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Cardiorespiratory fitness cut points to avoid cardiovascular disease risk in children and adolescents; what level of fitness should raise a red flag? A systematic review and meta-analysis
  1. Jonatan R Ruiz1,
  2. Ivan Cavero-Redondo2,
  3. Francisco B Ortega1,
  4. Gregory J Welk3,
  5. Lars B Andersen4,
  6. Vicente Martinez-Vizcaino2
  1. 1PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
  2. 2Universidad de Castilla-La Mancha, Health and Social Research Center, Granada, Spain
  3. 3Department of Kinesiology, Iowa State University, Ames, Iowa, USA
  4. 4Faculty of Teacher Education and Sport, Sogn og Fjordane University College, Sogndal, Norway
  1. Correspondence to Dr Jonatan R Ruiz, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Ctra de Alfacar s/n, CP 18011, Granada, Spain; ruizj{at}


Background Poor cardiorespiratory fitness is associated with cardiovascular disease risk factors.

Aim To perform a systematic review and meta-analysis of the relationship between poor cardiorespiratory fitness and cardiovascular disease risk in children and adolescents.

Methods Systematic literature search (1980 to 11 April 2015) for studies that determined a cardiorespiratory fitness cut point that predicted cardiovascular disease risk in children and adolescents.

Results We identified 7 studies that included 9280 children and adolescents (49% girls) aged 8–19 years from 14 countries. Cardiovascular disease risk was already present in boys (6–39%) and girls (6–86%). Boys with low fitness (<41.8 mL/kg/min) had a 5.7 times greater likelihood of having cardiovascular disease risk (95% CI 4.8 to 6.7). The comparable diagnostic OR for girls with low fitness (<34.6 mL/kg/min) was 3.6 (95% CI 3.0 to 4.3). The 95% confidence region of cardiorespiratory fitness associated with low cardiovascular disease risk ranges, 41.8–47.0 mL/kg/min in boys (eg, stages 6–8 for a boy aged 15 years) and 34.6–39.5 mL/kg/min in girls (eg, stages 3–5 for a girl aged 15 years). The cardiorespiratory fitness cut point to avoid cardiovascular disease risk ranged 41.8 mL/kg/min in boys and was 34.6 mL/kg/min in girls.

Summary Fitness levels below 42 and 35 mL/kg/min for boys and girls, respectively, should raise a red flag. These translate to 6 and 3 stages on the shuttle run test for a boy and a girl, both aged 15 years, respectively. These cut points identify children and adolescents who may benefit from primary and secondary cardiovascular prevention programming.

  • Aerobic fitness
  • Children
  • Adolescent
  • Cardiovascular
  • Exercise testing

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  • Contributors JRR and VM-V had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. They are also responsible for study concept and design. JRR, IC-R and VM-V contributed to acquisition of data and statistical analysis. JRR, IC-R, GJW, LBA, FBO and VM-V involved in the analysis and interpretation of data and critical revision of the manuscript for important intellectual content. JRR, IC-R, LBA and VM-V involved in the drafting of the manuscript.

  • Funding JRR and FBO are recipients of a Ramón y Cajal Fellowship by the Spanish Ministry of Economy and Competitiveness (grants RYC-2010-05957 and RYC-2011-09011, respectively) and by the University of Granada.

  • Competing interests None declared.

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

  • Data sharing statement Data are available in the tables.

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