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Temporal trends in the cardiorespiratory fitness of children and adolescents representing 19 high-income and upper middle-income countries between 1981 and 2014
  1. Grant R Tomkinson1,2,
  2. Justin J Lang3,
  3. Mark S Tremblay3
  1. 1 Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, North Dakota, USA
  2. 2 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
  3. 3 Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  1. Correspondence to Dr Grant R Tomkinson, Department of Kinesiology and Public Health Education, University of North Dakota, 2751 2nd Avenue North, Stop 8235, Grand Forks, ND 58202, USA; grant.tomkinson{at}


Objective To estimate international and national temporal trends in the cardiorespiratory fitness (CRF) of children and adolescents and to examine relationships between temporal trends in CRF and temporal trends in broad socioeconomic and health-related indicators across countries.

Methods Data were obtained from a systematic search of studies that explicitly reported 20 m shuttle run test (a validated measure of CRF) descriptive data on apparently healthy individuals aged 9–17 years. Following the estimation of relative peak oxygen uptake (mL/kg/min) as a measure of CRF, sample-weighted temporal trends were estimated at the country–sex–age level using best-fitting linear or polynomial regression models relating the year of testing to mean CRF. Poststratified population-weighted mean changes in absolute and per cent CRF were estimated. Pearson’s correlations were used to describe the association between linear temporal trends in CRF and linear temporal trends in broad socioeconomic and health-related indicators.

Results Temporal trends were estimated from 965 264 children and adolescents from 19 high-income and upper middle-income countries between 1981 and 2014, using data from 137 studies. Collectively, there was a moderate decline in CRF of 3.3 mL/kg/min (95% CI −3.5 to −3.1), equivalent to a decline of 7.3% (95% CI −7.8% to −6.7%) over the 33-year time period. This international decline diminished with each decade and stabilised near zero around 2000. The decline was larger for boys than girls and was similar for children and adolescents. Trends also differed in magnitude and direction between countries, with most showing declines. There was a strong negative association between country-specific trends in income inequality (Gini index) and trends in CRF across 18 countries; meaning, countries approaching income equality had more favourable trends in CRF.

Conclusions There has been a substantial decline in CRF since 1981, which is suggestive of a meaningful decline in population health. However, the international trend in CRF has not followed the anticipated trajectory, diminishing and stabilising with negligible change since 2000. CRF data are needed from children in low-income and middle-income countries to more confidently determine true international trends and determine whether temporal trends are similar to those observed in high-income and upper middle-income countries.

  • vo2max
  • exercise testing
  • adolescent
  • aerobic fitness
  • children
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  • Contributors All authors developed the research question and designed the study. GRT and JJL had full access to all the data in the study and take responsibility for the integrity of the data. GRT led the statistical analysis, synthesis of results and writing of the report. All authors contributed to the interpretation of results, editing and critical reviewing of the final report and approved the final report.

  • Competing interests None declared.

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

  • Correction notice This article has been corrected since it published Online First. Reference 11 has been corrected.

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