Table 3

Longitudinal studies on predictive validity of physical fitness for CVD risk factors and disease in children and adolescents

Fitness componentAuthor/study quality scoreYears of follow-upSubjectsAge (years)Fitness testOutcome variablesResults
Low-quality studies
Cardiorespiratory fitness and body compositionEisenmann et al49∼11Boys 3615.9Maximal treadmill test using the modified Balke protocol (expressed as duration of the treadmill test), BMI, WC and BF (estimated using equations)TG, TC, HDLc, glucose and BPBoys and girls
The Aerobics Center Longitudinal StudyGirls 12to 27.2Adolescent CRF and ΔCRF showed moderate negative correlations with adult BF indicators (BMI, WC and %BF, r  =  −0.34 to −0.47) and ΔBF (r  =  −0.24 to −0.46), respectively. Adolescent CRF was not significantly related to CVD risk factors in adulthood. Adolescent WC was positively related to adult BP (r  =  0.33–0.45), and BF variables during adolescence were negatively related to adult CRF (r  =  −0.32 to −0.44). The ΔWC was negatively related to ΔCRF (r  =  −0.46) and ΔHDLc (r  =  −0.51), and ΔBMI was negatively related to ΔBP (r  =  0.45) and ΔHDLc (r  =  −0.34)
Quality score 2
Cardiorespiratory fitness and body compositionMcGavock et al 37220895–1920 mSRT (estimated Vo2max expressed as ml/kg/min) and weightBP, large-artery compliance and systemic vascular resistanceBoys and girls
Quality score 22004–67–21Weight gain and changes in heart rate and stroke volume were independently associated with changes in SBP over time. Specifically, SBP increased 0.77 mm Hg for every kilogram of weight gain over the 2-year follow-up. CRF was not a significant predictor of the baseline or age-related change in SBP
Cardiorespiratory, motor and musculoskeletal fitnessMonyeki et al381Boys 3807–141600 m run, standing broad jump, bent arm hang, sit-ups, 4×5 m shuttle run and 50 m runBMI, FFM, sum of four skinfolds, BF estimated with equations, arm muscle area, SS/SSFBoys and girls
The Ellisras Longitudinal Study2001–2Girls 322to8–15The changes in weight/age, BMI, sum of skinfolds, FFM and SS/SSF were inversely related with bent arm hang in the pre-adolescent and adolescent boys and girls. Changes in BMI were negatively associated with sit-ups in girls. Changes in height/age, weight/age, BMI, sum of skinfolds, BF and arm muscle area showed negative relationships with changes in shuttle run, 1600 m run and 50 m run
Quality score 2
Body compositionRaitakari et al502135963–18BMI, skinfold thicknessInsulin, glucose, blood pressure, carotid artery IMT and carotid artery elasticityBoys and girls
Cardiovascular Risk in Young Finns Study19802283to 24–39BMI was positively associated with adult IMT (p<0.05). However, when adulthood BMI was entered into the model, the effect of childhood BMI became non-significant. The age and sex-adjusted multivariate correlates of carotid artery elasticity included childhood skinfold thickness (sum of biceps, triceps and subscapular; p<0.05). However, the effect of childhood skinfold thickness on carotid artery elasticity became non-significant (p = 0.16) when adjusted with adult BMI
Quality score 22001–2
High-quality studies
Cardiorespiratory fitnessAndersen et al208Boys 13316–19Maximal cycle ergometer test (measured Vo2max expressed as l/min and l/kg/min)TG, TC/HDLc, SBP, BF derived from skinfolds. The upper quartile was defined as being at risk. If the subject has two or more risk factors, she/he was defined as “a case”Boys and girls
Girls 172to
Danish Youth and Sport Study1983–91Boys 9824–27ORs for having two or more risk factors between quartiles of CRF were 3.1, 3.8 and 4.9 for quartiles two to four, respectively. At the second examination, OR were 0.7, 3.5 and 4.9, respectively. The probability for “a case” at the first examination to be “a case” at the second was 6.0
Quality score 3Girls 137
Cardiorespiratory and musculoskeletal fitnessHasselstrom et al188Boys 13315–19Maximal cycle ergometer test (measured Vo2max expressed as ml/kg/min). Isometric muscular strength index (calculated as the sum of the scores obtained in elbow flexors, knee extensors, trunk flexors and truck extensors relative to body weight)TG, HDLc, BP, %BF and risk score (calculated as the sum of the measured outcomes)Boys
Girls 132to 23–27CRF changes were negatively correlated with the changes in TC, TG, HDLc/TC (p<0.05). Muscular strength changes were negatively correlated with the changes in WC and %BF (p<0.05).
