EFFECT OF AN AEROBIC EXERCISE PROGRAM ON METABOLIC DISORDERS LEVELS IN HIGHER EDUCATION STUDENTS AT THE UNIVERSITY OF COLIMA, RANDOMIZED CLINICAL TRIAL.
Phase: NA
Conditions: Metabolic Disorders, Abdominal Obesity, Blood Pressure Disorders, Hypertriglyceridemia, Hyperglycemia, HDL-Deficiency
Sponsor: Universidad de Colima

FACULTY OF MEDICINE
MASTER’S DEGREE IN MEDICAL SCIENCES
THESIS TO OBTAIN THE MASTER’S DEGREE IN MEDICAL
SCIENCES
EFFECT OF AN AEROBIC EXERCISE PROGRAM ON METABOLIC DISORDERS
LEVELS IN HIGHER EDUCATION STUDENTS AT THE UNIVERSITY OF COLIMA,
RANDOMIZED CLINICAL TRIAL.
PRESENTED BY
Nelson Enrique Ramos Cuevas
ADVISORS
CLINICAL ADVISOR: Dr. FABIÁN ROJAS LARIOS
BASIC ADVISOR: Dr. PEDRO JULIÁN FLORES
Colima, Col, Mexico, August 2024

Index
Content
Abbreviations............................................................................................................................. 4
Resumen......................................................................................................................................5
Abstract.......................................................................................................................................6
1. Introduction............................................................................................................................7
2. Theoretical Framework.........................................................................................................9
2.1.1 Definition of Metabolic Disorders...............................................................................9
2.1.2. Epidemiology of Metabolic Disorders.........................................................................9
2.1.3. Aetiology of Metabolic Disorders...........................................................................................10
2.1.4. Abdominal Obesity................................................................................................................. 10
2.1.4.1. Epidemiology of Abdominal Obesity............................................................................10
2.1.4.2. Aetiology of abdominal obesity.....................................................................................11
2.1.4.3. Pathophysiology of abdominal obesity..........................................................................11
2.1.5 Dyslipidemias...........................................................................................................................13
2.1.5.1. Epidemiology of dyslipidemias..................................................................................... 13
2.1.5.2. Aetiology of dyslipidemias............................................................................................13
2.1.5.3. Pathophysiology of dyslipidemias.................................................................................14
2.1.5.4 Hypertriglyceridemia......................................................................................................15
2.1.5.5. Epidemiology of hypertriglyceridemia..........................................................................15
2.1.5.6 High-density lipoproteins (HDL)................................................................................... 15
2.1.5.7. Altered HDL epidemiology........................................................................................... 16
2.1.6. Arterial hypertension...............................................................................................................16
2.1.6.1. Epidemiology of high blood pressure............................................................................16
2.1.6.2. Aetiology of Arterial Hypertension...............................................................................17
2.1.6.3. Pathophysiology of arterial hypertension...................................................................... 17
2.1.7. Hyperglycemia........................................................................................................................ 18
2.1.7.1. Epidemiology of Hyperglycemia...................................................................................18
2.1.7.2. Aetiology of Hyperglycemia......................................................................................... 18
2.1.7.3. Pathophysiology of Hyperglycemia...............................................................................19
2.2. Diagnosis and evaluation of metabolic disorders.......................................................................19
2.2.1. Tests and Diagnosis for Determining Abdominal Obesity......................................................19
2.2.2. Testing and diagnosis of factors (TG and HDL) involved in dyslipidemia............................ 19
2.2.3. Test and diagnosis of systemic arterial hypertension.............................................................. 20
2.2.4. Testing and Diagnosis of Blood Glucose Alterations............................................................. 21
2.3. Factors Associated with Metabolic Disorders in Higher Education Students........................... 21
2.3.1. Unbalanced diet as a risk factor in metabolic disorders among higher education students....21

2.3.1. Sedentary lifestyle and physical inactivity as a risk factor in metabolic disorders in higher
education students............................................................................................................................. 22
2.4. Impact of physical exercise on metabolic disorders...................................................................24
3. Justification........................................................................................................................................ 25
4. Problem statement............................................................................................................................. 26
5. Methodological Design...................................................................................................................... 27
5.1. Research Question......................................................................................................................27
5.2 Objectives....................................................................................................................................27
5.2.1 General Objective.............................................................................................................. 27
5.2.2. Specific Objectives........................................................................................................... 27
5.3 Hypothesis...................................................................................................................................28
6. Methods and materials...................................................................................................................... 28
6.1 Study design................................................................................................................................ 28
6.2 Sample size..................................................................................................................................28
6.3. Selection criteria.........................................................................................................................30
7. Variable operationalisation...............................................................................................................31
8. Location for carrying out the protocol.............................................................................................33
9. Study Procedure.................................................................................................................................33

Abbreviations
PA
Physical Activity
MD
Metabolic Disorders
ATP
Adenosine Triphosphate
AC
Abdominal Circumference
CEPT
Cholesteryl Ester Transfer Protein
ENSANUT
National Health and Nutrition Survey
NCDs
Non-communicable Diseases
GLUT2
Glucose Transporter Type 2
HD
High-Density Lipoprotein
AH
Arterial Hypertension
BMI
Body Mass Index
INEGI
National Institute of Statistics and Geography
IPA-Q
International Physical Activity Questionnaire
LDL
Low-Density Lipoprotein
WHO
World Health Organization
PAHO
Pan American Health Organization
TG
Triglycerides
UNAM
National Autonomous University of Mexico.

Resumen
Este estudio es un ensayo clínico aleatorizado simple, y tendrá como objetivo: Evaluar el
efecto de un programa de ejercicio físico aeróbico sobre la disminución de los triglicéridos
,presión arterial, obesidad abdominal, glucosa alterada y el aumento en el HDL en estudiantes
de nivel superior de la Universidad de Colima, ya que en esta población mexicana se ha
presentado una alta prevalencia de obesidad, sedentarismo e inactividad física, factores que
influyen en el alto riesgo para el desarrollo de los trastornos metabólicos y enfermedades
cardiovasculares. Material y método: Se implementará un ensayo clínico aleatorizado simple.
La muestra será de 48 estudiantes de nivel superior voluntarios de la Universidad de Colima,
que estarán divididos en dos grupos de 24 personas. Instrumentos: Cuestionario IPA-Q (Anexo
6), circunferencia abdominal (anexo 7), presión arterial (anexo 8), extracción de sangre por
punción venosa para el HDL, triglicéridos y glucemia (anexo 9) Queen´s college step test (10).
Procedimiento: Una vez se reclute y se procese toda la información de las pruebas, se tomarán
en cuenta los criterios de inclusión establecidos (tabla 2) para obtener el total de la muestra. Se
realizará una aleatorización simple a través de una bolsa con sobres blancos sellados que
contendrán por dentro la letra al grupo que pertenece el sujeto. Cada participante sacará un
sobre, escribirá su nombre encima de él y lo entregará a la persona encargada, posteriormente,
estos sobres se abrirán y se asignarán los participantes a los grupos siguiendo el criterio del
simple ciego, de acuerdo con la letra que tenga dentro del sobre (control n=24 y experimental
n=24). El Grupo experimental realizará un programa de ejercicio físico aeróbico (EFA) que
involucra trote, natación (actividades acuáticas) y bicicleta estática durante 8 semanas, tres
veces por semana con una duración de 60 minutos por sesión de ejercicio a una intensidad del
57% al 76% de la frecuencia cardiaca máxima (FCM). El grupo control realizará un ejercicio
físico aeróbico de caminata al 57% al 76% de la FCM. Posibles resultados: Se espera de esta
intervención tener cambios favorables en los trastornos que padece la muestra de intervención
y corroborar la eficiencia del ejercicio físico aeróbico planificado en disminuir estos riesgos.
Palabras claves: Ejercicio, obesidad, HDL, Triglicéridos, hipertensión.

Abstract
This study is a simple randomized clinical trial, its objective is to evaluate the effect of an
aerobic physical exercise program on the reduction of triglycerides, blood pressure, abdominal
obesity, altered glucose levels, and the increase in HDL in college-level students at the
University of Colima, due to the high prevalence of obesity, a sedentary lifestyle, and physical
inactivity in Mexican population, all of which contribute to a high risk for the development of
metabolic disorders and cardiovascular diseases. Methods and Materials: A simple
randomized clinical trial will be conducted with a sample of 48 voluntary students from the
University of Colima, divided into two groups of 24 people. Instruments: IPA-Q
questionnaire (Annex 6), waist circumference (Annex 7), blood pressure (Annex 8), blood
extraction by a venous puncture for HDL, triglycerides, and blood glucose (Annex 9), Queen’s
College Step Test (Annex 10). Procedure: Once all the information from the tests is collected
and processed, inclusion criteria (table 2) will be taken into consideration to obtain the total
sample. Simple randomization will be carried out through a bag of sealed envelopes that will
contain the letter of the group to which the subject belongs. Each participant will draw an
envelope, write their name on it and hand it to the supervisor. Afterwards, these envelopes will
be opened and participants will be assigned to the groups following the simple blind criteria,
according to the letter on the envelope. The Experimental Group will undergo an aerobic
physical exercise (APE) program involving jogging, swimming, and static cycling, three times
a week with a duration of 60 minutes per exercise session with a progressive intensity, which
will start at 57%-63% of the maximum heart rate (HRmax) in the first 4 weeks of the study,
and will increase to 64% -76% in the final four weeks, fulfilling the principle of progressive
overload. The control group will perform aerobic physical exercise, which will be walking at
57% to 76% of HRmax. Expected results: This intervention will lead to favourable changes
in the disorders experienced by the intervention population and, at the same time, confirm the
effectiveness of the planned aerobic physical exercise in reducing these risks.
Keywords: Exercise, Obesity, HDL, Triglycerides, Hypertension.

1. Introduction
The World Health Organization (WHO), in 2022, defines physical activity (PA) as any bodily
movement produced by skeletal muscles. Its level of effort is classified into three categories:
light, moderate, or vigorous (1). The effects of PA are strongly influenced by factors such as
volume, rest, quantity, and frequency of physical activity performed per week or day. It is
widely known that PA has numerous benefits, including the prevention of non-communicable
diseases such as overweight, obesity, type 2 diabetes mellitus, hypertension, and dyslipidemias
(2).
The Pan American Health Organization (PAHO) mentions that sedentary behaviour and
physical inactivity in the general population have contributed to the exponential increase in
non-communicable diseases, which are the most common metabolic alterations, including
dyslipidemia, hypertension, and type 2 diabetes mellitus, since more than 1.9 billion adults
worldwide have reported some form of metabolic issue (3). This silent epidemic, driven by
lifestyle habits and choices, has become a worrying shadow that looms over global health.
Henceforth, these environmental and cultural conditions disproportionately affect countries in
Latin America, particularly university students (4).
For instance, in Mexico, the National Health and Nutrition Survey (ENSANUT) in 2022
revealed that the prevalence of overweight and obesity among undergraduate students ranged
from 72.5% to 75.2%. Abdominal adiposity was reported in 39.6% of the population (5).
Additionally, high blood pressure values (>130/80 mmHg) were observed in 39.8% of the
students (6). The National Autonomous University of Mexico (UNAM) also reported that 66%
of its students across various faculties exhibited two to three metabolic alterations due to
sedentary lifestyles and inactivity (7). Therefore it is estimated that 30% of adolescents and
adults are inactive, while 50% spend an average of 1 hour and 40 minutes on transportation, 2
hours minimum on digital screens, and 3 hours and 30 minutes sitting (8). These data highlight
the high risk of metabolic imbalances, which could lead to low HDL, elevated triglycerides,
abdominal obesity, glucose alterations, and hypertension (3).

Evidence shows that adopting healthy habits through regular physical exercise significantly
reduces metabolic disturbances that substantially impact overall health (4). For instance,
engaging in concurrent aerobic exercise—based on a circuit of up to 10 exercises, each lasting
45 seconds, with 30 seconds of recovery for 8 weeks—may reduce visceral fat, lower blood
pressure, and prevent cardiopulmonary pathologies (9). Therefore, further scientific research is
necessary to maximize the evidence supporting the benefits of aerobic physical exercise for
the well-being of university populations.

2. Theoretical framework
2.1.1 Definition of Metabolic Disorders
Metabolic disorders represent a medical condition group that predisposes individuals to
imbalances in the body’s metabolic processes. These imbalances encompass physiological,
chemical, and energetic transformations within the organism. Consequently, they significantly
increase the risk of developing cardiovascular diseases and type 2 diabetes mellitus (10). This
group includes a spectrum of anomalies such as elevated triglycerides (TG), decreased
high-density lipoproteins (HDL), arterial hypertension (AH), alterations in glucose levels, and
an increase in abdominal fat. See Table 1 for details.
Table 1. Criteria for Metabolic Disorders in Adults. Ramírez 2022.
Women
Men
Abdominal Obesity
>85 cm
>90 cm
Triglycerides
≥150 mg/dl
≥150 mg/dl
HDL
<50 mg/dl
<40 mg/dl
Blood Pressure
130 mmHg/ >85 mmHg
130 mmHg/ <85 mmHg
Fasting Glucose
> 100 mg/dL
>100 mg/dL
Source: Based on reference (11)
2.1.2. Epidemiology of metabolic disorders
The prevalence of these disorders has been increasing in recent years, especially in developing
countries, where it is estimated that between 20% and 50% of the population may be affected
(3). Cristóbal in 2021 and Ismael in 2022 have reported a high prevalence of abdominal fat
among young university students in Mexico, ranging from 56.6% to 72.5% (5,7). Likewise,
this population significantly exceeds the prevalence of arterial hypertension (AH), with
multiple authors, such as Hidalgo in 2019 and Campos in 2022, revealing that 56.49% to 60%

of individuals present this condition (6, 12). These statistics reflect a broader health issue, as
evidenced by the fact that cardiovascular diseases rank among the leading causes of death in
young adults aged 15 to 24 years, according to data from the National Institute of Statistics
and Geography (INEGI) in 2022 (13).
2.1.3. Aetiology of Metabolic Disorders
The factors contributing to the development of metabolic disorders are multifactorial,
involving genetics, as well as environmental and cultural influences. However, environmental
factors, particularly unhealthy eating habits, sedentary lifestyles, and lack of physical activity,
play a predominant role (14), since the trend towards a diet high in saturated and trans fats,
along with the consumption of ultra-processed foods, combined with a sedentary lifestyle,
contributes greatly to the onset and progression of these disorders, increasing the chances of
developing cardiovascular and cerebrovascular diseases (14).
2.1.4. Abdominal Obesity
According to Rebolledo in 2020, abdominal obesity is an excessive accumulation of lipids in
the abdominal area, which is divided into two types: subcutaneous fat, located beneath the
skin, and visceral fat, situated around internal organs within the abdominal cavity (10).
According to the World Health Organization (WHO), the risk thresholds for abdominal
circumference are 90 cm for men and 85 cm for women.
2.1.4.1. Epidemiology of Abdominal Obesity
Abdominal obesity is a multifactorial condition. Research by Flores in 2020, Cristóbal in
2021, and Ismael in 2022 revealed the prevalence of this condition among university students
in Mexico, ranging from 56.6% to 72.5% (2,5,7).
Likewise, Salazar and colleagues investigated students' body mass index (BMI) and
physical activity levels at the University of Colima in 2013, finding that 37.9% of students fell

into the overweight or obese range. They also used the International Physical Activity
Questionnaire (IPAQ) to assess physical activity levels and found that 53.7% had deficiencies
in it, providing additional insight into the link between physical activity and obesity (15).
2.1.4.2. Aetiology of abdominal obesity
Abdominal obesity results from the interaction of multiple factors, encompassing biology,
individual psychology, food consumption, and physical activity (10). Biological factors play a
primary role in abdominal obesity, influencing not only the distribution of body fat but also the
individual’s metabolic response to various stimuli and conditions (16). Variations in genes that
regulate appetite and satiety, such as leptin, have been identified as capable of determining a
person’s predisposition to accumulate fat in the abdominal region and their ability to
metabolize nutrients efficiently (10).
Environmental factors, including socioeconomic, cultural, and racial aspects, significantly
impact the development of abdominal obesity. Specifically, sedentary lifestyles, and physical
inactivity, accompanied by diets rich in saturated fats and sugars contribute exponentially to
increased abdominal fat (17).
2.1.4.3. Pathophysiology of abdominal obesity
The process begins with the ingestion of these foods, which are broken down into glucose
within the small intestine. Subsequently, the pancreas receives information about high glucose
concentrations in the body through the facilitated diffusion of glucose transporter type 2 (Glut
2). In response, it secretes insulin, which assists glucose entry into the cell membrane with the
help of Glut 4 via exocytosis (18).
Once glucose is inside the cell, it initiates various metabolic processes. The first one is
glycolysis, which functions to break down glucose into its simplest form through ten steps:
(Glucose 6 phosphate, fructose 6 phosphate, fructose 1,6 diphosphate, dihydroxyacetone,
glyceraldehyde 3-phosphate, 1,3 bisphosphoglycerol, 3 phosphoglycerate, 2 phosphoglycerate,

