A high level of physical fitness in childhood and adolescence is associated with lower risks of future overweight, fatness, and metabolic syndrome. |
There is no convincing evidence linking a high level of physical fitness in childhood and adolescence to healthier future blood pressure, lipid profile, or glucose homeostasis. |
1 Introduction
2 Methods
2.1 Literature Search
2.2 Eligibility Criteria
2.3 Study Selection Process
2.4 Data Extraction and Assessment
Rating | QUIPS | STROBE |
---|---|---|
High quality | All items scored as low risk, or at most one item scored as moderate risk | Good |
Moderate quality | Two items scored as moderate risk and other items scored as low risk, or five items scored as low risk and one item scored as high risk | Sufficient |
Low quality | Three or more items scored as moderate risk or at least one item scored as moderate and one or more items scored as high risk | Poor |
2.5 Data Synthesis
Reference | Population baseline (N, % male, age, country) | Follow-up duration and N at follow-up | Type and method of fitness testing | Outcomes of interest | Adjustment for confounders | Relevant result |
---|---|---|---|---|---|---|
Aires et al. (2010) [63] Portuguese cohort | N = 345, 50% boys, age 11–19 years, Portugal | 3 years, N = 225 | Composite Z score of curl-ups, push-ups and 20 m shuttle run; ‘Low-fit’ below first tertile vs. ‘High-fit’ ≥ first tertile | BMI and ΔBMI | N/A | BMI Low-fit 23.3 kg/m2 vs. high-fit 21.5 kg/m2, (p = unknown) ΔBMI High-fit from 2006 to 2008 = 1.28 ± 3.48 Low-fit from 2006 to 2008 = 1.44 ± 1.76 (p = unknown) |
Aires et al. (2010) [64] Portuguese cohort | N = 345, 50% boys, age 14 ± 1.38 years (range 11–16 years), Portugal | 2 years, N = not specified | Score of curl-ups, push-ups and 20 m shuttle run; Characterized as healthy zone or under healthy zone | BMIc | Model 1: Adjusted for time Model 2: Also, mother’s education, curl-up, push-up, back-saver sit&reach, screen time, school commute, physical activity index |
BMIc
1) B 0.435 (95% CI 0.116; 0.754) P = 0.008 2) B 0.766 (95% CI 0.289; 1.244) P = 0.002 |
Boreham et al. (2002) [56] Northern Ireland Young Hearts Project | N = 1015, 50% boys, age group 1: 12.5 ± 0.3, group 2: 15.5 ± 0.3 years, Northern Ireland | 10 years, N = 459 | 20 m-MSRT, number of complete laps | SumSF SBP, DBP TC, HDL-C, TC:HDL | Social class and sexual maturity | SumSF (M) 12 years β − 0.37 (P < 0.01); 15 years β − 0.38 (P < 0.01) (F) 12 years β − 0.41 (P < 0.01); 15 years β − 0.34 (P < 0.01) |
SBP (M) 12 years β 0.05 NS, 15 years β 0.02 NS, (F) 12 years β − 0.018 NS, 15 years β − 0.07 NS DBP (M) 12 years β − 0.06 NS, 15 years β 0.08 NS, (F) 12 years β − 0.01 NS, 15 years β − 0.10 NS | ||||||
TC (M) 12 years β − 0.12 NS, 15 years β 0.00 NS (F) 12 years β − 0.02 NS 15 years β 0.00 NS HDL-C (M) 12 years β 0.14 NS, 15 years β 0.21 NS, (F) 12 years β − 0.02 NS, 15 years β 0.00 NS TC:HDL (M) 12 years β − 0.15 NS, 15 years β − 0.22 (P = 0.05), (F) 12 years β − 0.27 (P = 0.01), 15 years β − 0.06 NS | ||||||
Twisk et al. (1999) [54] Northern Ireland Young Hearts Project | N = 509, 49% boys, age 12 years, Northern Ireland | 3 years, N = 459 | 20 m-MSRT, number of completed laps (divided into a ‘risk’ quartile versus the other three ‘non-risk’ quartiles) | SumSF | Maturity and SES | SumSF (M) OR 5.46 (95% CI 3.42; 8.73) (F) OR 4.00 (95% CI 2.46; 6.51) |
DBP | DBP (M) OR 1.62 (95% CI 1.04; 2.53) (F) OR 1.05 (95% CI 0.71; 1.56) NS | |||||
TC:HDL | TC:HDL (M) OR 1.66 (95% CI 1.12; 2.45) (F) OR 1.76 (95% CI 1.11; 2.81) | |||||
Ferreira et al. (2005) [57] Amsterdam Growth and Health Longitudinal study | N = 450, 48% boys, age 13.1 ± 0.8 years, the Netherlands | 24 years, N = 364 | Test not specified, used VO2max in ml/min/kg | MetS (≥ 3 out of 5 risk factors) (1) SBP ≥ 130 mmHg and/or DBP ≥ 85 mmHg; (2) HDL cholesterol (M: < 40 mg/dl, F: < 50 mg/dl; (3) TG > 150 mg/dl; (4) HbA1c > 6.1% (5) WC M: > 94 cm, F: > 80 cm | Sex | No differences at adolescents in CRF in those with and without MetS at 36 years (extracted from graph) |
