed to clarify the influence of exercise on circulating serotonin levels.

Aim: Back pain is one of the most prevalent and potentially disabling musculoskeletal conditions experienced by individuals, leading to reduced quality of life and long-term disability. The main objective of this study was to develop a simplified visual decision tree algorithm for the classification and prediction of severe or mild/moderate pain in the middle-aged and elderly European population with back pain, using as predictors sociodemographic variables and variables related to physical condition, pain symptom expansion, and mental health. Subject and methods: This was a cross-sectional study of 15,314 middle-aged and older European individuals with back pain. A predictive algorithm for the level of pain was developed using classification and regression tree (CRT) analysis. A cross-validation study was conducted to assess the performance of the model. In addition, a multivariate logistic binary regression model was developed to predict the level of pain and compare its performance with the CRT model. Results: The CRT found that physical inactivity, depression, and pain expansion were the combination of variables that predicted a high level of pain. The CRT model performed better than the logistic regression model in terms of accuracy (area under the curve [AUC] = 0.67 versus AUC = 0.66), and both identified physical inactivity, depression, and pain expansion as the main predictors of high pain levels. Conclusion: Our findings provide useful information for clinicians and those involved in physical activity, exercise and sport programs for assessing the level of pain in people with back pain, offering an easy-to-interpret visual model with similar accuracy to traditional models.

Introduction: Widespread or all over pain (AOP) can affect daily life by reducing functional capacity and fitness, and increases motor difficulties (MD), frailty and dependence more severely than localized pain. Physical activity (PA) may be related to hand grip strength (HGS), MD and frailty in people with AOP. Material and methods: This cross-sectional study, based on data from the SHARE Wave 9 survey 2021-22, in middle-aged and older European people with pain had as objectives: 1) To analyse the relationships between pain type (localized vs all over), HGS, MD and frailty; 2) To assess the associations between PA and HGS, MD and frailty in people with AOP; 3) To analyse risk factors for MD and frailty in people with AOP. Results: People with AOP presented the highest prevalence of weak HGS, MD and frailty. In people with AOP, PA was found to be related to HGS, MD and frailty. Physical inactivity was related to weak HGS and higher prevalences of MD and frailty. Physical inactivity was presented as a risk factor for MD and frailty. Conclusions: Type of pain affects HGS, MD and frailty. AOP is associated with lower HGS, greater MD and frailty. People with AOP who perform PA have higher HGS and lower MD and frailty. Physical inactivity is a significant risk factor for MD and frailty in people with AOP. These findings provide insight into the relationship between pain expansion, HGS, MD and frailty in people with pain. These findings could help new hypotheses and new care programs to address prevention and intervention in people with AOP.

Severe fatigue, difficulty falling asleep, body stiffness, cognitive impairment, and widespread pain are some of the primary symptoms experienced by individuals with fibromyalgia (FM), leading to reduced physical function, increased frailty, and elevated fall risk. The present study aimed to evaluate the effects of the Virtual Square Step Exercise (V-SSE) program on physical function, frailty, FM impact, pain, fear, and risk of falling, and fall incidence in women with FM. A randomized controlled trial was conducted with 61 sedentary Spanish women with FM. Participants were randomly assigned to two groups: V-SSE and the control group. The V-SSE group completed an exercise program based on the V-SSE for 12 weeks (3 sessions/week), while the control group maintained their usual lifestyle and treatment. Physical function was assessed using the Timed Up and Go (TUG), Four-Step Square (FSST), 6-Minute Walking Test (6MWT), and others. Frailty was assessed with the Short Physical Performance Battery (SPPB). FM impact, pain, falls, and fear of falling were evaluated via questionnaires. Significant intergroup differences were only found in the 30 m Walking Test (p = 0.023; E.S. = 0.539), due to worsening in the control group. Although significant improvements were found in other variables in the V-SSE group, Dual Sit to Stand (p = 0.038), FM impact (p = 0.010), pain (p = 0.003) and falls (p = 0.037), these did not remain statistically significant after adjusting for multiple comparisons, nor were they corroborated in the intergroup comparison. A 12-week program based on the V-SSE was not effective in improving physical function, frailty, FM impact, pain, falls, fear, and risk of falling in Spanish women with FM.