phosphopyruvate and finally 2 molecules of pyruvate). In the first four steps, two ATP
molecules are consumed. Following this, two pathways are formed: dihydroxyacetone and
glyceraldehyde-3-phosphate, the first pathway is quickly converted into glyceraldehyde
3-phosphate by an enzyme called Triose-phosphate isomerase to continue its degradation
process (17). These reactions conclude in two molecules of pyruvate, two ATP and two
molecules of NADH, after this result, the pyruvate molecules start the second process in the
Krebs cycle (initially converting to Acetyl-CoA), which has the function of extracting the
maximum amount of energy possible through different molecules (ATP, FAD, NAD). These
molecules act on another molecule called citrate (union of oxaloacetate and acetyl-CoA),
which undergoes 8 changes (citrate, cis-aconitate, D-isocitrate, ketoglutarate, succinyl-CoA,
succinate, fumarate, malate, and oxaloacetate). Among these changes, two involve water
binding and recovery, five involve dehydrogenase production, and one produces synthetase.
For each Krebs cycle, 10 NADH and 2 FADH molecules are made, and then these
energy-loaded hydrogen molecules proceed to the final step of oxidative phosphorylation; This
consists of extracting the hydrogen protons through four complexes located in the
mitochondrial membrane to take them to the intermembranous space for them to be absorbed
again in an event called Chemiosmosis, which captures the hydrogen protons in an ADP
molecule to synthesize phosphate and thus create ATP with the assistance of oxygen.
Subsequently, the generated ATP is directed to all body tissues to provide said energy (7,17).
If this energy remains unused in any system or tissue, de novo synthesis occurs, converting it
into free fatty acids, Later, three fatty acids combine with glycerol-3-phosphate to become a
triglyceride, and be stored as an energy reserve at medium or long term in cells called white
adipocytes (19), abdominal adipocytes are most susceptible to this process, since they have a
greater capacity for hypertrophy.
If an individual continues to consume such foods while
leading a sedentary lifestyle, the body will induce adipocyte hyperplasia, resulting in
abdominal obesity. Various authors have determined that an increase in this condition elevates
the risk of cardiovascular and cerebrovascular diseases (7,10).

2.1.5 Dyslipidemias
Dyslipidemias are imbalances or alterations in plasma lipids. They are characterized by an
elevation in triglycerides (>150 mg/dL), VLDL (>30 mg/dL), and cholesterol (>200 mg/dL).
As well as a decrease in high-density lipoprotein (HDL) levels (<40 mg/dL in men and <50
mg/dL in women) (20). Generally, this condition is 20% more common in individuals
diagnosed with type 2 diabetes mellitus (DM2), obesity, hypertension, and polycystic ovary
syndrome (PCOS) (17,21). Table 1.
2.1.5.1. Epidemiology of dyslipidemias
Dyslipidemias are one of the most frequent causes in the development of cardiovascular
diseases (3). Ismael in 2022, and Ortega & Macheno in 2023 revealed the prevalence of
dyslipidemias among university students in Mexico, which ranged from 21.1% to 37.1% (5,
22–24).
Similarly, in 2020, Ramos and colleagues investigated the prevalence of dyslipidemias
among university students in southern Mexico. Their results indicated that the most significant
alteration observed in these students was hypertriglyceridemia at 35.7%, followed by
hypercholesterolemia at 21.4%. Thus, it is concluded that these individuals were at a high risk
of complicating their health status (25)
2.1.5.2. Aetiology of dyslipidemias
Dyslipidemias can be caused by two factors: genetic or environmental. Genetic factors refer to
individuals with first-degree relatives affected by this condition, making them highly
susceptible
to
it.
The
primary
genetically
caused
dyslipidemias
are
familial
hypercholesterolemia, familial combined dyslipidemia, polygenic hypercholesterolemia, and
familial hypertriglyceridemia (26). On the other hand, environmental factors stem from the
unhealthy lifestyle of the aforementioned subjects (26,27).

2.1.5.3. Pathophysiology of dyslipidemias
Dyslipidemias due to environmental causes begin with an excessive accumulation of
triglycerides, which undergo five different states to be formed. Among them, we can mention
glycerol 3 phosphate (this molecule can come from two processes: from a Dihydroxyacetone
phosphate, which is an intermediate of glycolysis, or from glycerol which is part of lipolysis).
As this molecule forms, it activates the enzyme glycerol-3-phosphate acyltransferase (located
in the endoplasmic reticulum), which has the function of adding an activated fatty acid
(Acyl-CoA) to the molecule that then receives the name of Lysophosphatidate. In addition,
another enzyme called acyl glycerol phosphate acyltransferase immediately acts to add
another Acyl-CoA, but this time, an unsaturated one, resulting in a molecule named
phosphatidate (28). To capture the final unsaturated fatty acid, the glycerol-3-phosphate
molecule must eliminate its phosphate group through an enzyme called phosphatidate
phosphohydrolase. This process leads to the formation of diacylglycerol, which can then
accept the last activated fatty acid via the enzyme diacylglycerol acyltransferase, ultimately
forming triglycerides. Figure 1.
Figure: 1. Overview of lipoprotein metabolism.
Image taken from Pavia 2022(29).

Large amounts of triglycerides present in the blood can be harmful to health if they are not
stored as reserve energy through the process called lipogenesis, which results in their elevation
or conversion into very low-density lipoprotein (VLDL), and creates other health problems
such as the decrease in HDL, since it delivers stratified cholesterol to VLDL, which in turn
delivers triglycerides via a protein called CETP (cholesteryl ester transfer protein), when
triglyceride-loaded HDL reaches the liver, it does not release the triglycerides but instead
degrades
them
using pancreatic lipase. Consequently, this leads to decreased HDL
concentrations (26,27). Figure 2.
Figure 2. Behavior of HDL in the human organism.
Source: Taken from Macheno (24).
2.1.5.4 Hypertriglyceridemia
Triglycerides are a type of lipids present in the blood and adipose tissue. They function as
storage for unused calories, not utilized as energy. When their levels in the body exceed 150
mg/dL, they can lead to the excessive accumulation of fat in adipocytes, and thus increase the
risk of developing cardiovascular diseases such as hypertension, hyperlipidemia, and
hardening of the arteries (atherosclerosis) (21). Table 2.

2.1.5.5. Epidemiology of hypertriglyceridemia
Triglycerides can be referred to as multifactorial. In 2022, ENSANUT, and in 2021, Gallego,
reported the prevalence of this condition among university students in Mexico. According to
their findings, 8.6% to 21.1% of students had this alteration, which could increase the risk of
cardiovascular and cerebrovascular diseases (5,30). Table 2.
Table 2. Blood Triglyceride Leves in Adults
Triglyceride Level
Concentration (mg/dl)
Normal
< 149 mg/dl
Altered
≥150 mg/dl
Source: Adapted from ATP III (31)
2.1.5.6 High-density lipoproteins (HDL)
HDL has various functions, one of the most well-known being its role as a “scavenger” for
cholesterol, removing excess cholesterol from arterial walls and returning it to the liver, where
it is “discarded”, added to the bile and eliminated through feces, since the human body cannot
degrade cholesterol on its own (28). According to the Adult Treatment Panel III (ATP III)
guidelines for dyslipidemia, the cutoff points for potential risk are <40 mg/dL in men and <50
mg/dL in women (31).
2.1.5.7. Altered HDL epidemiology.
The epidemiology of HDL in individuals can be crucial for their overall health. Therefore, it
constitutes a crucial field in cardiovascular health research among university students in
Mexico. Some authors reported that the prevalence of this condition in this population ranged
from 6% to 21.1% (5,30,32).

In 2020, González conducted a study to determine the prevalence of lipid profile alterations
in students from two Mexican universities. Among their findings, HDL showed an alteration
rate of 6.7% in the subjects. It was also emphasized that this condition could lead to the
development of related diseases, which might play a decisive role in future cardiovascular and
cerebrovascular conditions (33).
2.1.6. Arterial hypertension.
According to the ATP III guidelines, arterial hypertension is a multifactorial disease
characterized by consistently high blood pressure, with a cutoff point of >130/85 mmHg (31).
These values are associated with an increased risk of cardiovascular diseases, stroke, and
chronic kidney diseases (12)
2.1.6.1. Epidemiology of high blood pressure
The 2022 ENSANUT study revealed that 39.6% of young adults in Mexico with education
beyond secondary school suffered from this condition. This percentage increased to 58.8% if
individuals had abdominal obesity (6).
Another study conducted by Almazán and colleagues in 2020 aimed to determine the
prevalence of metabolic disorders among Mexican university students. The study concluded
that 64.8% of students had systemic hypertension, which the author attributed to poor diet,
sedentary lifestyle, and physical inactivity (34).
2.1.6.2. Aetiology of Arterial Hypertension
Cardona and colleagues in 2022 affirm that the causes of hypertension are classified into two
categories: environmental and genetic. These, in turn, are further divided into two subtypes:
primary and secondary hypertension. Primary hypertension, which represents between 90%
and 95% of cases, is segmented into genetic and environmental factors (35). Genetic factors
include dysfunction of angiotensin receptors, reduced renal excretion, and the effects of

vasoconstrictive influences such as arterial hyperplasia or hypertrophy. These elements
significantly contribute to the increase in blood pressure (35).
2.1.6.3. Pathophysiology of arterial hypertension.
On the other hand, environmental factors associated with primary hypertension include being
overweight, lack of physical activity, high-stress levels, and the consumption of foods with
elevated amounts of salt or sodium chloride. These habits and conditions lead to a severe
imbalance in the body. Typically, this condition does not exhibit evident symptoms until blood
pressure is measured using a baumanometer (35,36).
The pathophysiology of hypertension is multifactorial. However, when there is an alteration
in the renal environment, sodium elimination may decrease, sequentially leading to increased
blood volume, cardiac output, and peripheral vasoconstriction. Additionally, there is an
imbalance in the renin-angiotensin-aldosterone axis. This axis, due to prior stability in
response to a false perception of pressure decline, stimulates the adrenal glands and promotes
aldosterone retention of sodium. Consequently, blood pressure within the blood vessels
transitions to a state of arterial hypertension through the aortic baroreceptors (blood
pressure-sensing receptors), which detect unusual pressure changes and, in turn, influence
cardiac output and peripheral resistance (35,37). Figure 3.

Figure 2. Regulation of blood pressure through the renin-angiotensin-aldosterone
system. Taken from González in 2020. Source: Based on reference (38).
2.1.7. Hyperglycemia
Alteration in glucose refers to a permanently abnormal change in these levels. According to
the ADA criteria in 2024, these alterations can be expressed through various tests, such as
fasting plasma glucose with a result >100 mg/dL or glycated hemoglobin (HbA1c) with results
exceeding >5.7% (39 mmol/mol) (39).
2.1.7.1. Epidemiology of Hyperglycemia
The epidemiology of blood glucose alterations is crucial for understanding the population’s
health status. In 2022, Baltazar in 2022 and Basto in 2023 reported the prevalence range of
glucose abnormalities among higher-level students in Mexico, which ranged from 14.3% to
29% (40,41).

Similarly, in 2022, Zenteno and colleagues conducted a study in a private school in Tuxtla
Gutiérrez, Chiapas, which aimed to determine the prevalence of different metabolic disorders
among students at that institution. The study revealed that 25.3% exhibited hyperglycemic
alterations, and 56% of them reported a sedentary lifestyle, extrapolating the risk factors for
cardiovascular diseases (32).
2.1.7.2. Aetiology of Hyperglycemia
Blood glucose alterations have different degrees. The first degree refers to genetic
modifications, which may involve changes in the TCF7L2 gene (which plays a role in insulin
control), the CAPN10 gene (calpain 10) which is linked to glucose homeostasis, and the
KCNJ11 gene (a potassium channel, Subfamily J11). The latter gene encodes a potassium
channel subunit associated with insulin secretion. Additionally, (42). The environmental
degree refers to diets with high consumption of saturated fats, excessive intake of sugary
products, and other components, such as a sedentary lifestyle and physical inactivity (43).
2.1.7.3. Pathophysiology of Hyperglycemia
The hormone responsible for regulating blood glucose is insulin, which is produced in the
pancreas, an organ that consists of two types of tissue: exocrine and endocrine. The endocrine
tissue includes Langerhans islets (these islets are composed of Alpha, Beta, and Delta cells).
Beta cells play a crucial role in this process, as they can produce up to 60% of active insulin
and Amylin (44). Whereby, If there is any disruption in the production of active insulin by
pancreatic cells, it directly leads to permanently elevated blood glucose levels. This, in turn,
can result in potential health complications for the individual. Figure 4.

Figure 3. Behaviour of glucose in the human body. Based on González in 2020
Source: Based in León in 2023(38).
2.2. Diagnosis and evaluation of metabolic disorders
2.2.1. Tests and Diagnosis for Determining Abdominal Obesity
There are two widely established methods for measuring abdominal fat parameters. One of
them is bioimpedance (a scale that quantifies body composition using electrodes), and the
second method is abdominal circumference measurement using a measuring tape, with results
given in centimetres. In order to perform the abdominal circumference test, the patient should
be in the anatomical position. Subsequently, the mid-axillary line is located, at the midpoint
between the costal margin and the iliac crest, which has to be marked with a pen, to serve as a
guide to place a certified measuring tape, to measure the circumference at the end of a normal
expiration. Making at least two measurements and calculating their average (45) is
recommended. The results are compared with the WHO cut-off points: >90 cm in men and
>85 cm in women (46).

2.2.2. Testing and diagnosis of factors (TG and HDL) involved in dyslipidemia.
For an initial detection of dyslipidemia, it is essential to consider the following: A
comprehensive
medical
history,
including
family
history
of
cardiovascular diseases,
pancreatitis, obesity, arterial hypertension, dyslipidemias, smoking, alcoholism, as well as an
evaluation of diet and physical activity (47).
Additionally, laboratory testing is a better option. The lipid profile is a laboratory analysis
that aims to determine the concentrations of various fats in the blood, including total
cholesterol, LDL, HDL, and triglycerides. These analyses are crucial for assessing the risk of
vascular and cardiovascular diseases (48). It is essential that the patient undergoes this analysis
after fasting (8 to 12 hours before the test) and abstains from alcohol consumption for 24
hours. The test involves a venous puncture to collect a blood sample, which will be analyzed
by authorized equipment (48). The obtained results should be correlated with established
cutoff points. Table 1. There is a close relationship between dyslipidemia and increased
hypertension, as cholesterol, LDL, and triglycerides can cause damage and blockages in
arterial walls (47).
2.2.3. Test and diagnosis of systemic arterial hypertension
For the diagnosis of systemic arterial hypertension (SAH), the test must be performed with a
stethoscope and a sphygmomanometer (Baumanometer) with a properly calibrated band. The
process begins with the patient sitting for 5 to 10 minutes to stabilize blood pressure.
Afterwards, the Baumanometer band will be wrapped around the arm, it should be 2 or 3 cm
above the fold of the elbow joint. Next, the brachial artery must be palpated to be able to place
the bell of the stethoscope at the level of the brachial artery (The centre of the camera must
align with the brachial artery). Once these steps have been completed, the handle of the
manometer will be inflated until a pressure of 160 mmHg is reached. After reaching this
reference, the valve will be opened gradually with a speed of 2 to 3 mmHg/second, listening in
turn to the pulsations emitted by the body to determine systolic and diastolic blood pressure

(35). If the patient obtains a systolic blood pressure of >130 mmHg and diastolic blood
pressure of >80 mmHg, an alteration in blood pressure must be confirmed (36). Annex 5.
2.2.4. Testing and Diagnosis of Blood Glucose Alterations
To determine blood glucose alterations, a step-by-step process should be followed, starting
with general recommendations. One of the most important steps is to fast for a minimum of 8
hours(49). The blood sample will be obtained through a venous puncture technique, filling a
clinical tube specifically for fasting glucose testing. After collection, the tube will be taken to
the laboratory for analysis(50). If the patient’s results show >100 mg/dL to 125 mg/dL, they
may be diagnosed with prediabetes(39).
2.3. Factors Associated with Metabolic Disorders in Higher Education Students
In 2022, the Pan American Health Organization (PAHO) reported that cardiovascular diseases
accounted for the majority of deaths due to non-communicable diseases (NCDs), totalling 17.9
million deaths annually, while diabetes contributed to 1.6 million deaths worldwide(3). The
risks that can exacerbate these figures include metabolic alterations such as Abdominal
obesity, hypertension, HDL, triglycerides, glucose alterations, sedentary lifestyle and physical
inactivity (51). These factors significantly impact young people and adolescents, since,
worldwide, over 80% of them exhibit insufficient levels of physical activity (52). The WHO
recommends adopting healthy practices, including quitting smoking, maintaining a balanced
diet, achieving a healthy weight, reducing alcohol consumption, and minimizing sedentary
behaviour and physical inactivity to mitigate the risks associated with these metabolic
disorders(7,52,53).