Ferreira et al. (2002) [58] Amsterdam Growth and Health Longitudinal study | N = 450, 49% boys, age 13.1 ± 0.8 years (range 13–16 years), the Netherlands | 24 years, N = 154 | Maximal running test on treadmill to measure VO2max in ml/min/kg | Ultrasound carotid arterial properties: intima media thickness; diameter; distension; distensibility; compliance coefficient; Young’s elastic modulus | Model 1. Sex Model 2. Also body height, body weight, sum of four skinfolds, mean blood pressure (systolic and diastolic blood pressure instead, in analyses with IMT), total and HDL-C, resting heart rate and smoking status |
Carotid arterial properties:
IMT 1) (M) β −0.244 (P = 0.035) (F) β 0.170 (P = 0.135) NS; 2) (M) β −0.381 (P = 0.012) (F) β 0.204 (P = 0.138) NS Diameter 1) (M) β −0.058 (P = 0.622) NS (F) β 0.145 (P = 0.202) NS; 2) (M) β −0.189 (P = 0.201) NS (F) β 0.149 (P = 0.242) NS Distension 1) (M) β −0.094 (P = 0.422) NS (F) β 0.150 (P = 0.188) NS; 2) (M) β −0.087 (P = 0.557) NS (F) β 0.105 (P = 0.414) NS Distensibility coefficient 1) (M) β −0.024 (P = 0.839) NS (F) β 0.163 (P = 0.150) NS; 2) (M) β 0.024 (P = 0.877) NS (F) β 0.107 (P = 0.406) NS Compliance coefficient 1) (M) β −0.038 (P = 0.743) NS (F) β 0.192 (P = 0.089) NS; 2) (M) β −0.077 (P = 0.606) NS (F) β 0.157 (P = 0.213) NS Elastic modulus 1) (M) β 0.124 (P = 0.288) NS (F) β −0.217 (P = 0.054) NS; 2) (M) β 0.112 (P = 0.468) NS (F) β −0.189 (P = 0.154) NS |
Femoral arterial properties: diameter; distension; distensibility; compliance coefficient | ||||||
Femoral arterial properties:
Diameter 1) β 0.382 (< 0.001); 2) β 0.252 (P = 0.026) Distension 1) β −0.188 (P = 0.171) NS; 2) β − 0.395 (P = 0.016) Distensibility coefficient 1): β −0.214 (P = 0.088) NS; 2) β − 0.344 (P = 0.024) Compliance coefficient 1) β −0.029 (P = 0.832) NS; 2) β −0.257 (P = 0.121) NS | ||||||
Twisk et al. (2002) [61] Amsterdam Growth and Health Longitudinal study | N = 307, 48% boys, age 13.1 ± 0.8 years, the Netherlands | 20 years, N = 277 | Maximal treadmill test to measure VO2max, expressed as absolute (L/min), ml/min/kg and maximal slope (%) of the treadmill (at 8 km/h) A) fitness at age 13 and B) “Maintained” exposure: the average VO2max over the first four annual measurements (between 13 and 16 years) | WHR, WC | Sex and age, if interaction with sex than separate for sex |
WHR
VO2max (absolute), A) β − 0.03 NS; B) β − 0.05 NS; VO2max (per kg), A) β − 0.01 NS; B) β 0.08 NS Maximal slope, A) β 0.00 NS; B) β 0.06 NS
WC
VO2max (absolute), A) β 0.11 NS; B) (M) β − 0.21 NS and (F) β − 0.34 P < 0.01 VO2max (per kg), A) (M) β − 0.01 NS and (F) β − 0.26 P < 0.01. B) β − 0.14 NS Maximal slope, A) (M) β 0.06 NS and (F) β − 0.23 P < 0.01; B) β − 0.10 NS |
SumSF | ||||||
SBP, DBP | ||||||
TC, HDL-C, and TC:HDL | ||||||
SumSF
VO2max (absolute), A) β − 0.02 NS; B) β 0.09 NS VO2max (per kg), A) β − 0.29 P < 0.01; B) β − 0.34 P < 0.01 Maximal slope, A) (M) β − 0.011 NS and (F) β − 0.25 P < 0.01; B) β − 0.32 P < 0.01 | ||||||
SBP
VO2max (absolute), A) (M) β − 0.27 P < 0.05 and (F) β 0.1 NS; B) (M) β − 0.16 NS and (F) β 0.19 NS VO2max (per kg), A) β − 0.01 NS; B) β − 0.25 P < 0.05 Maximal slope, A) β − 0.04 NS; B) β 0.06 NS
DBP
VO2max (absolute), A) β − 0.03 NS; B) (M) β − 0.06 NS and (F) β 0.16 NS. VO2max (per kg), A) β − 0.09 NS; B) β − 0.11 NS Maximal slope, A) β − 0.12 NS; B) β 0.05 NS | ||||||
TC
VO2max (absolute), A) β 0.04 NS; B) β 0.05 NS. VO2max (per kg), A) (M) β − 0.17 NS and (F) β 0.11 NS; B) − 0.27 NS Maximal slope A) (M) β − 0.19 P < 0.05 and (F) β 0.05 NS; B) β − 0.23 P < 0.05
HDL-C
VO2max (absolute), A) β 0.01 NS; B) β 0.01 NS. VO2max (per kg), A) β 0.04 NS; B) β 0.13 NS Maximal slope A) β − 0.05 NS; B) β 0.05 NS
TC:HDL ratio
