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Recommended aerobic fitness level for metabolic health in children and adolescents: a study of diagnostic accuracy
  1. Amanda RA Adegboye1,2,
  2. Sigmund A Anderssen3,
  3. Karsten Froberg2,
  4. Luis B Sardinha4,
  5. Berit L Heitmann1,2,
  6. Jostein Steene-Johannessen3,
  7. Elin Kolle3,
  8. Lars B Andersen2,3
  1. 1Research Unit for Dietary Studies, Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark
  2. 2Centre for Research in Childhood Health, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  3. 3Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  4. 4Exercise and Health Laboratory, Technical University of Lisbon, Lisbon, Estrada da Costa, Portugal
  1. Correspondence to Dr Amanda R Amorim Adegboye, Institute of Preventive Medicine, Copenhagen University Hospital, Øster Søgade 18, DK-1357 Copenhagen, Denmark; aar{at}


Objective To define the optimal cut-off for low aerobic fitness and to evaluate its accuracy to predict clustering of risk factors for cardiovascular disease in children and adolescents.

Design Study of diagnostic accuracy using a cross-sectional database.

Setting European Youth Heart Study including Denmark, Portugal, Estonia and Norway.

Participants 4500 schoolchildren aged 9 or 15 years.

Main Outcome Measure Aerobic fitness was expressed as peak oxygen consumption relative to bodyweight (mlO2/min/kg).

Results Risk factors included in the composite risk score (mean of z-scores) were systolic blood pressure, triglyceride, total cholesterol/HDL-cholesterol ratio, insulin resistance and sum of four skinfolds. 14.5% of the sample, with a risk score above one SD, were defined as being at risk. Receiver operating characteristic analysis was used to define the optimal cut-off for sex and age-specific distribution. In girls, the optimal cut-offs for identifying individuals at risk were: 37.4 mlO2/min/kg (9-year-old) and 33.0 mlO2/min/kg (15-year-old). In boys, the optimal cut-offs were 43.6 mlO2/min/kg (9-year-old) and 46.0 mlO2/min/kg (15-year-old). Specificity (range 79.3–86.4%) was markedly higher than sensitivity (range 29.7–55.6%) for all cut-offs. Positive predictive values ranged from 19% to 41% and negative predictive values ranged from 88% to 90%. The diagnostic accuracy for identifying children at risk, measured by the area under the curve (AUC), was significantly higher than what would be expected by chance (AUC >0.5) for all cut-offs.

Conclusions Aerobic fitness is easy to measure, and is an accurate tool for screening children with clustering of cardiovascular risk factors. Promoting physical activity in children with aerobic fitness level lower than the suggested cut-points might improve their health.

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  • Funding The EYHS is supported by the following grants from Denmark: Danish Heart Foundation, Danish Medical Research Council, Health Foundation, Danish Council for Sports Research, Foundation of 17 December 1981, Foundation in Memory of Asta Florida Bolding nee Andersen, and Faculty of Health Sciences, University of Southern Denmark, TRYG-foundation; from Estonia: Estonian Science Foundation grants 3277 and 5209; from Portugal: European Social Fund and from Norway: Directorate of Health and the Norwegian School of Sport Sciences.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was obtained in each of the four countries before the commencement of the study. Written informed consent was obtained from all children's parents or guardians.

  • Provenance and peer review Not commissioned; externally peer reviewed.