2.3.1. Unbalanced diet as a risk factor in metabolic disorders among higher education
students
Diet, in addition to serving as a fundamental human need, fulfils various societal functions
related to cultural customs, socioeconomic factors, and even shared events that reflect
collective well-being (54).
PAHO determined that eating habits are established during childhood and adolescence,
influenced by various channels of interaction, including family dynamics. However, over time,
social circles, lifestyle, and dietary patterns evolve to align with sociocultural trends and
demands (55). When students enter university life, they often move away from their family
nucleus, leading to an adjustment to new living situations. Economic circumstances, cooking
skills, and dietary customs shared with peers all play a role in this adaptation (54).
Therefore, the lifestyle changes associated with the start of university life significantly
impact both physical and mental health. Many young individuals exhibit inadequate eating
habits, characterized by excessive consumption of fast food, skipping breakfast, irregular meal
times, and high intake of meat, sweets, pastries, and sodas as their main beverages. These
dietary patterns negatively affect overall nutritional status and health (54, 56).
According to perspectives from Ramos 2020, Lozano 2021, and ENSANUT 2022, nutrition
surveys reveal that Mexican higher education students have obesity rates ranging from 48.6%
to 72.5%, which is highly detrimental to cardiovascular health, especially when combined
with the widespread physical inactivity and sedentary behaviour observed among young
individuals (5, 25).
2.3.1. Sedentary lifestyle and physical inactivity as a risk factor in metabolic disorders in
higher education students.
The World Health Organization (WHO) and Silveira in 2022 define physical inactivity as
failing to engage in 150 minutes of moderate-intensity physical activity or 75 minutes of

vigorous-intensity activity per week. Likewise, they define sedentary behaviour as engaging in
activities with a basal energy expenditure equal to or less than 1.5 METs (unit of measurement
for metabolic rate or energy consumed while at rest) (annexe 12). Examples of such activities
include sitting for long hours at university or home, lying down, looking at a cell phone, or
doing desk work (52,57).
According to the PAHO and the National Health and Nutrition Survey (ENSANUT) in
2022, physical inactivity levels in Latin America increased from 33% to 39% (58). In Mexico,
there has been a growth from 14% in 2016 to 20.8% in 2018(59). The latest ENSANUT report
reveals that 42.6% of adolescents aged 15 to 19 don’t accumulate an average of at least 60
minutes per day of moderate or vigorous physical activity (MVPA), 90.8% of them spend >2
hours daily in front of screens, and 48.1% of adolescents aged 14 to 17 do not get the
recommended sleep duration for their age (8 to 10 hours per day) (60).
In a study conducted by the National Autonomous University of Mexico (UNAM),
researchers identified the precursor factors for metabolic alterations that students at the
university might experience. Upon collecting this information, the results revealed that 56% of
the university population is sedentary, and 90% reported inadequate dietary habits. With such
compelling parameters, the author asserts that this population is at high risk of developing
metabolic disorders in the short or long term, thereby compromising their cardiovascular
health(7). Additionally, a study assessed the cardiorespiratory fitness VO2max of medical
students using the Queens College Step Test (a method to determine cardiorespiratory fitness
based on maximum oxygen consumption). The results indicated that the subjects had moderate
cardiorespiratory fitness, associated with physical inactivity, sedentary behaviour, and
unhealthy dietary changes, further increasing the risks of metabolic alterations(61).
Therefore, in 2022, the World Health Organization (WHO) and the Pan American Health
Organization (PAHO) recommended engaging in physical activity for at least 150 minutes per
week. This can be broken down into 75 minutes of vigorous activity and another 75 minutes
following the aerobic metabolic pathway to maximize oxygen transport across different body
systems(1,58). Likewise, there is evidence that aerobic exercise, adhering to the principles of

Frequency, Intensity, Time, and Progress (FIIT), can positively influence the reduction of these
metabolic alterations, potentially restoring balance(62).
Silveira in 2022, and Basto and Medina in 2023 have highlighted that inactive individuals
who gradually transition to moderate physical activity (MPA) do not face known risks of
sudden cardiac events, decrease metabolic alterations and have minimal chances of bone,
muscle, or joint injuries(40,57,60). Individuals accustomed to MPA can gradually progress to
vigorous physical activity (VPA)(63).
2.4. Impact of physical exercise on metabolic disorders
Physical activity (PA) encompasses any bodily movement generated by skeletal muscles,
requiring energy expenditure and is categorized into intensity levels: light, moderate, and
vigorous(1). In 2022, the World Health Organization (WHO) recommends engaging in PA
through planned, repetitive, and directed physical exercise. The goal is to improve and
maintain physical fitness, involving body and muscle movement to enhance strength, speed,
endurance, or flexibility, thereby promoting cardiovascular health(52). Likewise, PA aims to
tailor exercise to individual needs, considering diverse physical capacities, since each person
may have their advantages and limitations. Not least, PA aims to maintain proper warm-up,
central exercise, and cool-down phases for effective and safe practice, ultimately promoting an
active and healthy lifestyle(64).
Sequi in 2020 and Primo in 2022 reaffirmed the importance of physical exercise (PE) in
individuals with morbidities related to cardiovascular diseases, as it brings considerable health
benefits for those with these disorders(63,64). For instance, a study conducted by Chávez and
colleagues in 2021 demonstrated that implementing an aerobic physical exercise program
(such as walking, jogging, swimming, and dancing) for 20 to 30 minutes over 13 weeks
among higher education students in Mexico could significantly reduce parameters associated
with metabolic disorders. At the end of his intervention, he led to a considerable reduction of
these
parameters
in
this
population.
The
results
showed a decrease in abdominal
circumference from 110.88cm ±14.27 in the pretest to 106.90cm ±14.41 in the posttest, as well

as a reduction in triglycerides from 131.31 mg/dl ±22.53 to 116.90 mg/dl ±12.88 and a
reduction of the alteration in glucose, that went from 94.69 mg/dl ±7.98 to 92.50 mg/dl ±5.52.
The author attributes these results largely to the adequate application of the Frequency,
Intensity, Time, Type of activity, and Progression of load (FITT) principles, which are part of
exercise prescription(65).
2.5 Principles of FITT-VP
Exercise prescription is the process by which a systematic and individualized physical activity
regimen is recommended based on an individual’s needs and preferences, to achieve
maximum benefits while minimizing risks. This prescription follows an organized and
systematic approach, designed in terms of Frequency, Intensity, Time, Type, Volume, and
Progression, known as the FITT-VP principle (66). The goals of an exercise prescription vary
based on individual functions and interests, the person's health status, and environment, but in
most cases these goals involve; improvement in physical fitness and improvement in health by
reducing risk factors for suffering from chronic diseases(65,66).
The components of FITT-VP begin with Frequency, which refers to the number of days per
week that an individual engages in physical exercise, for example, one, two or five days a
week. According to the World Health Organization (WHO) guidelines from 2022, a minimum
exercise frequency of three days per week is recommended to maintain reasonably optimal
health (58,63).
The next component related to FITT-VP is Intensity, which is defined as the effort exerted
by an individual to maintain an activity. It is typically measured on a scale from 0 to 10, where
5 to 6 corresponds to moderate-intensity aerobic exercise and 7 to 8 corresponds to
vigorous-intensity aerobic exercise. Intensity is closely related to the concept of heart rate
reserve (HRR), which can be calculated by subtracting the resting heart rate (RHR) ((the
minimum heart rate at rest, it is usually determined mainly by taking the HR upon awakening)
from the maximum heart rate (MHR) (This can be obtained through the theoretical maximum
frequency, which consists of having a maximum of 220 beats and from this the age of the

subject is subtracted, obtaining the MHR)(67,68). Having these two results, the formula
proposed by Karvonen can be used (HR%= (HRR * % work intensity) + RHR). This result
shows greater accuracy regarding the heart rate at which the subject must perform the physical
exercise depending on the area in which they want to work. On the other hand, time refers to
the duration in which the session should be performed (30 min to 60 min with a moderate
intensity)(58).
The type of exercise is determined by the specific physical activity an individual wants to
engage in. For instance, if you intend to perform continuous aerobic exercise, the following
cyclic activities are recommended: walking, jogging, swimming, cycling or dancing, since
these activities are particularly suitable for individuals who want to initiate an active lifestyle
through physical exercise (58, 68).
Likewise, volume is one of the components of the FITT-VP. It is defined as the total
amount of physical exercise measured in repetitions, sets, distance, or time. For cardiovascular
health maintenance, a minimum of 150 minutes per week of physical exercise is recommended
according to the criteria established by the World Health Organization (WHO) in 2022(52).
Finally, one of the pillars of exercise prescription is progression, which is also part of the
FITT-VP components. Progression involves gradually increasing either the frequency (number
of days of activity) or intensity (exercise intensity zone based on heart rate) in an individual’s
physical exercise. This progression occurs at the end of a prescribed exercise period and takes
into account the individual’s cardiorespiratory capacity, perceived effort before potential
modifications, and tolerance to exposure (intensity or frequency). These modifications
contribute to improving overall health (6).
2.6 Zones of physical exercise according to intensity
In the prescription of physical exercise, there are different heart rate zones in which the person
can determine the intensity of work (using the Karvone formula mentioned above), these
zones are generally divided into five(70).

The first zone (referred to as the moderate activity zone) ranges from 50% to 59% of the
maximum heart rate (FCM). This zone is characterized by low intensity and aids in quicker
recovery for individuals. It is suitable for sedentary people with very low activity levels.
Activities associated with this zone include walking, jogging, and cycling (71). The second
zone (known as the weight control zone) spans from 60% to 69% FCM. In this zone, changes
occur in the body as overall endurance begins to improve. The body becomes more efficient at
oxidizing fats for energy utilization, and muscular capacity increases along with capillary
density(71). The third zone (referred to as the aerobic zone) covers 70% to 79% FCM. It is
characterized by improved aerobic capacity, strengthening of the cardiorespiratory system, and
producing adaptations and enhancements in cyclic speed. Fat oxidation is still maintained in
this zone (70). The fourth zone (known as the anaerobic threshold zone) ranges from 80% to
89% FCM. In this zone, the body’s ability to metabolize lactic acid improves, and muscular
power increases. Activities in this zone are typically of short duration, as fat oxidation
decreases, and there is an increased reliance on phosphogens and carbohydrates(71). Finally,
the fifth zone (referred to as the maximum intensity zone) is characterized by improved
maximum speed and power. It also involves oxygen debt and significant accumulation of
lactate, which later transforms into lactic acid(70). See Table 3.
Table 3. Exercise zones according to intensity. Garber 2011.
Intensity
% H. R. R.
% Max. H. R.
Very light
< 30%
<57%
Light
40% – 59%
57% – 63%
Moderated
40% - 59%
64% – 76%
Vigorous
69% - 89%
77% – 95%
Maximum
>90 %
>96%
Source: Adaptation based on reference(72)

2.7 Perceived Effort Scale
The Borg Scale, also known as the Perceived Exertion Scale, is a numerical tool used in
conjunction with objective evaluation of heart rate. It is expressed on a scale from 0 to
10(73,74). The higher the number, the greater the effort the individual perceives while
maintaining the activity (annexe 10). This scale indirectly measures the individual’s state
during execution and helps determine whether to increase or decrease work intensity to
achieve specific exercise objectives.
2.8 Training Methods
Various authors have determined that exercise training (EF) is planned and structured, a
concept known as periodization. The goal is to acquire, maintain, or improve an individual’s
physical condition (75,76). This concept encompasses essential elements such as volume,
which includes to the total amount of physical activity performed in a session, including
duration, distance, weight lifted, and repetitions executed (75). Intensity, on the other hand,
quantitatively represents the work performed within a specific period. Meanwhile, frequency
relates to how often an exercise prescription is carried out per week or month (76).
2.8.1 Continuous training methods
Continuous training is characterized by applying an uninterrupted training load during the
session, which can be prolonged and leads to constant physiological adaptations. These
training methods are generally based on cyclic exercises (walking, jogging, swimming,
cycling, and hiking), and classified into different forms (Variable Continuous Method and
Continuous Method)(75). The variable continuous method is characterized by intensity
variations during the performed work. These variations can occur through changes in the
athlete’s movement speed and/or due to irregularities in the terrain(75). On the other hand,
uniform continuous training is applied during preparatory periods of physical training to
improve cardiovascular capacity in subjects. One of the principles is to maintain a constant
load, meaning no breaks or rest periods during the training. This method is divided into two
sub-methods: extensive continuous method and intensive continuous method(58,77,78).

This latter method is characterized by being performed at moderate to moderate-high intensity,
falling within the aerobic and super-aerobic zones (70-80% of VO2max) and with a medium
to medium-high workload (between 30 and 90 minutes). Among its effects are the
improvement of glycogen metabolism, increased speed in anaerobic threshold situations,
increased
maximum
oxygen
volume,
cardiac
hypertrophy,
and
improved
lactate
production-reutilization(75). On the other hand, the extensive continuous method is an aerobic
physical training performed at low intensity, within the regenerative or sub-aerobic zone
(50-70% of VO2max) and with a high volume (from 30 minutes up to more than two hours).
Its effects include the utilization of free fatty acids, increased peripheral circulation, glycogen
savings, cardiac hypertrophy, and enhanced recovery(79).
2.8.2. Aerobic Physical Excercise
Aerobic physical exercise (APE) involves activities that raise the heart rate to improve the
body’s efficient utilization of oxygen. These exercises include sustained activities at moderate
intensity, such as running, swimming, jogging, cycling, and dancing. During aerobic exercise,
the body increases heart rate and respiration to supply more oxygen to the working muscles.
This strengthens the heart and lungs, improves blood circulation, and enhances overall aerobic
capacity. Additionally, APE is beneficial for weight loss and the prevention of chronic diseases
such as cardiovascular conditions(75,80).
The ADA in 2024 revealed that performing at least 150 minutes of moderate aerobic
activity or 75 minutes of vigorous activity each week is essential for maintaining good
cardiovascular and overall health(39). The physical activity guidelines from the WHO and the
American College of Sports Medicine (ACSM) recommend 20-60 minutes of aerobic exercise
3 to 5 days per week at an intensity of 64% to 70% of maximum heart rate, and 40% to
50-85% of heart rate reserve (HRR)(58,81,82).
From a physiological perspective, aerobic training involves various activities to achieve its
primary goal: improving an individual’s cardiovascular capacity while simultaneously
utilizing lipid reserves found in adipose tissue through the process of lipolysis. This process

converts lipids into energy for aerobic exercise, allowing sustained energy release over longer
periods, which is essential for this type of training(67,75). The lipolysis process is closely
linked to the energy expenditure required to sustain aerobic exercise, which, in turn, is closely
related to oxygen uptake in the respiratory system through alveoli, red blood cells, and
haemoglobin(62,74).
Habibzadeh conducted a study in 2010 with female students from the University of Guilan,
Iran, who presented alterations related to metabolic syndrome, including obesity. He
developed an aerobic physical training program lasting 30 minutes, three times a week for two
months, with an intensity ranging from 50% to 70% of maximum heart rate. Upon completing
the intervention, the results showed that the women experienced an improvement in their BMI,
which decreased from 30.20 kg/m² ±1.83 to 28.88 kg/m² ±2.10. Additionally, other altered
parameters included total cholesterol, which decreased from 190.01 mg/dL ±3.25 to 179.01
mg/dL ±0.55, and triglycerides, which decreased from 104.01 mg/dL ±2.30 to 82.01 mg/dL
±1.21(83).
Therefore, maximizing the conditional capacity of physical endurance through exercise
positively impacts the production of red blood cells, enhancing oxygen transport via
hemoglobin. This, in turn, results in increased ATP synthesis for energy production through
the breakdown of stored fatty acids in adipocytes. Ultimately, this event contributes to
improving body composition(84).
2.8.3. Aerobic physical exercise in university students with metabolic disorders
Jaramillo and colleagues conducted a literature review in 2019 on the effects of aerobic,
anaerobic, and mixed physical exercise in individuals over 18 years old, focusing on risk
factors
associated
with
metabolic
syndrome
(LDL,
HDL,
cholesterol,
triglycerides,
hypertension, type II diabetes, and obesity). After completing their review, they found that
individuals aged 18 to 25 who engaged in aerobic activity (10 to 12 weeks, 3 to 4 times per
week for 20 to 30 minutes) experienced an improvement in heart rate, decreasing from 136 ±