VO2max (absolute), A) β 0.03 NS; B) β 0.03 NS. VO2max (per kg), A) β − 0.07 NS; B) β − 0.26 P < 0.05 Maximal slope A) (M) β − 0.11 NS and (F) β 0.09 NS; B) β − 0.17 NS | ||||||
Grontved et al. (2011) [42] European Youth Heart Study | N = 589, 45% boys, age boys 9.8 ± 0.4, girls 9.7 ± 0.4 years, Denmark | 6 years, N = 226 | Graded maximal aerobic fitness test: A) Stage 2 exercise SBP, B) Last completed stage SBP, C) Slope of intensity-SBP function, D) HR at stage 2, E) HR at last completed stage, F) Rate pressure product (RPP) stage 2, G) RPP last completed stage | Resting SBP | Model 1: Age and sex Model 2: also childhood levels of resting SBP and DBP Model 3: also BMI, CRF, TC, HDL-C, TG, insulin and glucose at baseline |
SBP
β
1) A) B = 0.19 (95% CI 0.11; 0.27); B) B = 0.11 (95% CI 0.04; 0.18); C) B = 5.75 (95% CI − 0.17; 11.68) NS; D) B = 0.05 (95% CI − 0.01; 0.12) NS; E) B = 0.07 (95% CI − 0.02; 0.16) NS; F) B = 0,07 (95% CI 0.04; 0.11); G) B = 0.05 (95% CI 0.02; 0.08) 2) A) B = 0.09 (95% CI 0.002; 0.18); B) B = 0.04 (95% CI − 0.04; 0.11) NS; C) B = 4.46 (95% CI − 1.08; 10.01) NS; D) B = 0.05 (95% CI − 0.01; 0.11) NS; E) B = 0.07 (95% CI − 0.02; 0.16) NS; F) B = 0,05 (95% CI 0.01; 0.08); G) B = 0.02 (− 0.01; 0.05) NS 3) A) B = 0.09 (95% CI − 0.003; 0.18) NS; B) B = 0.03 (95% CI − 0.04; 0.11) NS; C) B = 5.52 (95% CI − 0.09; 11.13) NS; D) B = 0.06 (95% CI − 0.01; 0.13) NS; E) B = 0.06 (95% CI − 0.03; 0.16) NS; F) B = 0,05 (95% CI 0.01; 0.09); G) B = 0.02 (− 0.01; 0.05) NS |
Grontved et al. (2013) [59] European Youth Heart Study | First cohort N = 429, Second cohort N = 444, approx. 47% boys, age 15 years, Denmark | 6 or 12 years, N = 317 | Maximal progressive ergometer bicycle test. Estimated VO2max in ml/min/kg | Fasting glucose, insulin (%change), HOMA-IR (%change), and HOMA-B (%change) | Model 1: Adolescent age, adulthood age, sex, recruitment period Model 2: Also parental educational level, current smoking, family history of diabetes, soft drinks intake, and fruit and vegetables intake. Model 3: Also muscular strength Model 4: Also WC |
Glucose
1) B = − 0.04 (95% CI − 0.09; 0.01) NS 2) B = − 0.03 (95% CI − 0.08; 0.03) NS 3) B = − 0.02 (95% CI − 0.08; 0.04) NS 4) B = − 0.02 (95% CI − 0.09; 0.05) NS
Insulin
1) B = − 17.0 (95% CI − 22.7; − 10.9) 2) B = − 16.6 (95% CI − 22.5; − 10.2) 3) B = − 12.8 (95% CI − 19.2; − 5.8) 4) B = 11.4 (95% CI − 19.0; − 3.2)
HOMA-IR
1) B = − 17.8 (95% CI − 23.9; − 11.3) 2) B = − 17.3 (95% CI − 23.6; − 10.5) 3) B = − 13.3 (95% CI − 20.1; − 5.9) 4) B = − 12.1 (95% CI − 20.1; − 3.2)
HOMA-B
1) B = − 13.2 (95% CI − 18.7; − 7.4) 2) B = − 13.2 (95% CI − 18.8; − 7.2) 3) B = − 10.0 (95% CI − 16.1; − 3.4) 4) B = − 9.2 (95% CI − 16.5; − 1.4) |
Andersen et al. (2004) [38] | N = 305, 44% boys, age 16–19 years, Denmark | 8 years, N = 235 | Maximal progressive cycle test to measure VO2max in ml/min/kg, divided into quartiles | Metabolic syndrome: ≥ 2 risk factors (upper quartile of TC:HDL, TG, SBP and body fat) | Fitness at follow-up |
MetS
No significant relationships between fitness level at baseline and being a case (clustered risk CVD) at follow-up both with and without adjustment for fitness level at second examination (no data shown) |
Andersen et al. (2011) [39] | N = 706, %boys N/A, age boys 6.8 ± 0.4, girls 6.7 ± 0.3 years, Denmark | 2.5 years, N = 434 | Maximal progressive treadmill run to assess VO2max in ml/min/kg, divided into quartiles | Clustered risk (sum of z-scores > 1SD) including TC:HDL, TG, SBP, HOMA-IR and SumSF | Not specified |
Clustered risk
Quartile 1: OR 6.8 (95% CI 2.2; 21.0) Quartile 2: OR 2.9 (95% CI 0.9; 9.5) NS Quartile 3: OR 3.3 (95% CI 1.0; 10.5) Compared to upper fitness quartile |