Background/Introduction: Psychological inflexibility, which includes experiential avoidance, is a transdiagnostic process associated with multiple mental health issues in adolescence. Physical fitness (PF) has shown benefits for mental well-being, yet its specific relationship with psychological inflexibility remains understudied, particularly among youth. Objectives: To examine the association between components of PF and psychological inflexibility, measured by the Acceptance and Action Questionnaire-II (AAQ-II), in a representative sample of Spanish adolescents. Methods: A cross-sectional analysis was conducted using data from 631 adolescents (aged 12–17) participating in the Eating Healthy and Daily Life Activities (EHDLA) study. PF was assessed by the Assessing the Levels of PHysical Activity and Fitness (ALPHA-Fit) Test Battery (cardiorespiratory fitness, muscular strength, agility, and flexibility). Psychological inflexibility was measured using the AAQ-II. Generalized linear models (GLMs) were used to evaluate associations, adjusting for age, sex, body mass index, socioeconomic status, physical activity, sedentary behavior, sleep duration, and energy intake. Results: Unadjusted analyses showed weak but significant associations between psychological inflexibility and performance in the 20 m shuttle run test (p = 0.002), the 4 × 10 shuttle run test (p = 0.005), and the sit-and-reach test (p < 0.001). However, after adjusting for covariates, none of the PF components maintained a statistically significant association with the AAQ-II scores. Conclusions: In this adolescent sample, PF components were not independently associated with psychological inflexibility after adjustment for key confounders. These findings suggest that, while PF may contribute to general well-being, it is not a primary determinant of psychological inflexibility. Further longitudinal and intervention studies are needed to clarify the mechanisms linking physical and psychological health in youth.

Fibromyalgia is a condition that primarily affects women and compromises the quality of life (QoL), life satisfaction (SWL), mental health and cognitive function of sufferers. This study aimed to analyze the effects of a physical activity program based on Virtual Square Step Exercise on the above conditions in women with FM. A 12-week randomized controlled trial was designed with 61 women with FM assigned to a control group (CTL) and an experimental group (VSEE). The VSSE group performed VSSE sessions three times a week for 12 weeks, while the CTL continued with their usual treatment. The applicability and safety of the program was tested in this population. In addition, the participants’ QoL, SWL, mental health status, and cognitive function were assessed before and after the intervention program using different questionnaires and tests. VSEE was found to be applicable (with adherence greater than 85%) and safe (with no accidents, injuries, or health-compromising incidents) in women with FM. The VSEE showed a significant reduction in self-perceived depressive symptoms compared to the control group (p < 0.05). In contrast, no significant changes in QoL, SWL, mental health and cognitive function were observed in the VSEE compared to the CTL (p > 0.05). Therefore, even though our VSEE-based intervention was found to be applicable and safe in women with FM, it did not produce significant changes in improving QoL, SWL, mental health, and cognitive function in our sample. The small sample size and post-pandemic context may have affected the findings. More research with a larger sample size is needed to confirm the effects and applicability of VSEE in women with FM.

Healthy lifestyles may have the potential to be protective factors for mental health problems. The aim was to classify drinkers and former drinkers in depression sufferers or non-sufferers according to demographic data and lifestyle habits, using a classification and regression tree (CRT). This cross-sectional study is based on the NHANES 2011-20. 3175 participants (2342 males and 833 females) drinkers and former drinkers formed the final sample. CRT analysis was used to classify them in depression sufferers and non-sufferers. Odds ratio (OR) and relative risks (RR) of suffering depression for each branch of the tree were calculated. The model was found to have an 82.0% accuracy. Independent variables were classified by their importance in the model, in this order: diet (0.007; 100.0%), gender (0.004; 60.4%), PA group (0.003; 45.4%), sedentary time (0.002; 32.6%), education level (0.001; 29.1%) and age (<0.001; 7.1%). Elevated OR and RR of suffering depression were found for participants with: fair and poor diet compared to good, very good or excellent diet (OR = 2.02, CI95%: 1.69-2.43, RR = 1.77, CI95%: 1.52-2.10), for inactive, walkers and low PA, compared to moderate PA and high PA (OR = 1.99,CI95% = 1.53-2.60, RR = 1.68, CI95%:1.37-2.07), for females compared to males (OR = 2.00, CI95%:1.54-2.66, RR = 1.81, CI95%:1.45-2.26), for people with a '9-11th grade' or below education level compared to those with a higher level of education (OR = 1.50, CI95%:1.05-2.15, RR = 1.32, CI95%:1.04-1.67) in branch beneath node 3; and for people with a high school/GED or below education level, compared to those with higher education (OR = 1.99, CI95%:1.27-3.13, RR = 1.71, CI95%:1.21-2.43), in branch beneath node 6. Diet, PA group, sedentary time, gender, education level and age allow us to classify drinkers and former drinkers in sufferers or non-sufferers of depression. The CRT model combined with OR and RR allow us to identify which participants have greater odds of suffering depression based on lifestyle and demographic data.