5.9 mmHg to 124.5 ± 6.8 mmHg. Additionally, they observed an improvement in BMI, which
decreased from 36.45 ± 3.36 to 30.01 ± 2.56(85).
Likewise, Suárez conducted a study in 2020 where he proposed a physical activity program
for adults with various metabolic disorders, including visceral fat, high blood pressure,
cardiopulmonary pathologies, and sedentary lifestyles. After implementing a concurrent
physical training plan consisting of 10 circuit exercises with moderate aerobic intensity (45
seconds of exercise followed by 30 seconds of recovery) over 8 weeks, they observed a
significant improvement in body fat. The average body fat measurements decreased from
43.1±6.7 at the beginning to 42.3±6.5 at the end of the study, along with improvements in
metabolic imbalances (9).
Additionally, combining the findings from studies conducted by Kalley in 2004, Wang in
2017, and Igarashi in 2019, a meta-analysis of 140 studies demonstrated that an APE program
lasting more than 8 weeks—based on activities such as walking, running, swimming, and
cycling at an intensity of 50% to 70% of Vo2max—resulted in reductions in total cholesterol
from 2% to 3%, triglycerides up to 9%, and a notable increase in HDL cholesterol from 2% to
3%)(86–88).
2.8.4. Cardiovascular adaptations during aerobic physical exercise
The adaptations of aerobic exercise in the human body are primarily reflected in the
cardiovascular system, due to that various events are triggered during the period of such
activity. One of these events is the continuous delivery of oxygen and other nutrients to the
exercised muscles through the bloodstream. This process also leads to the elimination of
metabolites and other waste products (53). These events collectively benefit the human body,
including an increase in cardiac output, meaning the amount of blood the heart pumps per
minute (89).
When the body transitions from a resting state to a state of continuous extensive aerobic
exercise under lactate-stable conditions, cardiac output may increase rapidly initially, then

more gradually, and then reach stability(67). During maximal exercise, cardiac output may
increase up to four times the resting level, ranging from approximately 5 L/min to a maximum
of 20 to 22 L/min(89).
Other adaptations observed with aerobic capacity training include a reduction in resting
heart rate and heart rate during submaximal exercise, and an increase in capillary and
mitochondrial density since this type of training facilitates oxygen transport and delivery, as
well as the removal of waste products and carbon dioxide. Additionally, it significantly
reduces body composition in terms of adipose tissue (90).
A study conducted by Aristizábal in 2021, determined the efficiency of high-intensity
interval training (HIIT) and moderate-intensity continuous training (MICT) in adults with
metabolic syndrome-related disorders, using a 12-week protocol. The MICT sessions were
performed for 36 minutes at 60% of maximum oxygen consumption (VO2max). The HIIT
training sessions included 6 intervals at 90% of VO2max for one minute, followed by 2
minutes at 50% of VO2max. The results of this research revealed significant changes in both
groups. One of these changes was a decrease in body fat percentage after MICT training by
-0.9% (95% CI), and in the HIIT group by -1.0% (95% CI). Another result was the reduction
in fat mass for individuals: MICT showed a decrease of -0.14 kg (95% CI), while HIIT
increased to 0.9 kg (95% CI). Based on these findings, it can be affirmed that both training
methods are effective (74).
2.8.5. Methods or tests to evaluate aerobic resistance capacity and level of physical
activity.
There are various alternatives to measure and evaluate people’s cardiovascular condition, one
of the most used is: Queens College, which aims to determine aerobic capacity based on
cardiorespiratory tolerance(91).
The test consists of going up and down a step for three continuous minutes, following these
parameters: During the test, the same foot has to be used to go up and down, legs should fully

extend once on top of the step, and arms should be kept by the sides throughout the test, all
while maintaining the correct cadence per cycle (91).
To complete one execution or cycle, you must have gone up and down the step while
adhering to a metronome. For males, the metronome should be set at 96 beats per minute, and
for females, it should be set at 88 beats per minute. It is important for the subject to practice
the correct cadence for each completed execution or cycle: males – 24 executions per minute,
and females – 22 executions per minute. After completing the test, the subject remains
standing for 5 seconds, and then their pulse is taken for 15 seconds. Then, the palpated beats
during those 15 seconds are then multiplied by 4(91).
The interpretation of the results is not complex, as this test is quite straightforward for those
who perform it. The results can be estimated based on maximum oxygen consumption per unit
of body weight. Simply find the recovery heart rate (HRrec) result in this table and read the
estimated value of maximum oxygen consumption relative to weight in the next column. It’s
important to note that these ranges are for university students, as this population has different
conditions compared to other populations (91). For a more precise estimation, the following
regression equations should be used: Males: Vo2 max, ml x Kg-1 x min -1 = 111.33 – (0.42 x
HRrec), Females: Vo2 max, ml x Kg-1 x min -1 = 65.81 – (0.1847 x HRrec) (Anex 11).
Similarly,
there
is
a
questionnaire
known as the International Physical Activity
Questionnaire (IPAQ), which, according to Palma in 2022, aims to assess an individual’s level
of physical activity. It collects information through questions that inquire about time spent on
moderate and vigorous activities, as well as the time spent sitting or being inactive in daily
life. The IPAQ consists of two forms: a lengthy one and a short one(92).
Furthermore, the responses obtained from this questionnaire allow for the estimation of
energy expenditure (METs) during a typical week of physical activity. This information can be
valuable for evaluating the overall physical activity levels of a population and contributing to
scientific or clinical research aimed at determining the risk of diseases related to sedentary
behavior and physical inactivity(92).

According to Bustamante in 2022, METs (Metabolic Equivalent of Task) is the unit of
measurement for the metabolic energy index consumed by an individual at rest. It corresponds
to 3.5 ml O2/kg x min, which represents the minimum oxygen consumption required by the
body to maintain vital functions. METs are classified into three levels: Very light: < 3
METs/min, which can be associated with activities such as sleeping or sitting. The second
Light to moderate: 3 to 6 METs/min, examples of this level of expenditure include gardening
or cycling. And finally, intense or vigorous: > 6 METs/min, such as high-intensity exercise
(93), (See annex 12).
In 2020, Valdez conducted a study to determine the effect of a physical activity (PA)
program on cardiorespiratory capacity, considering METs (Metabolic Equivalent of Task) and
metabolic risks in university academics. The overall program focused on cardiorespiratory
endurance and included aerobic activities such as walking, swimming, stationary cycling, and
dancing. The study results revealed that 50% of overweight subjects improved their condition.
Additionally, at the beginning of the protocol, 20% of the population had altered triglyceride
levels, however, by the end of the intervention, 100% of the subjects were within a stable
range. These findings suggest that a properly structured PA program, adhering to fitness
training criteria, can lead to positive outcomes in the population(94).
3. Justification
The prevalence of metabolic disorders has been increasing, especially in developing countries.
According to the WHO in 2022, 20% to 50% of the population could be affected by these
disorders
(51). In Mexico, the prevalence of metabolic disorders is equally evident among
higher
education
students,
according
to
the
National
Health
and Nutrition Survey
(ENSANUT) 2022, 72.5% of the population had obesity, 25.5% had hypertension, and 21.1%
had some form of dyslipidemia. Additionally, Almazán reported in 2020, that 13.8% of the
population had hyperglycemia (5,6,34).
The importance of moderate and vigorous aerobic physical exercise could reduce the risk of
cardiovascular and cerebrovascular diseases in individuals with metabolic alterations(94,95).

Jaramillo in 2019, Sequi in 2020, and Primo in 2022 determined that MVPA can decrease
various metabolic disorders (such as triglycerides, hypertension, abdominal obesity, and
hyperglycemia) by 3% to 10% over 10 weeks (63,64,85). Along the same lines, Chávez in
2021 implemented an aerobic exercise program to assess its effect on reducing metabolic
disorders in university students over thirteen weeks. The program involved four weekly
sessions, each lasting 20 to 30 minutes. The results showed changes in triglycerides (131.31
mg/dl, post 116.90 mg/dl), heart rate (143.20 mmHg, post 127.40 mmHg) and abdominal
obesity (110.88 cm, post 106.90 cm) (65).
Considering the execution timeline and findings from Chávez’s study and other mentioned
research, this study proposes an improvement: reducing the intervention duration from 13 to 8
weeks and decreasing the intervention frequency from 4 to 3 days. Considering that the
volume of work will increase from 30 minutes to 60 minutes per session, complemented by
personalized physical exercise planning for each subject. The objective of this modification is
to achieve the same beneficial changes in metabolic alterations while reducing the intervention
time.
Laboratory tests and anthropometric measurements in each patient are part of the
assessment protocol at both the primary and secondary levels of care for screening
non-communicable diseases, which is reflected in the feasibility of the study. It should be
noted that the laboratory reagents available are easy to use and essential for comprehensive
diagnosis, complying with the operational definitions of each of the suspected diseases, taking
into account the clinical practice guide or international guides such as ADA or ATP III.
Additionally, the research team possesses the experience and infrastructure necessary for
screening and monitoring subjects participating in the study (39, 95)
The vulnerability of the study lies in patient recruitment, as it involves a young population
that may not recognize risk factors for non-communicable diseases, and those who participate,
often lack adherence to interventions due to various factors such as time constraints related to
work, school activities, and extracurricular commitments.

4. Problem statement
According to the PAHO in 2022, cardiovascular diseases remain the second leading cause of
death, with the number of affected individuals increasing from 1.9 million to 2 million in
2022(55). In 2021, PAHO and the American Diabetes Association (ADA) in 2024, reported
that Disability-Adjusted Life Years (DALYs) totalled 40.8 million, of which 36.4 million
represented Years of Life Lost due to premature death (YLLs), accounting for 89% of DALYs.
Additionally, the Years Lived with Disability (YLDs) for these individuals averaged 4.5
million(55,96). It is evident that both life expectancy and quality of life significantly decrease
when individuals experience these diseases.
Nowadays, metabolic disorders represent a significant risk for Mexico’s young population,
leading to substantial complications for cardiovascular health and overall well-being in
adulthood. Some authors reported the prevalence of different metabolic disorders among
university students in Mexico in 2022. They found that 72.5% of these students were
overweight or obese, and there was a marked incidence of hypertension, with 37.1%,
additionally, the prevalence of type 2 diabetes mellitus was 37%(98-101).
On the other hand, a study by Salazar and colleagues in 2013 revealed that students at the
University of Colima had 29.5% overweight and 8.4% obesity rates. The researcher associated
these results with the subjects' high prevalence of physical inactivity and sedentary behaviour
(15).
In
2018,
Colima
State
ranked
first
in obesity nationwide(101). Furthermore,
epidemiological bulletins from the Colima State Health Services, published in 2023, indicated
that obesity was one of the six most common comorbidities seen in health centres in the
Colima municipality, affecting 2,212 individuals(102). Exploring the underlying causes that
condition
these
epidemiological
data
is
crucial,
as
this
population
may
develop
non-communicable diseases in the medium term. Therefore, this research project represents an
opportunity for practical, objective, and timely intervention in evaluating physical fitness and
its impact on metabolic and anthropometric levels in a young population.

5. Methodological Design
5.1. Research Question
What is the effect of an aerobic physical exercise program on reducing blood pressure,
abdominal obesity, altered glucose levels, and increasing HDL in college-level students at the
University of Colima?
5.2 Objectives
5.2.1 General Objective
To evaluate the effect of implementing an aerobic physical exercise program on the reduction
of blood pressure, abdominal obesity, altered glucose levels, and increasing HDL in
college-level students at the University of Colima.
5.2.2. Specific Objectives
1. To establish the prevalence of metabolic disorders (abdominal obesity, triglycerides,
HDL, hypertension, and glucose alterations).
2. To determine and compare the post-intervention level of physical activity using the
long version of the International Physical Activity Questionnaire (IPAQ).
3. To determine and compare the post-intervention level of cardiorespiratory fitness
through the Queen’s College Step Test.
4. Compare
post-intervention
prevalence
levels
of
metabolic
disorders
(HDL,
triglycerides, abdominal fat, hypertension, blood glucose alterations) in higher
education students.
5. Determine the level of association between metabolic disorders and cardiorespiratory
fitness pre- and post-intervention.

5.3 Hypothesis
Hi. The implementation of an aerobic physical exercise program for eight weeks will have
effects on at least one of the levels of metabolic disorders such as: he reduction of blood
pressure, abdominal obesity, altered glucose levels, and increasing HDL in the study
population
H0. The implementation of an aerobic physical exercise program for eight weeks will not have
effects on any of the levels of metabolic disorders such as: he reduction of blood pressure,
abdominal obesity, altered glucose levels, and increasing HDL in the study population
6. Methods and materials
6.1 Study design
Single-blind randomized clinical trial.
6.2 Sample size
The sample size was calculated with a formula to compare two means:
Figure 5. Applied formula to calculate the sample size.
Source: Taken from García in 2013(104).
The sample size was determined through a study that assessed the impact of physical training
on metabolic alterations. The pre-intervention measurements were 131.31 ± 22.53, and the
post-intervention measurements were 116.90 ± 12.88 (65)

Error α= .05
Error β= 0.2 (20%)
Power 1- β= .8 (80)
K= 6.2
σ2= 22.53
σ2= 12.88
µ1= 131.31
µ2= 116.90
n= 20 ± 20%.
n= 24 subjects per group
6.3. Selection criteria
Table 4. Selection criteria
Inclusion
Exclusion
Elimination
University of Colima
students linked to the central
campus.
Students aged between 18
Motor limitations that may
hinder the performance of
physical exercise.
Musculoskeletal injuries
during the study period.
Unforeseen Medical Events:
Unexpected medical

and 25 years old.
Authorization to participate
in the project with a signed
informed consent.
Suffer from at least one of
the parameters of metabolic
disorders or cardiovascular
risk (Hyperglycemia,
decreased DHL, elevated
triglycerides, abdominal
obesity or hypertension)
following the clinical
assessment (Considering the
criteria established by the
ADA and ATPIII).
Pregnancy or lactation.
High Vigorous Physical
Activity Level according to
the IPA-Q.
To be currently under
pharmacological treatment to
manage altered metabolic
levels.
situations that could
influence study results, such
as hospitalizations, serious
illnesses, or surgeries.
Non-Compliance with
Follow-Up: Subjects failing
to meet a minimum of 80%
(19 out of 24 sessions) of the
stipulated physical
conditioning program time.
Initiation of clinical
treatment that may affect
protocol results, such as
medications that reduce
alterations.
Participants who voluntarily
withdraw from the study.
Source: self-made.
7. Variable operationalisation.
Table 5. Dependent variables.
Dependent
variables
Operational
definition
Nature
Scale
Instrument
Glucose
Alterations
Fasting plasmatic
glucose
concentration
determination:
Quantitative
Continuous
Ratio
It is considered
an alteration
>110 mg/dl
Fasting serum
glucose

Abdominal
Circumference
Total abdominal
perimeter
Abdominal
obesity based on
abdominal
circumference.
Quantitative
Continuous
Ratio
It is considered
an alteration
when:
Males >90cm
Females >85
cm
Circumferential
measurement with
ISAK tape measure
HDL
(High-Density
Lipoprotein)
Serum
concentration of
high-density
lipoprotein in
milligrams per
deciliter (mg/dl)
Quantitative
Continuous
Ratio
It is considered
an alteration
when:
Males < 40
mg/dl,
Females < 50
mg/dl
Lipid profile test
Triglycerides
Serum
concentration of
triglycerides in
milligrams per
deciliter (mg/dl)
Quantitative
Continuous
Ratio
It is considered
an alteration
when:
Males >150
mg/dl
Females >150
mg/dl
Lipid profile test
Arterial
Hypertension
Subject’s systolic
and diastolic
blood pressure
measured in
mercury
millimeters
(mmHg)
Quantitative
Continuous
Ratio
It is considered
an alteration
when:
Males > 130/85
mmHg
Females >
130/85 mmHg
Sphygmomanometer
Physical
Activity Level
Physical Activity
performed by the
subject 7 days
before the survey
Qualitative
Ordinal
PA: Low,
Medium, High
IPA-Q (International
Physical Activity
Questionnaire)
Physical
Fitness Test:
Aerobic
Subject’s
cardiorespiratory
capacity using an
Qualitative
Ordinal
Very Poor
Poor
Average
Quee’s College Step
Test

Capacity
effort test.
Good
Excellent
Superior
Source: self-made based on the reference (11,105).
Table 6. Independent variables
Variable
Operational
definition
Nature
Scale
Instrument
Aerobic
physical
exercise
Individually
adapted aerobic
physical
exercise
program
meeting the
WHO 2021
criteria and the
FITT Principles.
Quantitative
Continuous
Ration
57% - 76%
Prescription
Source: self-made.
Table 7. Intervinient variables
Variable
Operational
definition
Nature
Scale
Instrument
Age
Chronological
age in years
Quantitative
Continuous
18 - 24 years
Survey
Sex
Genetically
corresponding
sex
Qualitative
Dichotomous
nominal
Male and
Female
Survey
Source: self-made.
8. Location for carrying out the protocol
University of Colima’s Sports Center (central campus).