Barnekow-Bergkvist et al. (2001) [55] | N = 425, 52%boys, 16.1 ± 0.33 years (range 15–18 years), Sweden | 18 years, N = 278 | 9-min run/walk test, distance covered in meters, 9-min run (M ≥ 2,150 m F ≥ 1614 m) for Relative Risk and for logistic regression (OR) each 100-m decrease | BMI (M ≥ 27; F ≥ 27) | Sport club membership, Satisfied with sports performance, positive attitude to soccer, handball and aerobic exercise, BMI, School program level | BMI Bivariate RR: (M) 0.9 (95% CI 0.4; 1.9) NS; (F) 0.5 (95% CI 0.2; 1.2) NS Multiple logistic: (M) OR 1,4 (95% CI 1.1; 1.9); (F) OR 1.0 (95% CI 0.7; 1.5) NS |
WHR (M ≥ 0.95; F ≥ 0.85) | ||||||
WHR Bivariate RR: (M) 0.4 (95% CI 0.1; 1.3) NS; (F) OR 0.5 (95% CI 0.2; 1.2) NS Multiple Logistic: (M) OR 1.3 (95% CI 0.9; 1.8) NS; (F) N/A | ||||||
SBP ≥ 140 mmHg | SBP Bivariate RR: (M) 1.1 (95% CI 0.6; 2.0) NS; (F) 1.0 (95% CI 0.3; 3.2) NS OR: N/A | |||||
TC (M ≥ 6.2; F ≥ 6.2) | TC Bivariate RR: (M)1.0 (95% CI 0.5; 2.0); (F) 0.5 (95% CI 0.2; 1.3) OR: N/A | |||||
Byrd-Williams et al. (2008) [65] | N = 160, 53% boys, age boys 11.2 ± 1.6, girls 11.2 ± 1.8 years (range 8–13), USA (only Hispanic overweight children) | 4 years, N = 160 | Maximal progressive treadmill test to assess VO2max in ml/min and ml/min/kg | Change in total fat mass (kg) over age | Changes in total lean tissue mass, Tanner stage, sex and age | Fat mass (M) B = − 0.001 (SE 0.0004) P < 0.05 (F) B = 0.0005 (SE 0.0005) NS |
Chen et al. (2014) [40] | N = 2758, 51%boys, age 9.7 ± 0.5 years, Taiwan | 2 years, N = 1933 | 800-m sprint test time z-scores based on sex and age specific means and SD; a positive z-scores indicates high fitness | WC ≥ 85%, WHR ≥ 85%, WHtR ≥ 85% | Age, sex, parental educational level, family income, family history of atopy, breastfeeding, maternal smoking in pregnancy | WC: OR 1.14 (95% CI 1.12; 1.16) WHR: OR 1.11 (95% CI 1.09; 1.14) WHtR: OR 1.13 (95% CI 1.11; 1.16) |
Dwyer et al. (2009) [66] | N = 8498 of whom N = 2595 with CRF, 51% boys, age boys 11.9 ± 2.4, girls 11.8 ± 2.4 years (range 7–15 years), Australia | 19–21 years, N = 647 | Bicycle ergometer to assess physical working capacity at HR 170 bpm, as watts per kg lean mass expressed as unfit vs. normal fitness | BMI, Obesity | Sex, age, SES at baseline, and education level at follow-up. Obesity status and BMI additionally adjusted for BMI at baseline. | BMI B = 0.96 (95% CI 0.34; 1.58) Obesity OR 3.0 (95% CI 1.5; 5.6) |
Insulin resistance (= HOMA-IR ≥ 75th sex-specific percentile) HOMA-IR | Insulin resistance OR 1.7 (95% CI 1.1; 2.6) HOMA-IR OR 0.18 (95% CI − 0.0003; 0.36) NS | |||||
Eisenmann et al. (2005) [33] | N = 48, 75% boys, age boys: 15.9 ± 1.9, girls 15.2 (± 2.5) years, USA (only those < 18 years old measured) | 15 years, N = 48 | Maximal treadmill test, modified Balke protocol. Expressed as treadmill time | BMI | Length of follow-up, sex and age | BMI r = − 0.34 (P < 0.05) Low vs. high fitness: 24.6 (3.2) vs. 22.9 (2.4) (P < 0.05) |
WC r = − 0.38 (P < 0.05) Low vs. high fitness: 84.5 (11.4) vs. 79.6 (9.3) (P < 0.05) %BF r = − 0.47 (P < 0.05) Low vs. high fitness: 19.9 (4.9) vs. 14.6 (6.5) (P < 0.05) | ||||||
WC %BF | ||||||
SBP, DBP, MAP | ||||||
TC, HDL-C, TC:HDL, TG | SBP r = − 0.01 NS; Low vs. high fitness: 117.5 ± 9.8 vs. 116.9 ± 12.6 NS DBP r = − 0.12 NS; low vs. high fitness: 77.9 ± 7.6 vs. 77.1 ± 11.2 NS MAP r = − 0.10 NS; low vs. high fitness MAP 91.1 ± 6.7 vs. 90.4 ± 10.8 NS | |||||
Glucose | ||||||
Composite metabolic risks score | ||||||
TC r = − 0.20 NS; Low vs. high fitness: 189.8 ± 44.6 vs. 184.3 ± 42.4 NS HDL-C r = − 0.15 NS; Low vs. high fitness: 52.1 ± 17.3 vs. 44.9 ± 9.8 NS TC:HDL r = − 0.08 NS; Low vs. high fitness: 4.0 ± 1.6 vs. 4.3 ± 1.4 NS TG r = 0.03 NS; Low vs. high fitness: TG 96.7 ± 68.1 vs. 123 ± 67.9 NS | ||||||
Glucose r = 0.12 NS 4.0 (1.6) vs. 4.3 (1.4) NS: 93.2 ± 7.5 vs. 93.3 ± 6.0 NS | ||||||
Composite metabolic risk score r = 0.03 NS | ||||||