Danish Youth and Sports Study1983–91Boys 45CRF changes were negatively correlated with the changes in TG, SBP, %BF and risk score (p<0.05). Muscular strength was not associated with any of the outcome measures in girls
Quality score 3Girls 57
Cardiorespiratory fitnessPsarra et al212Boys 4776–1220 mSRT (no of completed laps)BMI, WC, W/H and %BF estimated using an electronic body composition analyser (Tanita)Boys and girls
2000–1,Girls 441toBMI at the baseline, parental obesity and low level of CRF were the main predictors of the 2-year tracking of BF. WC and CRF level were the only significant predictors of high WC after 2 years
Quality score 32002–38–14
Cardiorespiratory, musculoskeletal and motor fitnessTwisk et al191518113Maximal treadmill test (measured Vo2max expressed as ml/min/kg2/3). Neuromotor fitness index (muscle strength, speed of movement, and coordination)TC, HDLc, TC/HDLc, SBP, DBP, sum of four skinfolds and W/HBoys and girls
The Amsterdam Growth and Health Longitudinal Study1977–91to 27CRF was negatively related to TC, TC/HDL ratio and the sum of four skinfolds. Neuromotor fitness was positively related to SBP and DBP and inversely to the sum of four skinfolds (p<0.05)
Quality score 3
Body compositionSrinivasan et al221478313–17BMI, subscapular and triceps skinfoldsTG, TC, HDLc, TC/HDLc, LDLc, BP, insulin and glucoseBoys and girls
The Bogalusa Heart Studyto 27–31As young adults, the overweight individuals showed adverse levels of body fatness measures, SBP and DBP, lipid profile, insulin and glucose as compared with the lean individuals (p<0.01 to <0.001). The prevalence of clinically recognised hypertension and dyslipidaemia increased 8.5-fold and 3.1-fold to 8.3-fold, respectively, in the overweight individuals versus the lean individuals (p<0.05). Clustering of adverse values (>75th percentile) for the TC/HDLc, insulin level and SBP occurred only among the overweight individuals (p<0.001)
Quality score 3
Cardiorespiratory and musculoskeletal fitnessBarnekow-Bergkvist et al2318Boys 22015–18 to 33–361974: Run-walk test (score: distance covered in nine minutes)BMI, WC, W/H, TC, HDLc and SBPBoys and girls
Girls 2051992: Submaximal cycle ergometer test (estimated Vo2max expressed as ml/kg/min)CRF at the age of 16 years was not associated with any of the outcomes measures at the age of 34 years. Bench-press was negatively associated with BMI in boys/men, whereas two-hand lift was negatively associated with BMI in girls/women
Quality score 41974–92Boys 157Muscular strength: no of sit-ups and no of lifts in the bench-press test. Maximal static lifting strength was measured with the two-hand lift test
Girls 121
Cardiorespiratory fitnessBoreham et al268Boys 25112–15Submaximal cycle ergometer test (estimated Vo2max by extrapolation of Vo2 at 170 bpm to the age-adjusted estimated maximal heart rate, and expressed as ml/kg/min)Arterial stiffnessBoys and girls
The Northern Ireland Young Hearts ProjectGirls 203to 20–25CRF was inversely and significantly associated with pulse wave velocity of both the elastic aortoiliac segment and the muscular aortodorsalis pedis segment. These associations were only slightly stronger with the muscular segment and were independent of (ie, not confounded nor mediated by) lifestyle variables, BF and physical activity
Quality score 4
Body compositionGarnett et al3973427BMI and WCCVD risk clusteringBoys and girls
290toChildren who were overweight or obese at 8 years of age were 7 times (OR 6.9; 95% CI 2.5 to 19.0; p<0.001) as likely to have CVD risk clustering in adolescence than were their peers who were not overweight or obese. Those with an increased WC at 8 years were four times (95% CI 3.6; 1.0 to 12.9; p = 0.061) as likely to have CVD risk clustering in adolescence than were children with a smaller WC. Neither BMI nor WC were predictive of CVD risk clustering if adiposity was not included as a risk factor
Quality score 414
