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Review of criterion-referenced standards for cardiorespiratory fitness: what percentage of 1 142 026 international children and youth are apparently healthy?
  1. Justin J Lang1,
  2. Mark S Tremblay1,
  3. Francisco B Ortega2,3,
  4. Jonatan R Ruiz2,3,
  5. Grant R Tomkinson4,5
  1. 1 Healthy Active Living and Obesity (HALO) Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  2. 2 PROmoting FITness and Health through physical activity research group (PROFITH), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
  3. 3 Karolinska Institutet, Huddinge, Sweden
  4. 4 Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, North Dakota, USA
  5. 5 Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences & Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
  1. Correspondence to Dr Justin J Lang, Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research, 401 Smyth Rd, Institute, Ottawa, ON, K1H 8L1, Canada; jlang{at}


Purpose To identify criterion-referenced standards for cardiorespiratory fitness (CRF); to estimate the percentage of children and youth that met each standard; and to discuss strategies to help improve the utility of criterion-referenced standards for population health research.

Methods A search of four databases was undertaken to identify papers that reported criterion-referenced CRF standards for children and youth generated using the receiver operating characteristic curve technique. A pseudo-dataset representing the 20-m shuttle run test performance of 1 142 026 children and youth aged 9–17 years from 50 countries was generated using Monte Carlo simulation. Pseudo-data were used to estimate the international percentage of children and youth that met published criterion-referenced standards for CRF.

Results Ten studies reported criterion-referenced standards for healthy CRF in children and youth. The mean percentage (±95% CI) of children and youth that met the standards varied substantially across age groups from 36%±13% to 95%±4% among girls, and from 51%±7% to 96%±16% among boys. There was an age gradient across all criterion-referenced standards where younger children were more likely to meet the standards compared with older children, regardless of sex. Within age groups, mean percentages were more precise (smaller CI) for younger girls and older boys.

Conclusion There are several CRF criterion-referenced standards for children and youth producing widely varying results. This study encourages using the interim international criterion-referenced standards of 35 and 42 mL/kg/min for girls and boys, respectively, to identify children and youth at risk of poor health—raising a clinical red flag.

  • cardiorespiratory fitness
  • course navette
  • children and youth
  • 20-m shuttle run
  • multinational

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  • Contributors JJL ,GRT and MST developed the research questions and objectives. JJL led the data analysis and synthesis of results, and drafted the manuscript. All authors contributed to the interpretation of results, editing and reviewing of the final manuscript. All authors approved the final manuscript.

  • Funding FBO and JRR have received a grant from the Spanish Ministry of Science and Innovation (grant nos. RYC-2011–09011 and RYC-2010–05957, respectively), and FBO’s current research activity is under the umbrella of the ActiveBrains project (Reference DEP2013-47540).

  • Competing interests None declared.

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