Ekblom et al. (2009) [41] | N = 508, 56% boys, age 10 years, Sweden | 6 years, N = 296 | Submaximal ergometer test with estimated maximal VO2 in ml/min/kg—high fitness (top 2 tertiles) vs. low fitness | High BMIsds (> 2 sds), and increasing BMIsds (BMIsds-difference > 0) | Sex, PE teacher education level, level of MVPA, geographic region of school, BMIsds baseline | High BMIsds: OR 0.13 (95% CI 0.04; 0.44) Increasing BMIsds: no values given, NS |
Flouris et al. (2008) [67] | N = 210, 56% boys, age boys 12.3 ± 0.6, girls 12.3 ± 0.6 years, Greece | 6 years, N = 203 | 20-m MSRT, calculated VO2max in ml/min/kg | Metabolic syndrome (≥ 3 of 5 symptoms); SBP ≥ 90th (age, height and sex specific); HDL-C (M) < 45 mg/dl (F) < 50 mg/dl; TG ≥ 150 mg/dl; glucose ≥ 110 mg/dl; BMI ≥ 90th | Not specified |
MetS
Cut off point of VO2max for prediction of metabolic syndrome (Z value for Cohen’s Kappa): (M) 12yrs 31.8 (3.424), 13yrs 37.5 (3.341), 14yrs 37.8 (2.344); (F) 12yrs 26.8 (2.290), 13yrs 28.3 (3.341). 14yrs 28.3 (1.750) NS |
Freitas et al. (2012) [68] | N = 450, 51% boys, age group 1 (8 years), group 2 (12 years) and group 3 (16 years), Portugal | 7.2 years, N = 434 | 12-min run/walk test, distance covered | BMI | Not specified | NP means that fitness was not a predictor and it was not included in the model, therefore no data available. BMI (M) group 1: NP, group 2 NP, group 3 NP (F) group 1 NP, group 2 NP, group 3 NP |
WC | WC (M) group 1: NP, Group 2 NP, group 3 NP (F) group 1 NP, group 2 NP, group 3 NP | |||||
SumSF | SumSF (M) group 1: NP, Group 2 NP, group 3 B = − 0.014 Partial R2 = 0.03, P < 0.05 (F) group 1 NP, group 2 NP, group 3 NP | |||||
Hasselstrom et al. (2002) [60] | N = 305, 44% boys, age 17.1 ± 1.0 years (range 15–19 years), Denmark | 8 years, N = 203 | Maximal progressive cycle ergometer test, measured VO2max in ml/min/kg | WC | Age | WC: (M) B = 0.08 r = − 0.10 NS; (F) B = − 0.06 r = − 0.08 NS |
%BF | %BF: (M) B = − 0.22 r = − 0.18 NS, (F) B = − 0.38 r = − 0.27 P < 0.05 | |||||
SBP, DBP | SBP: (M) B = 0.05 r = 0.097 NS, (F) B = − 0.02 r = − 0.04 NS DBP: (M) B = − 0.61 r = − 0.11 NS, (F) B = 0.03 r = − 0.04 NS | |||||
TC, HDL-C, TC:HDL, TG | ||||||
Metabolic risk score risk score calculated as the sum of SBP, TC, TC:HDL, TG, and %BF (from skinfolds) | TC: (M) B = − 0.25 r = − 0.04 NS, (F) B = − 0.93 r = − 0.18 NS; HDL-C: (M) B = − 2.16 r = − 0.09 NS, (F) B = 0.72 r = 0.04 NS TC:HDL (M) B = − 5.84 r = − 0.07 NS, (F) B = 13.43 r = 0.19 NS TG (M) B = 1.68 r = 0.14 NS, (F) B = − 5.16 r = − 0.24, P < 0.05 | |||||
Metabolic risk score: (M) B = − 0.25 r = − 0.18 NS, (F) B = − 0.01 r = 0.00 NS | ||||||
Henderson et al. (2016) [43] | N = 630, 54.4% boys, age 9.6 ± 0.9 years, Canada (white, ≥ one obese parent) | 2 years, N = 564 | Maximal progressive cycle ergometer test, measured VO2peak as ml/min/FFM | Insulin sensitivity by Matsuda index; HOMA-IR | 1. Crude 2. Sex, age, Tanner stage, season 3. Also %BF | Insulin sensitivity: 1) B = 0.6 (95% CI − 0.5; 1.7) NS 2) B = − 0.05 (95% CI − 1.1; 1.0) NS 3) B = 0.3 (95% CI − 0.6; 1.1) NS HOMA-IR: 1) B = − 0.2 (95% CI − 1.4; 0.9) NS 2) B = 0.4 (95% CI − 0.7; 1.5) NS 3) B = − 0.05 (95% CI − 0.9; 0.9) NS |
Janz et al. (2000) [44] | N = 123, 50% boys, age boys 10.8 ± 1.0, girls: 10.3 ± 1.0 years (range 7–12 years), USA | 5 years, N = 110 | Maximal progressive ergometer test. Peak VO2max in ml/min | LVM; change in LVM | Age, FFM, height, peak SBP, SBP, SumSF, peak VO2max and maturity (Tanner and for boys testosterone) All predictor variables were included in the model and deleted if P > 0.05 | LVM Spearman correlation (M) r = 0.5; (F) r = 0.54 LVM (M) only FFM in model; (F) peak oxygen uptake explained ± 35%, and when FFM was added it explained 43% of the variability in LVM together |
Johnson et al. (2000) [45] | N = 115, 31% boys, age white boys 8.7 (± 1.76); black boys 7.6 (± 1.5); white girls 8.1 (± 1.38); black girls 8.1 (± 1.73) years, USA | 5 years, N = 95 | Maximal progressive walking treadmill test to measure VO2max in L/min | The increase in fat mass adjusted for the increase in lean mass. (FM/FFM) | Initial FM, LTM, and age Tanner stage, ethnicity and baseline energy expenditure | FM/FFM B = − 2, P = 0.05 |