9. Study Procedure
Once the project is approved by the Bioethics Committee from the Faculty of Medicine at the
University of Colima (Annex 1) and the Ethics Committee from Colima’s Regional Hospital
(Annex 2), annexing a no-conflict of interest letter (Annex 3), letters of intent will be prepared
and sent to the directors of the faculties within the central campus of the University of Colima
(Annex 4). Their purpose is to inform them about the project’s generalities, obtain permission
to share it with the students and address any questions they may have
Those who agree will receive an informed consent form (Annex 5) for their respective
signatures. They will be informed about the appropriate attire for the study (for women, this
includes sports shoes, leggings, and a top or T-shirt, and for men, shorts and a T-shirt), the
requirement to fast for a minimum of 8 hours on the data collection day, and the date
(Saturdays), time (8:00 am to 12:00 pm) and place (Faculty of Medicine, University of
Colima) of the initial tests (these tests will also be considered the baseline for people who are
found to have a metabolic alteration).
On assessment day, the project team will execute the following tests: application of the
IPA-Q questionnaire (annexe 6), abdominal circumference (annexe 7), blood pressure (annexe
8), blood collection by venipuncture for HDL, triglycerides and glycemia (annexe 9), and the
Queen's College step test (3 minutes) to determine their cardiorespiratory capacity (annexe
10), (after completing all the tests, every participant will receive refreshments and will be
asked if they are in good condition to conclude their assessments, if not, they will be
monitored until their answer is affirmative).
Once all blood samples are collected, they will be taken to the laboratory at the Faculty of
Chemical Sciences, University of Colima, for processing. Simultaneously, data from the other
assessments will be synthesized. When the final results from all 5 tests are collected, a sample
of 48 subjects will be selected for the protocol, considering the established inclusion criteria
(Table 2). With this sample, simple randomization will be performed in a new meeting, using
sealed envelopes (each containing a letter indicating group assignment that will not be seen by

participants). Participants will draw an envelope and mark it with their names, and they will
hand the envelope to the designated person (principal investigator).
At the end of the meeting, the envelopes will be opened by the organizers in the absence of
the participants to reveal whether they belong to the (A) control or (B) experimental group.
This process ensures single-blind criteria, where participants do not know their group
assignment.
After forming the (A) control and (B) experimental groups, they will be divided to provide
them instructions for compliance with the exercise program while maintaining single-blind
conditions. In the control group (A), the exercise prescription used by Habibzadeh in 2010 will
be implemented: which involves walking for 30 minutes at an intensity of 57% to 76% of the
maximum heart rate, three times per week (Monday, Wednesday, and Friday) for eight weeks
(annex 11). They will always be accompanied by a previously trained physical education
student (Monitoring the intensity range in which the subjects must be during the session, will
be done through the effort perception scale (Annex 12), heart rate at 15 seconds multiplied by
4 or the H10 polar monitor) (83). On the other hand, the experimental group (B) will engage in
an aerobic exercise program (jogging, aquatic activities, and stationary cycling) lasting 40 to
60 minutes, three times per week (Monday, Wednesday, and Friday) for eight weeks, always
under the supervision of the principal investigator. Each participant in the experimental group
will receive a structured exercise prescription tailored to their specific condition, considering
the established aerobic training ranges (57% to 63% of maximum heart rate) (annexe 11).
(Monitoring the intensity range in which the subjects must be during the session will be done
through the effort perception scale (Annex 12), heart rate at 15 seconds multiplied by 4 or the
H10 polar monitor).
By the end of the first four weeks, the second round of assessments and samples will be
done, taking into consideration: Abdominal circumference (annexe 7), blood pressure (annexe
8), blood collection by venipuncture for HDL, triglycerides and glycemia (annexe 9), and the
Queen's College step test will be performed (3 minutes) (annexe 10), (after completing all the
tests, every participant will receive refreshments and will be asked if they are in good

condition to conclude their assessments, if not, they will be monitored until their answer is
affirmative). Subsequently, after completing sample collection and assessments, the control
group (A) will continue with the same dynamics as in the initial weeks. The experimental
group (B) will maintain the same exercises (jogging, aquatic activities, and stationary cycling),
but their intensity may be adjusted from 64% to 76% of the maximum heart rate if favourable
results are obtained from the cardiorespiratory fitness test (annexe 11), since this shows the
level of evolution of the subject after the initial intervention and thus, the FITT-VP principle in
exercise prescription would be fulfilled.
At the end of the last 4 weeks of the aerobic physical exercise program, the same sampling
will be concluded; Abdominal circumference (annexe 7), arterial pressure (annexe 8), blood
collection by venipuncture for HDL, triglycerides and glycemia (annexe 9), and the Queen's
College step test will be performed (3 minutes) (annexe 10) (after completing all the tests,
every participant will receive refreshments and will be asked if they are in good condition to
conclude their assessments, if not, they will be monitored until their answer is affirmative),
finishing the proposed intervention protocol.

10. Study flowchart
11. Statistical analysis
The statistical analysis will be conducted using the Statistical Package for the Social Sciences
(SPSS) Statistics 26 from Business Machine (IBM). Descriptive statistics will be carried out,
including measures of central tendency for the variables of age, sex and IPA-Q. Normality
tests will be applied such as Kolmogorov-Smirnov for samples >50, and Shapiro-Wilk for
samples <50. For the levels of triglycerides, glucose, HDL (High-Density Lipoprotein),
abdominal circumference, and cardiorespiratory fitness, paired-sample T-tests will be used if
the data follow a normal distribution, but if they do not, the Wilcoxon signed-rank test will be
employed. To compare the control and experimental groups, independent-sample t-tests will
be used if the data is normally distributed, otherwise the Mann-Whitney U test will be used.
Likewise, a multivariate analysis will be carried out to relate the influence of physical exercise

on metabolic alterations. A significance level of p ≤0.05 will be considered statistically
significant.
12. Ethical considerations
According to international and national principles for research involving human subjects, as
outlined in the Declaration of Helsinki and the General Health Law in its Articles 100 and 101
of Chapter V, Research for Health, and in the General Health Regulation regarding Research
to Promote Health, specifically in Article 17, Section I, it is determined that this research is
classified as a minimal-risk study. This categorisation is based on its approach: a study
involving controlled and voluntary exercise intervention and blood extraction through
venipuncture. The blood extraction will not exceed a maximum frequency of twice a week or a
maximum volume of 450 ml, limited to only three samples during the identification of the
protocol sample, at the midpoint, and upon completion (106). Additionally, Article 15 of the
regulation stipulates that random selection methods will be adopted for experimental designs
involving human subjects with multiple groups. Impartial assignment of participants to each
group will be ensured, taking necessary measures to prevent risks or harm to research subjects.
Immediate attention will also be provided by the team implementing this protocol if any
adverse effects caused by exercise are observed. These criteria have been incorporated into the
research planning (106).
Following the guidelines established by the Declaration of Helsinki, the privacy and
confidentiality of information provided by participants will be safeguarded. An informed
consent form (Annex 1) has been prepared, detailing the exclusive use of data for research
purposes. This consent will be subject to approval by the Ethics and Research Committee
(107).
The questionnaires, tables, and formulas used are scientifically validated and publicly
available, affirming the certainty of the process and its results. Considering the above, this
research protocol will undergo evaluation and approval by the Honourable Bioethics
Committee of the Faculty of Medicine at the University of Colima. Following approval by this

committee, it will be submitted to the Ethics Committee of the University Regional Hospital
of Colima, which will issue an opinion for its implementation, with the support of the Federal
Commission for Protection against Sanitary Risks (Cofepris).
13. Human resources, financing and feasibility
13.1 Human Resources
●
Dr. Fabián Rojas Larios
●
Dr. Pedro Julián Flores
●
Bachelor of Physical Education, Nelson Enrique Ramos Cuevas
●
Nursing staff assigned for blood pressure measurement
●
Nursing staff assigned for blood extraction
●
Nutrition staff assigned for waist circumference measurement
●
Bachelor of Physical Education staff for conducting the Queens College test
●
Bachelor of Physical Education staff for administering the IPAQ survey
●
Bachelor of Physical Education staff for supporting the control group.
13.2 Material Resources
Table 8. Materials and costs
Resource Type
Unit
Amount
Cost per unit
Total cost
Elements are
available.
Computer
Piece
1
$ 7,000
$ 7,000
✓
Printer
Pieza
1
$ 3,794
$ 3,794
✓
Paper
Pack of
sheets
4
$ 500
$ 2,000

Pens
Pack of 20
2
$ 130
$ 260
✓
Speaker
Piece
1
$ 2,000
$ 2,000
✓
USB
Piece
1
$ 100
$ 100
✓
40 cm Bench
Piece
1
$ 750
$ 750
Lipid Profile Test
Unit
150
$ 17,250
$ 17,250
Fasting Plasma
Glucose Test
Unit
150
$ 8,304
$ 8,304
BD Vancutainer
SST Yellow Cap
Tube
Box
100
$350
$350
Green Flash Pulse
Needle / BD
Ancuntainer
216x1-1/1m
0.8x30 mm
Box
1
$ 600
$ 600
Centrifuge;
Centrifuge
580412-15 amp
EPPENDOR
Version
Unit
1
$15,142.17
$15,142.17
✓
Pipette Tips for
1000 Microliter
Transferpette
Unit
1
$ 1,000
$ 1,000

Axygen 1.5ml
Microtube,
Eppendorf Type,
500 pcs
Box
1
$ 900
$ 900
Autoclave/
Sterilizer
Unit
1
$ 45,321
$ 45,321
✓
Wrist Digital
Blood Pressure
Monitor
Piece
1
$ 800
$ 800
Metallic
Measuring Tape
Piece
1
$ 100
$ 100
Uline Silent Tape
- 3.1 Mil
Thickness, 3" x 55
yards,
Transparent, 75
mm x 50 M
Unit
1
$ 300
$ 300
Folio labels
Box
1
$ 150
$ 150
Powder-Free
Nitrile
Examination
Gloves, Blue
Box
1
$ 140
$ 140
Multitube Sample
Rack
Unit
10
$ 30
$ 300
-40° Freezer
Unit
1
$ 123, 455
$ 123,445
✓

Soft Tor
Medimetrics
Venous
Tourniquet for
Blood Extraction
Unit
1
$ 100
$ 100
Cotton Swabs
500g with 1000
Protec Pellets
Box
1
$ 170
$ 170
8.5 L Plastic
Container for
Infectious
Biological Sharps
Unit
1
$ 150
$ 150
Red Bag for
Biological Waste
50x60 cm, Pack of
20
Unit
4
$ 100
$ 400
3m Steam
Sterilization
Indicator Tape,
18mm x 55m
Unit
2
$ 130
$ 260
Kraft Wrapping
Paper Roll, 80 cm,
17.5 kg (227.50
m), 125gsm
Unit
1
$ 800
$ 800
Cones
Piece
1
$ 175
$ 175
Ropes
Piece
5
$50
$250

Hoops
Piece
10
$38
$380
Training Steps
Piece
3
$ 235
$ 705
Stopwatch
Piece
1
$ 500
$ 500
Polar H10 Heart
Rate Monito
Piece
4
$2.499
$9,996
Total Investment:
$ 237,602
$ 44,602
Source: Self-made based on reference (108)
14. Schedule of activities

Bibliography
1. World Health Organization. Activity and physical exercise [Internet].Switzerland: 2022.
[cited
November
7th
2023]
Available
in:
https://www.who.int/es/news-room/fact-sheets/detail/physical-activity
2.
Flores Paredes A. Effects of a physical activity and sports program in medicine
students.
Scielo
Perú:
2020;
11(2):142-152.
Available
in:
https://doi.org/10.33595/2226-1478.11.2.456
3.
Pan American Health Organization. Cardiovascular diseases [Internet]. Switzerland
[Consulted
October
2nd
2023].
Available
in:
https://www.paho.org/es/temas/enfermedades-cardiovasculares
4.
Pan
American
Health
Organization.
Non-communicable
diseases
[Internet].
Switzerland.
2022
[cited
8
de
noviembre
de
2023].
Available
in:
https://www.paho.org/es/temas/enfermedades-no-transmisibles
5.
Ismael Campos-Nonato, Oscar Galván-Valencia, Lucía Hernández-Barrera, Cecilia
Oviedo-Solís, Simón Barquera. ENSANUT. [Internet] 2022 [cited November 26th 2023].
Prevalence of obesity and associated risk factors in Mexican adults: results from Ensanut
2022.
Available
in:
https://ensanut.insp.mx/encuestas/ensanutcontinua2022/documentos_analiticos.php
6.
Campos-Nonato
I,
Oviedo-Solís
C,
Vargas-Meza
J,
Ramírez-Villalobos
D,
Medina-García C, Gómez-Álvarez E, et al. Prevalence, treatment and control of high blood
pressure in Mexican adults: Public Health Mexico [Internet] 2022. [Consulted June 14th
2023];65:s169-80. Available in: https://doi.org/10.21149/14779

7.
Cristóbal Flores Molina, Dolores Patricia Delgado Jacobo. Factors associated with
metabolic syndrome in UNAM students. Scielo [Internet]. 2021 [September 23rd 2023]; 8
(29). Available in: https://doi.org/10.22201/fesz.20075502e.2018.8.29.80727
8.
2020 National Health and Nutrition Survey on Covid -19. Public Health Mexico
[Internet]
2020
[October
2nd
2023].
Available
in:
https://www.insp.mx/resources/images/stories/2023/docs/230811_Ensanut2020sobreCovid_Na
cionales.pdf
9.
Suárez Carmona W, González-Jurado JA, Simón Mora R, Sánchez-Oliver AJ. Effect of
a physical exercise program on physical fitness and visceral fat in people with obesity.
Dialnet.[Internet]
2021
[Consulted
October
20th
2023];(39):723-30.
Available
in:
https://dialnet.unirioja.es/servlet/articulo?codigo=8028448
10.
Rebolledo Solleiro D, Solleiro Villavicencio H, Velasco M, Roldán Roldán G.
Obesidad, síndrome metabólico y percepción olfativa. Pubmed [Internet]2020 [Consulted 09
ene 2024] 70(02):53. Available in: 10.33588/n.7002.2019204
11.
Ramírez-López LX, Aguilera AM, Rubio CM, Aguilar-Mateus ÁM.
Síndrome
metabólico: una revisión de criterios internacionales. Revista Colombiana Cardiología
[Internet]
2021
[Consulted
en
20
ene
2024]
28(1):5885.
Disponible:
https://doi.org/10.24875/rccar.m21000010.
12.
Hidalgo-Parra EA. Factores de riesgo y manifestaciones clínicas de la hipertensión
arterial: Artículo de revisión bibliográfica. Rev GESTAR. [Internet] 2019 [ 3 feb 2024]
2(4):27-36. Available in: https://doi.org/10.46296/gt.v2i4.0010
13. Instituto Nacional de Estadística y Geografía. Defunciones registradas. México [Internet].
[Consulted
15
de
noviembre
de
2023].
Available
in:
https://www.inegi.org.mx/sistemas/olap/Proyectos/bd/continuas/mortalidad/MortalidadGeneral
.asp