Cardiorespiratory and musculoskeletal fitnessJanz et al255Boys 6310.5Maximal cycle ergometer test (measured Vo2max expressed as ml/min/kg2/3). Maximum handgrip strength test (sum of right and left hand)TC, HCLc, TC/HDLc, LDLc, sum of six skinfolds, WC and BPBoys and girls
The Muscatine StudyGirls 62to 15CRF changes were negatively correlated with changes in TC/HDLc, LDLc, sum of six skinfolds and WC (p<0.05) after controlling for age, gender, FFM and pubertal status. Muscular strength changes were negatively correlated with changes in SBP, sum of six skinfolds and WC (p<0.05) after controlling for age, gender, FFM and pubertal status
Quality score 4
Cardiorespiratory fitnessJohnson et al243–5White boys 174.6–11 toProgressive walking treadmill test (measured Vo2max expressed as l/min)BF and lean tissue mass measured by DXABoys and girls
White girls 558–16
Quality score 4Black boys 19CRF was negatively associated with increased adiposity. Children with a higher CRF at the start of the study had a lower rate of increase of adiposity over the course of the study
Black girls 24
Cardiorespiratory fitnessMcMurray et al277Boys 2127–10Submaximal cycle ergometry test (estimated Vo2max expressed as ml/min/kgFFM)BMI, BP, BF estimated from triceps and subscapular skinfolds, blood lipids, metabolic syndromeBoys and girls
toChildren with low (first third) CRF (ml/kg/min) were 5.5–6 times more likely to have metabolic syndrome as an adolescent. When childhood CRF was expressed in terms of ml/kgFFM/min, the OR for metabolic syndrome during adolescence comparing the low versus high Vo2max was not significant (p<0.07); however, when the low CRF (mL/kgFFM/min) was compared with the moderate (second third), the OR was significant (p<0.03)
Quality score 41990–6Girls 17714–17
Self-perceived physical fitnessPietilainen et al1744840 (including 1870 twins pairs)16–18Self-perceived physical fitness. Alternatives were “very good, fairly good, satisfactory, rather poor, very poor”. The two first and two last alternatives were combined to yield good, satisfactory and poor fitness classesBMI, WC, BF, FFM, %BF assessed by DXABoys and girls
toThose who perceived themselves as persistently unfit in adolescence had a marked risk of adult overall (5.1; 95% CI 2.0 to 12.7) and abdominal obesity (3.2; 95% CI 1.5 to 6.7). Adult obesity risk was also increased in those whose fitness declined from 16 to 18 years
Quality score 41975–922–27
Cardiorespiratory fitnessCarnethon et al3015Men 202918–30 toMaximal treadmill test according to a modified Balke protocol (expressed as duration of the treadmill test)Incidence of type 2 diabetes, hypertension, the metabolic syndrome and hypercholesterolaemiaBoys and girls
1985–6Women 245843–45
Coronary Artery Risk Development in Young Adults1992–32478Participants with low CRF (<20th percentile) were 3 to 6-fold more likely to develop diabetes, hypertension and the metabolic syndrome than participants with high CRF (⩾60th percentile; all p<0.001). Adjusting for baseline BMI diminished the strength of these associations to 2-fold (all p<0.001). In contrast, the association between low CRF and hypercholesterolaemia was modest (HR 1.4; 95% CI 1.1 to 1.7; p = 0.02) and attenuated to marginal significance after BMI adjustment (p = 0.13). Improved CRF over 7 years was associated with a reduced risk of developing diabetes (HR 0.4; 95% CI 0.2 to 1.0; p = 0.04) and the metabolic syndrome (HR 0.5; 95% CI 0.3 to 0.7; p<0.001), but the strength and significance of these associations was reduced after accounting for changes in weight
Quality score 52000–13550
Cardiorespiratory fitnessBoreham et al2910Boys 22912 and 15 to 22.520 mSRT (no of completed laps)TC, HCLc, BP, sum of four skinfoldsBoys
1989–90–1992–3–1997–9CRF changes were modestly and negatively associated with TC, HDLc and SBP (p>0.5)
The Northern Ireland Young Hearts ProjectGirls 230Girls