Klakk et al. (2014) [46] | N = 800, 44%boys, age 9.4 ± 0.8 years (range 7.7–11.4 years), Denmark | 2 years, N = 365 | Andersen Test, 10-min intermittent running test in meters | SBP | Model 1: baseline values of risk, age, sex, school type, pubertal status, birth weight, and parental educational level (WC also height and height2) Model 2: also BF% | SBP 1) β − 0.05 (95% CI − 0.14; 0.04) NS; 2) β − 0.05 (95% CI − 0.05; 0.15) NS |
TC:HDL, TG | TC:HDL 1) β − 0.06 (95% CI − 0.12; 0.01) NS; 2) β − 0.02 (95% CI − 0.10; 0.06) NS TG 1) β − 0.09 (95% CI − 0.19; 0.01) NS; 2) β − 0.02 (95% CI − 0.13; 0.10) NS | |||||
HOMA-IR | ||||||
Composite Risk score: standardized scores of logHOMA-IR, SBP, logTC:HDL and logTG | HOMA-IR 1) β − 0.16 (95% CI − 0.27; − 0.05); 2) β − 0.03 (95% CI − 0.14; 0.09) NS | |||||
Composite risk score 1) β − 0.12 (95% CI − 0.21; − 0.02); 2) β − 0.009 (95% CI − 0.11; 0.09) NS | ||||||
Latt et al. (2016) [70] | N = 313, 100% boys, age 11.9 ± 0.1 years, Estonia | 2 years, N = 120 | Maximal progressive cycle ergometer test, measured VO2max in ml/min/kg or per FFM. Low < 45 per kg or < 65.3 per FFM. Moderate 45–53 per kg or 65.3–71.7 per FFM High > 53 per kg or > 71.7 per FFM | TC:HDL, TG HOMA-IR | Tanner stage and second-year follow-up CRF | TC:HDL Low vs. High VO2max/kg OR 3.49 (95% CI 1.23; 9.86) Low vs. High VO2max/FFM OR 0.77 (95% CI 0.31; 1.97) NS TG Low vs. High VO2max/kg OR 2.99 (95% CI 1.07; 8.38) Low vs. High VO2max/FFM OR 1.15 (95% CI 0.47; 2.82) NS |
HOMA-IR: Low vs. High VO2max/kg OR 5.93 (95% CI 2.01; 13.38) Low vs. High VO2max/FFM OR 1.23 (95% CI 0.50; 3.03) NS | ||||||
Liew et al. (2011) [47] | N = 533, 54% boys, age 10.9 ± 0.49 years, USA | 4 years, N = 246 | 1 mile walk/run time | BMI | Age and sex |
BMI
Partial correlation coefficients: 5th grade with 8th grade: r = 0.21 NS; 7th grade: r = 0.25 P < 0.05, 6th grade with 8th grade BMI: r = 0.56 P < 0.01 |
Lopes et al. (2012) [37] | N = 285, 50% boys, age boys 5.9 ± 0.3, girls 5.9 ± 0.3 years, Portugal | 4 years, N = 285 | 1 mile walk/run time | SumSF | Sex, time squared, time cubed, motor coordination, curl-up, push-up, baseline SumSF | SumSF B = 0.12 (SE 0.05) (95% CI 0.02; 0.22) |
Martins et al. (2009) [48] | N = 153, 43% boys, age boys 9.1 ± 0.87, girls 9.1 ± 0.90 years, Portugal | 5 years, N = 153 | 20-m MSRT, estimated VO2max in ml/min/kg | BMI | Model 1 for time Model 2 also for sex and age | BMI 1) B = − 0.14 (95% CI − 0.20; − 0.09), 2) B = − 0.15 (95% CI − 0.21; − 0.09) |
SBP, DBP | SBP 1) B = − 0.04 (95% CI − 0.18; 0.25) NS, 2) B = 0.04 (95% CI − 0.18; 0.27) NS DBP 1) B = − 0.13 (95% CI − 0.33; 0.66) NS, 2) B = − 0.02 (95% CI − 0.22; − 0.19) NS | |||||
TC | TC 1) 0 = B− 0.46 (95% CI − 1.02; 0.95) NS, 2) B = − 0.18 (95% CI − 0.77; − 0.41) NS | |||||
McGavock et al. (2009) [49] | N = 222, =%boys N/A, age 11 years, Canada | 2 years, N = 222 | 20-m MSRT, estimated VO2max in ml/min/kg | BMI | Age, baseline BMI and sex | BMI B = − 0.09 (SE 0.05) NS |
McMurray et al. (2008) [50] | N = 2207, 55% boys, age 8.6 ± 0.8 years, USA | 6.5 years, N = 389 | Multi-stage submaximal cycle ergometer test to estimate VO2max, VO2max in ml/min/kg or in ml/min/FFM in tertiles | Presence of MetS (criteria of Jolliffe and Janssen) | Sex, baseline BMI and blood pressure (both > sex and age specific 95th percentile), cholesterol (> 200 mg/dl) |
MetS
Low vs. high VO2max/kg: OR 6.09 (95% CI 1.184; 60.296) Low vs. moderate VO2max/kg: OR 5.58 (95% CI 1.152; 53.775) Low vs. high VO2max/FFM: OR 3.64 (95% CI 0.93; 20.826) Low vs. moderate VO2max/FFM: OR 5.71(95% CI 1.197; 54.455) |