14.
Akıllıoğlu T, Baş M, Köse G. La alimentación restringida y emocional y la depresión
pueden ser un factor de riesgo para el síndrome metabólico. Nutr Hosp. [Internet] 2022
[Consulted 2 Feb 2024] 39(6):1264-71. Available in: https://dx.doi.org/10.20960/nh.03947.
15.
Salazar C, Feu, S, Vizuete Carrizosa, M. IMC y actividad física de los estudiantes de la
Universidad de Colima. Revista Internacional de Medicina y Ciencias de la Actividad Física y
del
Deporte.
[Internet]2013
[
13
feb
2024]
;13(51):17.
Available
in:
http://hdl.handle.net/10486/13776.
16.
Koenen M, Hill MA, Cohen P, Sowers JR. Obesidad, tejido adiposo y disfunción
vascular. Pubmed [Internet] 2021 [Consulted 02 feb 2024]128(7):951-68. Available in:
10.1161/CIRCRESAHA.121.318093
17.
Salehidoost R, Korbonits M. Anomalías del metabolismo de la glucosa y los lípidos en
el síndrome de Cushing. J Neuroendocrinología. [Internet] 2022 [Consulted 13 ene 2024];
34(8):e13143. Available in: https://doi.org/10.1111/jne.13143
18.
Chaudhry R, Varacallo M. Bioquímica, Glucólisis. Pubmed [Internet] 2024 [Consulted
28 de enero de 2024]. Available in: http://www.ncbi.nlm.nih.gov/books/NBK482303/.
19.
Castro- A, Rivera-N, Rim EB, Tresserra‐Rimbau A, Romaguera D, Martínez JA, et al.
Síndrome Metabólico: generalidades y abordaje temprano para evitar el riesgo cardiovascular
y
diabetes
mellitus
tipo
2.
Revista
Médica
Sinergia.
[Internet]
2023
[2
feb
2024];67(4):2200264. Available in: https://doi.org/10.31434/rms.v8i2.960
20.
Diabetes Mellitus Tipo 2 Hospitalaria 2022 4to. Trim. Dirección de Vigilancia
Epidemiológica de Enfermedades No Transmisibles. Secretaría de Salud [Internet] México;
2022
[cited
9
de
noviembre
de
2023].
Available
in:
http://www.gob.mx/salud/documentos/diabetes-mellitus-tipo-2-hospitalaria-2022

21. García-H. Análisis de la relación entre recursos humanos para la salud y el control de
diabetes mellitus hipertensión arterial y dislipidemia en México un estudio transversal
multinivel.
ESPM
INSP.
[Internet]
2022
[18
nov
2023].
Available
in:
http://repositorio.insp.mx:8080/jspui/handle/20.500.12096/8070.
22.
Ortega R, Grandes G, Gómez-Cantarino S. Vulnerabilidad de la obesidad definida por
el índice de masa corporal, perímetro abdominal y porcentaje de grasa corporal. Elsevier.
[Internet]
2023
[Consulted
21
ene
2023]
;55(2):102523.
Available
in:
10.1016/j.aprim.2022.102523.
23.
Herrera-R. Prevalencia de dislipidemias en estudiantes universitarios y su asociación
con el índice de masa corporal y la actividad física. [Internet] 2021 [Consulted 16 de
noviembre
de
2023];
Available
in:
https://repositorioinstitucional.uaslp.mx/xmlui/handle/i/7436.
24.
Mancheno-A, Chiluisa-R, Fiallos-M. Impacto de las dislipidemias en el riesgo
cardiovascular.
ProQuest.
[Internet]
2023
[19
nov
2023];18(1):5.
Disponible:
doi:10.5281/zenodo.7778817.
25.
Ramos-Arellano
LE,
Matia-Garcia
I,
Marino-Ortega
LA,
Castro-Alarcón
N,
Muñoz-Valle JF, Salgado-Goytia L, et al. La obesidad, la dislipidemia y la hipertensión arterial
se asocian con el riesgo cardiovascular, determinado mediante la concentración de proteína C
reactiva de alta sensibilidad, en adultos jóvenes. PubMed. [Internet] 2020 [Consulted 18 ene
2024];48(12). Available in: 10.1177/0300060520980596.
26.
Pavía-AA, Alcocer-MA, Ruiz-G, Mayorga-JL, Mehta R, Díaz-Aragón FA, et al. Guía
de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y
enfermedad cardiovascular aterosclerótica. Pubmed. [Internet] 2022 [2 feb 2024]; 92:1-62.
Available in: 10.1177/0300060520980596.

27.
Jeon YG, Kim YY, Lee G, Kim JB. Funciones fisiológicas y patológicas de la
lipogénesis.
Pubmed.
[Internet]
2023
[4
feb
2024];
5(5):735-59.
Available
in:
10.1038/s42255-023-00786-y.
28.
Kane JP, Pullinger CR, Goldfine ID, Malloy MJ. Dislipidemia y diabetes mellitus:
papel de las especies de lipoproteínas y vías interrelacionadas del metabolismo de los lípidos
en la diabetes mellitus. Pubmed. [Internet]
2021 [5 feb 2024]; 61:21-7. Available in:
10.1016/j.coph.2021.08.013.
29.
Pavía-López AA, Alcocer-Gamba MA, Ruiz-Gastélum ED, Mayorga-Butrón JL,
Mehta R, Díaz-Aragón FA, et al. Guía de práctica clínica mexicana para el diagnóstico y
tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica. Arch Cardiol
México. 14 de marzo de 2022;92(91):8094.
30.
Sarmiento Llatas R. Niveles de perfil lipídico en los estudiantes de 1° año de la
facultad de Tecnología Médica de la Universidad Nacional Federico Villarreal del 2019. Univ
Nac Federico Villarreal [Internet]. 2022 [cited 28 de noviembre de 2023]; Available in:
https://repositorio.unfv.edu.pe/handle/20.500.13084/6178
31.
Guías para el tratamientode las dislipemias en el adulto:Adult Treatment Panel III
(ATP-III).
2004;
Available
in:
https://www.sciencedirect.com/science/article/abs/pii/S1575092204746148
32.
Zenteno CAC, Pérez JDG, Feliciano MÁR. Relación del Índice de Masa Corporal
(IMC) y Circunferencia de Cintura (CC) con Glucosa, Colesterol y Triglicéridos en
Estudiantes de Medicina. Espac ID Innov Más Desarro [Internet]. 2 de junio de 2020 [cited 17
de noviembre de 2023];9(23). Available in: https://www.espacioimasd.unach.mx
33.
González-Mercado
A,
Magaña-Torres
MT,
Sánchez-López
JY,
Ríos-Silva
M,
Ibarra-Cortés B, Trujillo X, et al. La relación de los polimorfismos de un solo nucleótido en el

gen TRPV1 con el perfil lipídico, la glucosa y la presión arterial en población mexicana.
Genet Test Mol Biomark. 1 de julio de 2020;24(7):420-4.
34.
Almazán-Ávila MA. Factores de riesgo cardiovascular en adultos jóvenes mexicanos.
Arch Cardiol México. diciembre de 2020;90(4):427-35.
35.
Cardona-Müller D, Cardona-Muñoz EG. Entender la hipertensión arterial: avances
fisiopatológicos. Cardiovasc Metab Sci. 12 de mayo de 2022;33(S3):s211-215.
36.
Organización Mundial de la Salud. Hipertensión [Internet]. 2023. Available in:
https://www.who.int/es/news-room/fact-sheets/detail/hypertension
37.
Ungvari Z, Toth P, Tarantini S, Prodan CI, Sorond F, Merkely B, et al. Deterioro
cognitivo inducido por hipertensión: de la fisiopatología a la salud pública. Nat Rev Nephrol.
octubre de 2021;17(10):639-54.
38.
González-Mercado
A,
Magaña-Torres
MT,
Sánchez-López
JY,
Ríos-Silva
M,
Ibarra-Cortés B, Trujillo X, et al. La relación de los polimorfismos de un solo nucleótido en el
gen TRPV1 con el perfil lipídico, la glucosa y la presión arterial en población mexicana.
Genet Test Mol Biomark. 1 de julio de 2020;24(7):420-4.
39.
American Diabetes Association Professional Practice Committee, ElSayed NA, Aleppo
G, Bannuru RR, Bruemmer D, Collins BS, et al. Diagnóstico y clasificación de la diabetes:
estándares
de
atención
en
diabetes.
Diabetes
Care.
1
de
enero
de
2024;47(Supplement_1):S20-42.
40.
Basto-Abreu
A,
López-Olmedo
N,
Rojas-Martínez
R,
Aguilar-Salinas
CA,
Moreno-Banda GL, Carnalla M, et al. Prevalencia de prediabetes y diabetes en México:
Ensanut 2022. Salud Pública México. 13 de junio de 2023;65:s163-8.

41.
Baltazar Corona JA. Prevalencia de los factores de riesgo del síndrome metabólico en
alumnos pacientes del proyecto “PRONUTRI” de la Universidad Autónoma Metropolitana,
Unidad
Xochimilco.
2022
[cited
17
de
noviembre
de
2023];
Available
in:
https://repositorio.xoc.uam.mx/jspui/handle/123456789/38898
42.
Montserrat Briseño-Castellanos. Determinación niveles de glucosa por medio de
espectroscopía
como
método
no
invasivo.
2021;
Available
in:
https://www.redalyc.org/journal/4577/457769655012/457769655012.pdf
43.
ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al.
Classification and Diagnosis of Diabetes: Standards of Care in Diabetes—2023. Diabetes
Care. 12 de diciembre de 2022;46(Supplement_1):S19-40.
44.
Marušić M, Paić M, Knobloch M, Liberati Pršo AM. NAFLD, resistencia a la insulina
y diabetes mellitus tipo 2. Filipović B, editor. Can J Gastroenterol Hepatol. 17 de febrero de
2021;2021:1-9.
45.
Maria Elena Palafox Lopéz, José Ángel Ledesma Solano. Manual de formulas y tablas
para la intervención nutriológica. tercera. 2015.
46.
Laura
X.
Ramírez-López.
Síndrome
metabólico:
una
revisión
de
criterios
internacionales.
2020;
Available
in:
http://www.scielo.org.co/pdf/rcca/v28n1/0120-5633-rcca-28-1-60.pdf
47.
Mecanismos fisiopatologicos de la dislipidemia | Nova. 29 de junio de 2023 [cited 15
de noviembre de 2023]; Available in: https://hemeroteca.unad.edu.co/index.php/nova/index
48.
Arrobas-Velilla
T,
Guijarro
C,
Campuzano-Ruiz
R,
Rodríguez-Piñero
M,
Valderrama-Marcos
JF,
Botana-López
AM,
et
al.
Documento
de
consenso para la
determinación e informe del perfil lipídico en laboratorios clínicos españoles ¿Qué parámetros
debe incluir un perfil lipídico básico? Rev Clínica Med Fam. 2023;16(1):33-45.

49.
Justin B. Echouffo-Tcheugui, Leigh Perreault. Diagnóstico y manejo de la prediabetes,
Una
revisión.
2023;
Available
in:
https://jamanetwork.com/journals/jama/article-abstract/2803510
50.
American Diabetes Association. Estándares de atención en diabetes guía 2023 para
atención
primaria
[Internet].
2023.
Available
in:
https://saludescolar.org/wp-content/uploads/2023/07/guia-diabetes-asociacion-americana-diab
etes.pdf
51.
Organización Mundial de la Salud. Enfermedades no transmisibles [Internet]. 2023.
Available
in:
https://www.who.int/es/news-room/fact-sheets/detail/noncommunicable-diseases#:~:text=Los
%20principales%20tipos%20de%20ENT,el%20asma)%20y%20la%20diabetes.
52.
Orgenización Mundial de la salud. Actividad física [Internet]. 2022. Available in:
https://www.who.int/es/news-room/fact-sheets/detail/physical-activity
53.
Calderón FJ, Cupeiro R, Peinado AB, Lorenzo-Capella I. Variabilidad de la frecuencia
cardiaca y ejercicio. ¿fundamentación fisiológica? Rev Int Med Cienc Act Física Deporte. 1 de
junio de 2020;20(78):299-320.
54.
Lozano Marroquín C, Calvo Díaz G, Armenta Hurtarte C, Pardo R. La influencia de
los grupos sociales en la alimentación de estudiantes universitarios mexicanos. Psicumex. 2 de
junio de 2021;11:1-21.
55.
OPS. Organización Panamericana de la Salud. 2021 [cited 1 de febrero de 2024]. La
carga de las enfermedades cardiovasculares en la Región de las Américas, 2000-2019.
Available in: https://www.paho.org/es/enlace/carga-enfermedades-cardiovasculares
56.
OPS, OMS. Organización Panamericana de la Salud. 2021 [cited 2 de febrero de
2024]. La carga de las enfermedades cardiovasculares en la Región de las Américas,

2000-2019.
Available
in:
https://www.paho.org/es/enlace/carga-enfermedades-cardiovasculares
Silveira EA, Mendonça CR, Delpino FM, Elias Souza GV, Pereira De Souza Rosa L, De
Oliveira C, et al. Sedentary behavioUr, physical inactivity, abdominal obesity, and obesity in
adults and older adults: a systematic review and meta-analysis. Clin Nutr ESPEN. Aug
2022;50:63-73.
58.
Actividad física - OPS/OMS | Organización Panamericana de la Salud [Internet]. [cited
20 de noviembre de 2023]. Available in: https://www.paho.org/es/temas/actividad-fisica
59.
ENSANUT. Encuesta Nacionalde Salud y Nutrición 2018 [Internet]. 2018. Available
in:
https://ensanut.insp.mx/encuestas/ensanut2018/doctos/informes/ensanut_2018_presentacion_r
esultados.pdf
60.
Medina C, Jáuregui A, Hernández C, González C, G Olvera A, Blas N, et al.
Prevalencia de comportamientos del movimiento en población mexicana. Salud Pública
México. 14 de junio de 2023;65:s259-67.
61.
Khushoo TN, Rafiq N, Qayoom O. Assessment of cardiovascular fitness [VO2 max]
among medical students by Queens College step test. Int J Biomed Adv Res. 30 de mayo de
2015;6(5):418-21.
62.
. Castro Pantoja, Edison Andres. Aerobic training in the development of muscular
resistance
in
university
students.
2021;
Available
in:
https://repositorio.uta.edu.ec/jspui/handle/123456789/33324
63.
Sequi-Dominguez I, Alvarez-Bueno C, Martinez-Vizcaino V, Fernandez-Rodriguez R,
Del Saz Lara A, Cavero-Redondo I. Effectiveness of Mobile Health Interventions Promoting
Physical Activity and Lifestyle Interventions to reduce cardiovascular risk among people with

metabolic syndrome: systematic review and meta-analysis. J Med Internet Res. 2020 Aug
31;22(8):e17790.
64.
Primo D, García Rioja J, Izaola O, del Río San Cristóbal C, Piñero Teno R, de Luis D,
et al. Real Life Study of an online platform for the prescription of physical exercise to obese
patients: effect on anthropometric and biochemical parameters, and on quality of life. Nutr
Hosp. Apr 2022;39(2):337-47.
65.
Chávez Valenzuela ME, Valdez García M, Bautista Jacobo A, Hoyos Ruiz G, Barahona
Herrejón NC, Ogarrio Perkins CE. Evaluation of the Effect of a physical exercise program on
cardiorespiratory capacity in academics from the University of Sonora with metabolic
syndrome. Challenges. 2021 Oct 31;44:264-75.
66.
Abellán J, Sainz P. Guía para la prescripción de ejercicio físico en pacientes con riesgo
cardiovasculares. 2017. 67 p.
67.
*Santiago Guijarro-Romero. An intermittent fitness teaching unit only improves the
cardiorespiratory fitness levels of students with an unhealthy fitness profile. 2020; Available
at:
https://digibug.ugr.es/bitstream/handle/10481/62504/73605-245611-1-PB.pdf?sequence=1&is
Allowed=y
68.
Playle R, Dimitropoulou P, Kelson M, Quinn L, Busse M. Exercise Interventions in
Huntington’s Disease: An Individual Patient Data Meta‐Analysis. Mov Disord Clin Pract.
septiembre de 2019;6(7):567-75.
69.
García
SH,
Revuelta
MEG.
Elementos
esenciales
del
ejercicio físico en la
rehabilitación cardíaca. Rev Cuba Med Física Rehabil [Internet]. 2021 [cited 19 de noviembre
de
2023];13(3).
Available
in:
https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=110049