Mikkelsson et al. (2005) [35] | N = 624, 100% boys, age 12–17 years, Finland | 25 years, N = 29 from subgroup with clinical assessment | 2000-m distance run test, classified as slow and fast runners based on a median split per age group | SBP, DBP | In ANCOVA 1. For age and 2. Also for adult BMI | SBP 1) 141 mmHg (95% CI 134; 148) vs. 134 mmHg (95% CI 126; 141) NS 2) P = 0.05 DBP 1) 90 mmHg (95% CI 86; 93) vs. 83 mmHg (95% CI 80; 87), P = 0.013; 2) P = 0.003 |
Ortega et al. (2011) [51] | N = 1144, 46% boys, age 9.5 ± 0.4 years, Estonia and Sweden | 6 years, N = 598 | Maximal progressive cycle ergometer test, estimated VO2max in ml/min/kg | Incidence of overweight/obesity at follow-up for normal weight children at baseline | 1. Country, sex, age, and sexual maturation 2. Baseline BMI |
Overweight/obesity incidence
1) OR 0.89 (95% CI 0.84; 0.95). 2) OR 0.96 (95% CI 0.89; 1.04) NS |
Savva et al. (2014) [36] | N = 4878, 46%boys, age boys 11.4 ± 0.4, girls 11.4 ± 0.3 years. Range 10–13.5 years, Cyprus | 4.6 years, N = 4878 | 20-m MSRT, estimated VO2max in ml/min/kg divided into quartiles | Incidence of overweight/obesity according to IOTF criteria | 1. Unadjusted 2. Age, length of follow-up, area of residence, and average monthly air temperature at time of fitness test | Overweight/obesity 1) (M) Quartile 2: OR 0.82 (95% CI 0.55; 1.23) NS; Quartile 3: OR 0.66 (95% CI 0.44; 0.99); Quartile 4: OR 0.40 (95% CI 0.26; 0.61) (F) Quartile 2: OR1.23 (95% CI 0.76; 2.02) NS; Quartile 3: OR 0.50 (95% CI 0.28; 0.88); Quartile 4: OR 0.55 (95% CI 0.32; 0.95) 2) (M) Quartile 2: OR 0.85 (95% CI 0.5; 1.28) NS; Quartile 3: OR 0.68 (95% CI 0.46; 1.03) NS; Quartile 4: OR 0.40 (95% CI 0.26; 0.61) (F) Quartile 2: OR1.26 (95% CI 0.77; 2.08) NS; Quartile 3: OR 0.52 (95% CI 0.29; 0.92); Quartile 4: OR 0.57 (95% CI 0.33; 0.99) |
Schmidt et al. (2016) [69] | N = 8498, % boys unknown, age 7–15 years, Australia | 19.9 years, N = 1792 (52.3% boys) | 1 mile run, run time used to estimate VO2max, in tertiles (< 20th percentile (low), 20–59th percentile (moderate) and ⩾60th percentile (high)) | Metabolic syndrome (≥ 3:WC (M) ≥ 102 cm (F) ≥ 88 cm; SB ≥ 130 mmHg or DBP ≥ 85 mmHg or treatment; HDL-C (M) < 1.0 mmol/, (F) < 1.29 mmol/L or treatment; TG ≥ 1.70 mmol/L or treatment; glucose ≥ 5.6 mmol/L or treatment | 1. Age, sex, length of follow-up 2. Also for waist circumference |
MetS
1) Mid fitness: RR 0.55 (95% CI 0.37; 0.80). High fitness RR 0.46 (95% CI 0.30; 0.69). 2) Mid fitness: RR 0.68 (95% CI 0.46; 1.01) NS. High fitness RR 0.64 (95% CI 0.43; 0.96) |
Sun et al. (2014) [34] | N = 8498, 51% boys, age boys 11.2 ± 2.5 girls 10.9 ± 2.6 years, Australia | 20 years, N = 1976 | 1.6-km run, inverse of time to complete | Serum hsCRP and plasma fibrinogen | 1. Age, childhood and adulthood SES, smoking, fat intake and alcohol consumption, education, and hormonal contraceptive use for females 2. Also adiposity |
hsCRP
(M)Crude: B = − 0.11 (95% CI − 0.19; − 0.03) P = 0.005 (F) B = − 0.22 (95% CI − 0.3; − 0.14) P < 0.001 1) B = − 0.11(95% CI − 0.19; − 0.03) P = 0.005 (F) B = − 0.24 (95% CI − 0.32; − 0.17) P < 0.001 2) B = − 0.07 (95% CI − 0.15; 0.01) NS (F) B = − 0.20 (95% CI − 0.28; − 0.12) P < 0.001
Fibrinogen
(M) Crude: B = − 0.13 (95% CI − 0.17; − 0.09) P < 0.001 (F) B = − 0.13 (95% CI − 0.17; − 0.08) P < 0.001 1) B = − 0.13 (95% CI − 0.17; − 0.09) P < 0.001 (F) B = − 0.14 (95% CI − 0.19; − 0.09) P < 0.001 2): B = − 0.11 (95% CI − 0.14; − 0.07) P < 0.001 (F) B = − 0.10 (95% CI − 0.15; − 0.05) P < 0.001 |
Telford et al. (2015) [52] | N = 694, 50% boys, age 8.1 (± 0.3) years | 4 years, N = 469 | 20-m MSRT, number of stages | HDL-C, HDL-C and logTG | 1. Height, age, pubertal development, school, and socioeconomic status 2. Also BF% in case model 1 was significant |
HDL-C
1) (M) B = − 0.17 (SE 0.07 Effect size: − 2.4; P = 0.014), 2) no values given NS 1) (F) B = − 0.09 (SE 0.085 Effect size 0.22) NS
HDL-C
1) (M) B = − 0.003 (SE 0.035 Effect size 0.09) NS 1) (F) B = − 0.02 (SE 0.04 Effect size 0.05) NS
LogTG
1) (M) B = − 0.14 (SE:0.063; Effect size − 2.2; P = 0.03), 2) NS 1) (F) B = − 0.14 (SE:.07; Effect size: − 2.0; P = 0.04), 2) NS |
Treuth et al. (2003) [53] | N = 101, 0% boys, age 8–9 years, USA | 2 years, N = 88 | Maximal progressive treadmill test measured VO2peak in ml/min | FM and %BF | Time, ethnicity, Tanner stage, parent weight group, baseline weight | FM Estimate − 0.004 (SE 0.001) P < 0.01 %BF Estimate − 0.008 (SE 0.0028) P = 0.008 |
Yoonsuk et al. (2014) [62] | N = 1006, 59%boys, age 17 years, Korea | 23 years, N = 1006 | 100-m dash time (s), standing long jump distance (cm), sit and reach distance (flexibility test, cm), 1000-m (male)/800-m (female) meter (min), sit-ups (reps) and chin-ups (male) or arm-hanging (female). Each test was converted to categorical scale and sum scores were divided in tertiles | BMI ≥ 25 kg/m2 | Not specified |
BMI
(M) Mid: OR 1.6 (95% CI 0.99; 2.57) NS; Low: OR 2.23 (95% CI 0.76; 6.52) NS. (F) Mid: OR 1.40 (95% CI 0.78; 2.53) NS; Low: OR 2.48 (95% CI 0.99; 6.23) NS |
WC ≥ 90 cm | ||||||
WC
(M) Mid: OR 1.18 (95% CI 0.75; 1.85) NS; Low: OR 1.55 (95% CI 0.89; 2.68) NS. (F) Mid: OR 1.26 (95% CI 0.77;2.06) NS; Low: OR 2.34 (95% CI 1.03;5.32) | ||||||
SBP ≥ 130 mmHg or DBP ≥ 85 mmHg | ||||||
SBP or DBP
(M) Mid: OR 1.12 (95% CI 0.78; 1.62) NS; Low: OR 0.90 (95% CI 0.41; 1.99) NS. (F) Mid: OR 1.15 (95% CI 0.63; 2.11) NS; Low: OR 1.77 (95% CI 0.66; 4.70) NS | ||||||
HDL-C < 40 mg/dl, TG ≥ 150 mg/d | ||||||
HDL-C
(M) Mid: OR 0.88 (95% CI 0.56; 1.38) NS; Low: OR 1.38 (95% CI 0.58; 3.24) NS. (F) Mid: 1.44 (95% CI 0.87; 2.39) NS; Low: 2.34 (95% CI 1.02; 5.41) NS
TG
(M) Mid: OR 1.04 (95% CI 0.74; 1.47) NS; Low: OR 0.73 (95% CI 0.35; 1.52) NS. (F) Mid: 1.31 (95% CI 0.65; 2.65) NS; Low: 1.42 (95% CI 0.43; 4.75) NS | ||||||
Fasting glucose ≥ 110 mg/dl | ||||||
Glucose
(M) Mid: OR 0.89 (95% CI 0.52; 1.53) NS; Low: OR 0.68 (95% CI 0.19; 2.40) NS. (F) Mid: 0.60 (95% CI 0.18; 2.01) NS; Low: 0.81 (95% CI 0.09; 7.22) NS | ||||||
MetS 1 or more of above risk factors | ||||||
MetS
(M) Mid: OR 0.88 (95% CI 0.55; 1.41) NS; Low: OR 0.89 (95% CI 0.33; 2.37) NS. (F) Mid: N/A; Low: N/A |
Sex | Association | References |
---|---|---|
Body mass index/weight status
| ||
Boys | [+] [o] [+] [o] | |
Girls | [o] [o] [+] [o] | |
Not separately reported | [o] [+] [+] [+] [+] [+2yr/o3yr] [+] [o] [o] | |
Waist circumference
| ||
Boys | [o] [o] [o] | |
Girls | [o] [oabsolute 13yr/+absolute 13–16yr/+kg 13yr/okg 13–16yr] [+] | [60] [61] [62] |
Not separately reported | [+] [+] [o] | |
Waist-to-hip ratio
| ||
Boys |
[o]
| |
Girls |
[o]
| |
Not separately reported | [+] [o] | |
Body composition
| ||
Boys | [+] [+] [o8&12yr/+ 16yr] [o] [+] | |
Girls | [+] [o] [o] [+] [+] | |
Not separately reported | [+] [+] [+] [+FM&%BF] [oabsolute/+kg] | |
Systolic blood pressure
| ||
Boys | [o] [o] [o] [+] [+absolute 13yr/o] [o] | |
Girls | [o] [o] [o] [o] [o] | |
Not separately reported | [o] [o/+RPP] [o] [o] | |
Diastolic blood pressure
| ||
Boys | [o] [o] [+] [+] [o] | |
Girls | [o] [o] [o] [o] | |
Not separately reported | [o] [o] [o] | |
Total cholesterol
| ||
Boys | [o] [o] [o] | |
Girls | [o] [o] [o] | |
Not separately reported | [o] [o] [o] | |
HDL-Cholesterol
| ||
Boys | [o] [o] [o] | |
Girls | [o] [o] [o] | |
Not separately reported | [o] [o] [o] | |
TC:HDL ratio
| ||
Boys | [o12yr/+15yr] [o] [o] [+kg/oFFM] [+] | |
Girls | [+12yr/o15yr] [o] [o] [+] | |
Not separately reported | [o] [o] | |
Triglycerides
| ||
Boys | [o] [+kg/oFFM] [o] [o] | |
Girls | [+] [o] [o] | |
Not separately reported | [o] [o] | |
Glucose
| ||
Boys | [o] | [62] |
Girls | [o] | [62] |
Not separately reported | [o] [o] | |
HOMA-IR
| ||
Boys | ||
Girls | ||
Not separately reported | [o/+75th] [+] [o] [o] [+kg/oFFM] | |
Metabolic syndrome or composite risk scores
| ||
Boys | [+] [o] | |
Girls | [+/o14yr] | [67] |
Not separately reported | [o] [+] [o] [o] [o] [o] [+] [+] |