70.
Entrenamiento funcional de alta intensidad y su cuantificación por Escala de Esfuerzo
Percibido en sujetos físicamente activos. Cult Cienc Deporte [Internet]. 1 de marzo de 2022
[cited
28
de
febrero
de
2024];
Available
in:
https://ccd.ucam.edu/index.php/revista/article/view/1425/864
71.
Jimenéz M. Los ejercicios aérobicos y su influencia en la mejora del rendimiento físico
de los estudiantes de 16 a 18 años que practican fútbol sala en la Unidad Educativa
Calicuchima. [Internet]. [Ecuador]: UNIVERSIDAD ESTATAL DE MILAGRO; 2023.
Available in: https://repositorio.unemi.edu.ec/handle/123456789/7159
72.
Ewing C, Blissmmer B. Quantity and Quality of Exercise for Developing and
Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently
Healthy Adults: Guidance for Prescribing Exercise.
73.
Da Silva LA, Tortelli L, Motta J, Menguer L, Mariano S, Tasca G, et al. Efectos del
ejercicio acuático sobre la salud mental, la autonomía funcional y el estrés oxidativo en
personas mayores deprimidas: un ensayo clínico aleatorizado. Clinics. 2019;74:e322.
74.
Aristizabal JC, Montoya E, Sánchez YL, Yepes-Calderón M, Narvaez-Sanchez R,
Gallo-Villegas JA, et al. Effects of high-intensity, low-volume interval training compared to
continuous training on regional and global body composition in adults with metabolic
syndrome:
a
post
hoc
analysis
of
a
randomized
clinical
trial.
Ann
Nutr
Metab.
2021;77(5):279-88.
75.
Lisbet Guillén Pereira, Yaxel Ale De La Rosa, José Ramón Sanabria Navarro.
Principios del entrenamiento deportivo moderno [Internet]. FUNGADE; 2023. Available in:
https://www.researchgate.net/publication/373549806_Principios_del_Entrenamiento_Deportiv
o_2/link/64f11e5ab55e1d34158e4de6/download
76.
Alarcón-Gómez J, Chulvi-Medrano I, Martin-Rivera F, Calatayud J. Effect of
high-intensity interval training on quality of life, sleep quality, exercise motivation and

enjoyment in sedentary people with diabetes mellitus type 1. Int J Environ Res Public Health.
Nov 30, 2021;18(23):12612.
77.
Gallegos-Gonzalez G, Pineda-García G, Serrano-Medina A, Martinez AL, Ochoa-Ruiz
E. Association between stress and metabolic syndrome and its mediating factors in university
students. Am J Health Behav. 2021 Nov 15;45(6):1091-102.
78.
Organización Mundial de la Salud. De la evidencia a las recomendaciones. En:
Directrices de la OMS Sobre Actividad Física y Comportamientos Sedentarios [Internet].
World
Health
Organization;
2021 [cited 20 de noviembre de 2023]. Available in:
https://www.ncbi.nlm.nih.gov/books/NBK581965/
79.
Guillen Pereira L, Sanabria Navarro J. Principios del Entrenamiento Deportivo
[Internet]. 1°. Sucre, Colombia: FUNGADE; 2023. 303 p. (Gade; vol. 1). Available in:
https://www.researchgate.net/publication/373549806_Principios_del_Entrenamiento_Deportiv
o_2
80.
Raul Alberto Zambrano Cordova, Angélica Cristina Meza Saltos. Actividades de
Iniciación deportiva y su incidencia en el acondicionamiento físico de los estudiantes de la
Unidad
Educativa
Abdón
Calderón
de
Portoviejo.
2023;
Available
in:
https://polodelconocimiento.com/ojs/index.php/es/article/view/5748/14308
74.
American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and
Prescription 9th Ed. 2014 Novena[internet] . Estados Unidos: Wolters Kluwer; 2014. 455 p.
82.
Lopategui
E.
PRESCRIPCIÓN
DE EJERCICIO - DELINEAMIENTOS MÁS
RECIENTES: AMERICAN COLLEGE OF SPORTS MEDICINE (ACSM) - 2014 [Internet].
Ciencias
del
Movimiento
Humano
y
de
la
Salud.
2013.
Available
in:
http://www.saludmed.com/rxejercicio/rxejercicio.html

83.
Habibzadeh N. Efecto del ejercicio aeróbico sobre algunos de los síndromes
metabólicos seleccionados en mujeres jóvenes obesas. Sport Medicine Journal. 2010;40(24):4.
84.
Álvaro Cristian Huerta Ojeda, Nelson Castillo Hernández. Ejercicio fisico y condición
fisica
2da
edición
[Internet].
2;
2018.
Available
in:
https://www.researchgate.net/publication/332116711_EJERCICIO_Y_CONDICION_FISICA
_2da_Edicion
85.
Jaramillo Montoya, Manuel Alejandro, Ramírez Orejuela, José Julián. Effects of
aerobic, anaerobic and mixed physical exercise, in people over 18 years of age, on the risk
factors associated with metabolic syndrome (LDL, HDL, cholesterol, triglycerides, high blood
pressure,
type
II
diabetes
and
obesity).
2019;
Available
at:
https://bibliotecadigital.univalle.edu.co/entities/publication/030feedf-b03b-4776-8574-b459aaf
6ec03
86.
Kelley GA, Kelley KS, Tran ZV. Aerobic exercise and lipids and lipoproteins in
women: a meta-analysis of randomized controlled trials. J Womens Health. December
2004;13(10):1148-64.
87.
Wang Y, Xu D. Efectos del ejercicio aeróbico sobre lípidos y lipoproteínas. Lipids
Health Dis. diciembre de 2017;16(1):132.
88.
Igarashi Y, Nogami Y. Respuesta de lípidos y lipoproteínas al ejercicio de resistencia
acuático regular: un metanálisis de ensayos controlados aleatorios. J Atheroscler Thromb. 1 de
enero de 2019;26(1):14-30.
89.
Bermúdez Garcell AJ, Serrano Gámez NB, Leyva Montero M de los Á, Bermúdez
Garcell AJ, Serrano Gámez NB, Leyva Montero M de los Á. La importancia del ejercicio
físico para disminuir la obesidad y su riesgo cardiovascular. Correo Científico Méd. marzo de
2019;23(1):275-80.

90.
Escuela Profesional de Educación Física. Efectos del programa de actividad física y
deportes
en
estudiantes
de
medicina.
2021;
Available
in:
http://www.scielo.org.pe/scielo.php?pid=S2219-71682020000200142&script=sci_arttext&tlng
=pt
91.
Rincón JCG, Cano JEM, Espinosa PJ. Correlación del Queen’s College Step Test y
ergoespirometría para estimación de VO2max. Rev Iberoam Cienc Act Física El Deporte. 16
de julio de 2020;9(2):94-107.
92.
Palma-Leal
X,
Costa-Rodríguez
C,
Barranco-Ruiz
Y,
ernández-Jaña
S,
Rodríguez-Rodríguez F. Fiabilidad del Cuestionario Internacional de Actividad Física
(IPAQ)-versión corta y del Cuestionario de Autoevaluación de la Condición Física (IFIS) en
estudiantes universitarios chilenos. Journ M Health [Internet]. 2022;19(2). Available in:
10.5027/jmh-Vol19-Issue2(2022)art161 [Accessed 5 dic. 2023]. Copiar
93.
Bustamante-Ara,
Natalia,
Russell-
Guzmán
, Javier, Godoy-Cumillaf, Andrés,
Merellano-Navarro, Eugenio, Uribe, Natasha. Rendimiento académico, actividad física, sueño
y género en universitarios durante la pandemia-2020. Dialnet. 2022;17(53):109 a 131.
94.
Valdez Garcia M. Evaluación del efecto del programa de activación física sobre la
capacidad cardiorrespiratoria en académicos con factores de riesgo del síndrome metabólico
de la Universidad de Sonora [Internet]. VALDEZ GARCIA, MELANIE; 2020 [cited 10 de
noviembre
de
2023].
Available
in:
http://repositorioinstitucional.uson.mx/handle/20.500.12984/4208
95.
Sequi-Dominguez I, Alvarez-Bueno C, Martinez-Vizcaino V, Fernandez-Rodriguez R,
Del Saz Lara A, Cavero-Redondo I. Efectividad de las intervenciones de salud móviles que
promueven la actividad física y las intervenciones en el estilo de vida para reducir el riesgo
cardiovascular entre personas con síndrome metabólico: revisión sistemática y metanálisis. J
Med Internet Res. 31 de agosto de 2020;22(8):e17790.

96.
Woodward A, Broom D, Dalton C, Metwally M, Klonizakis M. Entrenamiento con
ejercicio supervisado y aumento de la actividad física para reducir el riesgo de enfermedad
cardiovascular en mujeres con síndrome de ovario poliquístico: protocolo de estudio para un
ensayo de viabilidad controlado aleatorio. Trials. diciembre de 2020;21(1):101.
97.
American Diabetes Associatión. Enfermedades cardiovasculares y gestión de riesgos:
estándares
de
atención
en
diabetes—2023
[Internet].
2023.
Available
in:
https://diabetesjournals.org/care/article/46/Supplement_1/S158/148038/10-Cardiovascular-Dis
ease-and-Risk-Management
98.
Ismael Campos-Nonato, Oscar Galván-Valencia, Lucía Hernández-Barrera, Cecilia
Oviedo-Solís, Simón Barquera. ENCUESTAS. 2022 [cited 26 de noviembre de 2023].
Prevalencia de obesidad y factores de riesgo asociados en adultos mexicanos: resultados de la
Ensanut
2022.
Available
in:
https://ensanut.insp.mx/encuestas/ensanutcontinua2022/documentos_analiticos.php
99.
Ismael
Campos-Nonato,
)
Cecilia
Oviedo-Solís,
Jorge
Vargas-Meza,
Dolores
Ramírez-Villalobos. ENCUESTAS. 2022 [cited 26 de noviembre de 2023]. Prevalencia,
tratamiento y control de la hipertensión arterial en adultos mexicanos: resultados de la Ensanut
2022.
Available
in:
https://ensanut.insp.mx/encuestas/ensanutcontinua2022/documentos_analiticos.php
100.
Basto-Abreu
A,
López-Olmedo
N,
Rojas-Martínez
R,
Aguilar-Salinas
CA,
Moreno-Banda GL, Carnalla M, et al. Prevalencia de prediabetes y diabetes en México:
Ensanut 2022. Salud Pública México. 13 de junio de 2023;65:s163-8.
101.
Abrantes LCS, De Souza De Morais N, Gonçalves VSS, Ribeiro SAV, De Oliveira
Sediyama CMN, Do Carmo Castro Franceschini S, et al. Actividad física y calidad de vida en
estudiantes universitarios sin comorbilidades por enfermedades cardiometabólicas: revisión
sistemática y metanálisis. Qual Life Res. julio de 2022;31(7):1933-62.

102.
ENSANUT. Encuesta Nacionalde Salud y Nutrición 2018 [Internet]. 2018. Available
in:
https://ensanut.insp.mx/encuestas/ensanut2018/doctos/informes/ensanut_2018_presentacion_r
esultados.pdf
103.
Gutiérrez I, Hernández L. Servicios de Salud del Estado de Colima Dirección de
Servicios de Salud Subdirección de Epidemiología. 2023 [cited 2 de febrero de 2024]. Boletín
Epidemiológico
Estadístico.
Available
in:
https://www.saludcolima.gob.mx/boletinepidemiologico/epidemiologia/2023/boletin-epid-202
3-43.pdf
104.
García-García JA, Reding-Bernal A, López-Alvarenga JC. Cálculo del tamaño de la
muestra en investigación en educación médica. Investig En Educ Médica. octubre de
2013;2(8):217-24.
105.
Ramírez-López LX, Aguilera AM, Rubio CM, Aguilar-Mateus ÁM. Síndrome
metabólico: una revisión de criterios internacionales. Rev Colomb Cardiol. 25 de febrero de
2022;28(1):5885.
106.
Reglamento de la Ley General de Salud en Materia de Investigación para la Salud
[Internet].
[cited
9
de
noviembre
de
2023].
Available
in:
http://www.salud.gob.mx/unidades/cdi/nom/compi/rlgsmis.html
107.
Damián Del Percio. La Declaración de Helsinki: sinopsis de su nacimiento y
evolución.
2020;
Available
in:
https://www.revistasar.org.ar/revistas/2009/numero_1/articulos/declaracion_helsinki.pdf
108.
Antonio Castillo-Paredes, Felipe Montalva Valenzuela, Rodrigo Nanjarí Miranda.
Actividad Física, Ejercicio Físico y Calidad de Vida en niños y adolescentes con Trastorno por
déficit
de
atención
y/o
hiperactividad.
2021;
Available
in:
http://scielo.sld.cu/pdf/rhcm/v20n5/1729-519X-rhcm-20-05-e3714.pdf

109.
Corona Juan, Torres Lilian, Edith, Bañuelos. Circunferencia abdominal e índice
cintura-altura
como
criterio
de
obesidad
en
síndrome
metabólico.
Med
Int
Méx.
2022;38(2):235-47.
110.
Rubio A. Nuevas guías del American College of Cardiology/American Heart
Association Hypertension para el tratamiento de la hipertensión. ¿Un salto en la dirección
correcta?
2018;34(2).
Available
in:
https://medicinainterna.org.mx/article/nuevas-guias-del-american-college-of-cardiology-ameri
can-heart-association-hypertension-para-el-tratamiento-de-la-hipertension-un-salto-en-la-direc
cion-correcta/
111.
Varon SSLB, Artigues SAP, Garcia SCN, Eiriz SMR, Britel RB, Mollo MGT. Punción
arterial y venosa ¿es útil utilizar el ultrasonido? Seram [Internet]. 18 de mayo de 2021 [cited 5
de
diciembre
de
2023];1(1).
Available
in:
https://www.piper.espacio-seram.com/index.php/seram/article/view/4653
112.
Chen K, Kong W, Liao C, Liang Y, Ding J, Zhu X, et al. Comparación de resultados de
laboratorio entre dispositivos de acceso venoso central y venopunción: una revisión
sistemática y un metanálisis. J Vasc Access. 28 de febrero de 2023;112972982311555.
113.
Koju B, Chaudhary S, Shrestha A, Joshi LR. Cardio-respiratory Fitness in Medical
Students by Queen’s College Step Test: A Cross-sectional Study. J Lumbini Med Coll. 28 de
junio de 2019;7(1):29-33.
114.
Jaramillo Montoya MA, Ramírez Orejuela JJ. Efectos del ejercicio físico aeróbico,
anaeróbico y mixto, en personas mayores de 18 años, sobre los factores de riesgo asociados al
síndrome metabólico (LDL, HDL, colesterol, triglicéridos, hipertensión arterial, diabetes tipo
II y obesidad). 19 de febrero de 2019 [cited 9 de noviembre de 2023]; Available in:
https://bibliotecadigital.univalle.edu.co/entities/publication/030feedf-b03b-4776-8574-b459aaf
6ec03

115.
Repositorio Universidad Técnica de Ambato: El entrenamiento aeróbico en el
desarrollo de la resistencia muscular en estudiantes universitarios [Internet]. 2023 [cited 8 de
noviembre
de
2023].
Available
in:
https://repositorio.uta.edu.ec/jspui/handle/123456789/33324
116.
Frasie A, Bertrand-Charette M, Compagnat M, Bouyer LJ, Roy JS. Validation of the
Borg CR10 Scale for the evaluation of shoulder-perceived fatigue during work-related tasks.
Appl Ergon. abril de 2024;116:104200.

Annexes
Annexe 1. Annex 1: Approval from the Bioethics Committee of the Faculty of Medicine,
University of Colima.
University of Colima
Faculty of Medicine
Bioethics Committee
Researcher: Phd Fabián Rojas Larios
PROJECT: EFFECT OF AN AEROBIC PHYSICAL EXERCISE PROGRAM ON
METABOLIC DISORDERS IN COLLEGE-LEVEL STUDENTS AT THE UNIVERSITY OF
COLIMA: A SIMPLE RANDOMIZED CLINICAL TRIAL.
Reg. 2024-6
In response to your application on March 20th 2024 for the revision of the project
under your direction mentioned above by the Research Ethics Committee at the Faculty of
Medicine. You are hereby informed that said project has been:
APPROVED WITH MINIMAL CORRECTIONS
Based on the current regulations for this commission and according to the General Law
of Health Research.
This is extended on April 23rd 2024, for any relevant paperwork.
SINCERELY THE COMMITEE
(SIGNATURES:)
PHD. CARMEN ALICIA SÁNCHEZ RAMÍREZ
PHD. IVÁN DELGADO ENCISO
PHD. BENHAMÍN TRUJILLO HERNÁNDEZ
PHD. MARIO RAMÍREZ FLORES

PHD. JOSÉ GUZMÁN ESQUIVEL
PHD. EFRÉN MURILLO ZAMORA
PHD. EMILIO PRIETO DÍAZ CHAVEZ
DIRECTOR OF THE FACULTY OF MEDICINE

Annex 2. Approval from the Ethics Committee of the Regional University Hospital of
Colima
RULING. RESEARCH COMMITTEE. UNIVERSITY REGIONAL HOSPITAL
PRINCIPAL RESEARCHER: Nelson Enrique Ramos Cuevas, PhD. Pedro Julián Flores,
PhD Fabián Rojas Larios
ANALIZED PROJECT’S TITLE: EFFECT OF AN AEROBIC PHYSICAL EXERCISE
PROGRAM ON METABOLIC DISORDERS IN COLLEGE-LEVEL STUDENTS AT THE
UNIVERSITY OF COLIMA: A SIMPLE RANDOMIZED CLINICAL TRIAL.
The Reseach Committe at the University Regional Hospital (COFEPRIS 17CI06002152)
based on the faculties and atributios given by the articles 41 Bis and 98 to 103 from the
General Law of Health, as well as the General Law of Health Regulation for Health Research
regarding functioning and operation of the Research Committees, informs you that said
document has been revised, analized and taken into consideration at an ordinary session
celebrated on June 13th 2024, at the designated space for Committee meeting, located at
Highway Colima-Guadalajara Kilometer 2, Col. El Porvenir, Colima, Colima, being the duty
of these collegiate body to inform you that OBSERVING that derived from the review made
by the members of these committee to the mentioned protocol, a) Complies with the
fundamental theoretical conceptual elements and partially the methodological desing for the
correct research development; b) Complies with the team trained from the clinical point of
view and partially for the methodological part; c) Complies with the substantial ethical
parameters. Therefore, this Committee resolve that the protocol meets the requirements, which
is why this resolution is issued as follows:
FAVOURABLE with register number CI 2024/1/CR/EFD/242
Along with this document, we attach certain observations that require your attention, for their
analysis and, in their case, modification or correction. This project will be sent for evaluation

by the Research Ethics Committee from this Hospital. After this Committee’s authorization,
you may include patients in your study. Given that this research protocol will not be done in
this Hospital, you must solicit authorisation for its implementation from the responsible at the
unit where it is intended to be done. Once the research is concluded, you must notify this
Research Committee, attaching a written structured summary about the work done. This ruling
is emitted in Colima City, Colima, on June 17th 2024.
PhD. Fabián Rojas Larios
Director at the University Regional Hospital

Annex 3: No-Conflict of interest letter
Colima, Col., May 17th 2024
Dr. Fabián Rojas Larios
Principal
of
the
University
Regional
Hospital
Dr. José Jorge Marentes Etienne
President of the Research Ethics Committee
at the University Regional Hospital
No-Conflict of interest letter
Through this letter, I, B.S. Nelson Enrique Ramos Cuevas, Principal Investigator and licensed
physical education professional, currently pursuing a Master’s degree in Medical Sciences at
the Faculty of Medicine, University of Colima, along with thesis advisors PhD. Fabián Rojas
Larios (Medical Specialist A, affiliated with the Hospital Directorate) and PhD. Pedro Julián
Flores Moreno (Bachelor’s degree in Exercise Science, external associate researcher), declares
that we have no conflicts of interest related to the research protocol titled “EFFECT OF AN
AEROBIC PHYSICAL EXERCISE PROGRAM ON METABOLIC DISORDERS IN
COLLEGE-LEVEL STUDENTS AT THE UNIVERSITY OF COLIMA: A SIMPLE
RANDOMIZED CLINICAL TRIAL.”
We confirm that we have no financial, personal, or professional relationships with individuals
or organizations that could inappropriately influence our work. This study has been conducted
using our own funds, and we have not received any external funding for its execution.
We commit to promptly inform the Research Committee (CI) and the Ethics and Research
Committee (CEI) of any changes to the study protocol or the investigators’ circumstances that
may lead to a conflict of interest. We appreciate your attention and remain available for any
additional information you may require.
Sincerely,
B.C. Nelson Enrique Ramos Cuevas
PhD. Fabián Rojas Larios
PhD. Pedro Julián Flores Moreno
Research Candidate
Methodological Advisor
Clinical Advisor

Annex 4. Letter for Faculty Principals
Date:________________
Proffessor. _______________________
Principal: ________________________
Subject: Invitation to students to participate in the research protocol entitled: EFFECT OF
AN AEROBIC PHYSICAL EXERCISE PROGRAM ON METABOLIC DISORDERS
LEVELS IN HIGHER LEVEL STUDENTS AT THE UNIVERSITY OF COLIMA, SIMPLE
RANDOMIZED CLINICAL TRIAL.
I am Nelson Enrique Ramos Cuevas, a Master's student in Medical Sciences at the Faculty of
Medicine (nramos6@ucol.mx), assessed by the CLINICAL ADVISOR: D. C. FABIÁN
ROJAS LARIOS and the BASIC ADVISOR: D. C. PEDRO JULIÁN FLORES.
The reason for this document is to request your honourable authorization to share with your
students the initiative of voluntary participation in the project: EFFECT OF AN AEROBIC
PHYSICAL EXERCISE PROGRAM ON METABOLIC DISORDERS LEVELS IN HIGHER
LEVEL STUDENTS AT THE UNIVERSITY OF COLIMA, SIMPLE RANDOMIZED
CLINICAL TRIAL, which aims to determine the effect of implementing an eight-week
aerobic physical exercise program on metabolic levels (HDL, triglycerides, abdominal
obesity, glucose disturbance, hypertension) in higher level students (University of Colima), the
protocol intervention is estimated upon returning from the Easter holidays, having the due
approval of the respective bioethics committees of the university to intervene with the
students.
Therefore, your support is essential for the execution of this project in favour of the health and
well-being of the university students.
Without further ado, I look forward to your response.
Student signature
Clinical Advisor Signature
Basic Advisor Signature
Nelson Enrique Ramos Cuevas
PhD. Fabián Rojas Larios
PhD. Pedro Julián Flores

Annex 5. Informed Consent
INFORMED CONSENT LETTER
RESEARCHER. NELSON ENRIQUE RAMOS CUEVAS
CLINICAL ADVISRO: PhD. FABIÁN ROJAS LARIOS
BASIC ADVISOR: PhD. PEDRO JULIÁN FLORES
Research Project Name: EFFECT OF AN AEROBIC PHYSICAL EXERCISE PROGRAM
ON METABOLIC DISORDERS LEVELS IN HIGHER LEVEL STUDENTS AT THE
UNIVERSITY OF COLIMA, SIMPLE RANDOMIZED CLINICAL TRIAL.
Dear participants, the main objective of this work is to include all young university students
from the University of Colima who are pursuing higher-level studies and who suffer from
some type of metabolic disorder (decreased HDL, increased concentration of triglycerides,
abdominal circumference, blood pressure and glucose), the staff will be responsible for
providing and guiding:
●
Blood tests before, during and at the end of the protocol
●
Blood pressure before, during and at the end of the protocol
●
The international physical activity questionnaire to complete
●
Queens College test before, during and at the end of the protocol
This project will evaluate the effect of an aerobic physical conditioning program on factors
associated with indicators of metabolic alteration in higher education students, which will not
have negative effects on health, since the guidelines for the applicability of the physical
exercise program are taken into account.
If you participate voluntarily, the team that makes up this study (nutritionists, doctors and
physical educators) will be taking different data, tests and samples to determine your progress
in the protocol before, during and at the end. A responsible person (Nelson Enrique Ramos
Cuevas) will safeguard all the information provided and will ensure its discretion and
confidentiality.
People who wish to participate in the project have the following rights:

7. Be fully informed of the project’s objectives.
8. Receive detailed information on the procedures that will be carried out during the
intervention.
9. Receive clear information on the possible benefits and/or risks that may arise when
carrying out the intervention.
10. Have the opportunity to ask any type of question that may arise during the sample
collection, physical test or during aerobic physical exercise.
11. Be informed about the process for voluntary withdrawal at any time during the process,
without any harm or aggravation.
12. Receive a copy of this informed consent signed by the parties and filed.
13. Participate of your own free will without any reasons, lies, pressure or influence that
may affect your decision.
By signing, you acknowledge that you have read and understood the entire content of this
letter. You also confirm that you have asked the relevant questions, which have been answered
appropriately. You also acknowledge that you agree to participate in the established protocol,
based on the information provided. Finally, you are informed that a copy of this consent has
been delivered to you via email: nramos6@ucol.mx. Likewise, if at any time you have any
doubts or questions, you can contact us via the same email so that we can respond
appropriately.
Participant’s signature: _________________________________
Participant’s name: _________________________________
Witness 1 Name: __________________ Witness 2 Name: _____________________
Witness 1 Addres: __________________ Witness 2 Addres: _____________________
Principal Researcher signature. ______________________________
Principal Researcher Name. ____________________________

Annexe 6. Application of the IPA-Q questionnaire and format.
Application of the IPA-Q questionnaire
The purpose of this questionnaire, in its extended version, is to evaluate the level of physical
activity and cardiac output of study participants during the last 7 days before completion. This
is administered before and after the intervention and is aimed at individuals aged 15 to 69
years (92). Participants will receive a detailed introduction on the purpose of the
questionnaire, followed by a step-by-step breakdown of the questionnaire, and will be
provided with clarity on how to complete it (minutes or hours). All information will be
provided, all questions or concerns of the participants will be answered, and then they will be
provided with a designated space with a chair, table, pen, and the corresponding questionnaire
to complete it. At all times, participants will have the support of a highly trained professional
in the questionnaire, available to resolve any questions that arise during the process.

Annexe 7. Test and cut-off points for abdominal obesity
For this test, a certified measuring tape will be used and it will also have the objective of
determining the abdominal circumference taking into account the morphophysiological
parameters established by the International Society for the Advancement of Kinanthropometry
(ISAK) and a marker (109). The subject must be placed in an anatomical position and then
will be told to raise his arms crossed at chest height, then the upper edge of the iliac crest will
be identified by marking it with the marker, and after that the lower edge of the last rib will be
identified, so a marking will be made, then the two established references will be taken to
identify the middle area of ​the markings, then the abdomen will be surrounded with the tape
and the subject will be told to breathe normally and at the end of this the circumference will be
taken (Table 1).
Annexe 8. Blood pressure cut-off points.
Tabla 9. Estadios de la presión arterial.
X
Systolic (mmHg)
Diastolic (mmHg)
Normal blood pressure
<120
< 80
High
Between 120 – 129
< 80
Hypertension stage 1
Between 130 – 139
Between 80 - 89
Hypertension stage 2
>140
> 90
Source: Reference table for classification of hypertension based on reference (35,110)

Annexe 9. Test and cut-off points for hyperglycemia.
For the venous blood extraction, the subject will be informed that he/she must attend the test
after fasting for at least eight hours, to decrease the probability of test alterations. Once the
subject is at the blood extraction location, a health professional will take the sample using the
venipuncture technique in the radial area, extracting about 10 ml (111). From this sample, the
DHL sample, triglycerides and the glycosylated haemoglobin sample will be extracted. After
the procedure, the participant will be told to remain seated for at least 5 minutes, after which
he/she will be asked again about their condition. If they are feeling fine, they will leave the
designated area. If they are not, they will remain monitored by the staff until stabilized. See
Appendix 7. When all the samples from the participants are obtained, they will be taken to the
University of Colima laboratory for centrifugation, extraction of the pertinent components,
labelling and freezing for shipment, which will give the final results (112).
Tabla 10. Pruebas para el diagnóstico de la hiperglicemia.
Test name
Acronym
Normal Valeus
Altered Valeus
Glycosylated
hemoglobin
HbA1c
5.6%
>5.7%
39 mmol/ml
Fasting plasma
glucose
FPG
99 mg/dl
>100 mg/dl
Tolerancia a la
glucosa
2H- PG
139mg/dl
140 mg/dl
Source: Cut-off points for an alteration in blood glucose by the different laboratory tests ADA2023 taken based
on reference (50).

Annexe 10. Test, data sheet and results for Queens College test
Application of the Queen College step test.
This test aims to monitor the maximum oxygen consumption of the study subjects in 3
continuous minutes, Lopategui in 2014 stated that to perform this test it is necessary to have a
16-inch or 40.64 cm bench, a digital stopwatch, a metronome and an assistant during the test
(113).
Previously trained personnel demonstrate the correct way to ascend and descend the step.
Subjects should be instructed during the test to always lead with the same foot, fully extend
their legs once on the step, and keep their arms at their sides at all times.
Following the explanation of the performance, the subject will be allowed a 15-second
practice session. The correct cadence for each completed performance or cycle must be
checked. To complete a performance or cycle, the step must have been ascended and
descended once, to a count of four: up-up-down-down! setting the metronome to: men - 96
beats min-1 and women - 88 beats min-1. The subject must practise the correct cadence for
each completed performance or cycle: men - 24 performances/min, 2.5 seconds for each cycle
and women - 22 performances/min, 1 second for each cycle (113).
Set the watch for the test: 3 minutes for both men and women. Activate the metronome: for
men, the metronome is set at 96 beats/min, and for females it should be 88 beats/min. At the
beginning of the test, the step is ascended and descended at a rate of 24 (men) and 22 (women)
times per minute. After the 3-minute test has been completed, the participant remains standing
for 5 seconds and immediately afterwards the pulse is taken for 15 seconds, then the beats felt
during these 15 seconds are multiplied by 4 (pulse-15 sec x 4) to convert it into beats/minute.
This resulting value is known as the Recovery Heart Rate (HRrecup) (113).

Percentile ranks and classification for the Queens College Step Test recovery heart rate and
its estimate of maximal oxygen uptake for male and female college students.
Percentile rank
Women's heart
rate frequency
(Lat/min)
VO2max
Men’s heart
frequency
(lat/min)
VO2max

Annexe 11. Sports planning for intervention and control groups
Table 11. General physical exercise prescription for the control group (A)
Means
Day of the
week
Duration
First four weeks
intensity
Last four weeks
intensity
Cardiorespiratory
endurance
Walk
Monday
60 min
57% - 76% of HR
Frequency
57% - 76% of HR
Frequency
Cardiorespiratory
endurance
Walk
Wednesday
60 min
57% - 76% of HR
Frequency
57% - 76% of HR
Frequency
Cardiorespiratory
endurance
Walk
Friday
60 min
57% - 76% of HR
Frequency
57% - 76% of HR
Frequency
Source: Based on reference (83)
Table 12. General physical exercise prescription for the Experimental group (B).
Means
Day of the
week
Duration
First four weeks
intensity
Last four weeks
intensity
Cardiorespiratory
endurance
Jogging
Monday
60 min
57% - 63% of HR
Frequency
64% - 76% of
HR Frequency
Cardiorespiratory
endurance
Swimming
Wednesday
60 min
57% - 63% of HR
Frequency
64% - 76% of
HR Frequency
Cardiorespiratory
endurance
Static
Bicycle
Friday
60 min
57% - 63% of HR
Frequency
64% - 76% of
HR Frequency
Source: Self-made based on references (72, 114, 115)
Note: This planning will be adjusted in volume after the first 4 weeks, considering the subject's
adaptations in the second test session.

Annexe 12. Borg Scale
Table 13. Modified Borg Scale
Modified Borg Scale
0
Total rest
1
Very low effort
2
Soft
3
Moderated effort
4
A bit hard
5
Hard
6
Hard
7
Very hard
8
Very hard
9
Very hard
10
Maximal effort
Source:Self-made based on reference (116)

Annexe 13. Aerobic or Cardiorespiratory Fitness. Classification Scale. Estimated
Maximum Oxygen Consumption (ml • kg-1 • min-1).

Annexe 14. Mests and their equivalence by physical activity
Table 14. Relationship between physical activity and mets.
Source: Taken from reference (57, 86, 102)

Annexe 15. Temporal-spatial distribution of the tests

Annexe 16. Turnitin Similarity Report