Quality score 5CRF changes were modestly and negatively associated with TC, HDLc and skinfold thicknesses (p>0.17), and significantly (negatively) associated with DBP (p = 0.03)
Cardiorespiratory fitnessByrd-Williams et al344Boys 8411 to 15Maximal treadmill test (measured Vo2max expressed as l/min)BF, soft lean tissue mass, and %BF measured by DXABoys
CRF was a significant predictor of change in BF after adjusting for changes in lean tissue mass, Tanner stage, and age (β  =  −0.001, p = 0.03). That is, higher initial CRF was associated with less subsequent gain in body fat
Study of Latino Adolescents at Risk2001–5Girls 76Girls
Quality scoreCRF was not a significant predictor of change in BF after controlling for changes in Tanner stage, lean tissue mass and age (β  =  0.0005, p = 0.37)
Cardiorespiratory fitnessFerreira et al3124Boys 7513–16Maximal treadmill test (measured Vo2max expressed as ml/min, as ml/kg/min and as ml/min/kg2/3)Carotid IMT and stiffness of the carotid, femoral and brachial arteriesBoys and girls
and 21–26
Cardiorespiratory fitness and body compositionFerreira et al3323Boys 17513Maximal treadmill test (measured Vo2max expressed as ml/min/kg). BMI, WC, sum of four skinfolds. Subcutaneous trunk fat (subscapular plus the suprailiac to the sum of skinfolds)Prevalence of the metabolic syndromeBoys and girls
The Amsterdam Growth and Health Longitudinal Study1977–91Girls 189toSubjects with the metabolic syndrome at the age of 36 years, compared with those without the syndrome, had (from adolescence to the age of 36 years) a more marked increase in BF and in subcutaneous trunk fat, and a more marked decrease in CRF
Quality score 536
Cardiorespiratory fitnessKoutedakis et al322 three time point21012.320 mSRT (estimated Vo2max (expressed as ml/kg/min)%BF estimated from skinfolds (triceps and medial calf)Boys and girls
20413.3Vo2max was inversely associated with changes in BF (β  =  −0.09; p⩽0.05)
Cardiorespiratory, motor and musculoskeletal fitnessTwisk et al2820Boys 13213Maximal treadmill test (measured Vo2max expressed as l/min, ml/kg/min and the maximal slope), motor fitness (index of muscular strength, flexibility, speed of movement and coordination)TC, HDLc, SBP, DBP, sum of four skinfolds and W/HBoys and girls
Girls 145toCRF (expressed as ml/kg/min) in 13–16-year-old group was negatively associated with sum of skinfolds, TC/HDLc and with SBP at 32 years of age in men and women
32CRF (expressed as ml/min) was negatively associated with BP in men, TC, sum of four skinfolds and W/H (p<0.05)
The Amsterdam Growth and Health Longitudinal Study1985Boys 8013–16 to 32
CRF (expressed as maximal slope) in 13-year-old group was negatively associated with sum of skinfolds and TC at 32 years of age in men and women
Quality score 51996–7Girls 96Neuromotor fitness was positively related to SBP (β  =  0.11; p<0.01) and inversely to the sum of four skinfolds (β  =  0.21; p<0.01). Neuromotor fitness was not associated with TC, HDLc or TC/HDLc
Body compositionBaker et al445Boys 139 8577–13 toBMICHD eventsBoys and girls
Quality score 51955–60Girls 136 978⩾23The risk of any CHD event, a non-fatal event and a fatal event among adults was positively associated with BMI at 7–13 years of age for boys and 10–13 years of age for girls. Adjustment for birth weight strengthened the results
Body compositionBjorge et al5334.9226 68214–19BMIMortalityAdolescent obesity was related to increased mortality in middle age from several important causes. Higher BMI at adolescence was associated with an increased relative risk of death from endocrine, nutritional and metabolic diseases and from diseases of the circulatory system. The relative risks of death from diseases of the respiratory system and symptoms, signs, abnormal findings and ill-defined causes were increased in the group with higher BMI (>85th percentile)
Quality score 5to
Body compositionEngeland et al5431.5227 00314–19BMIMortalityAn increasing risk of death by increasing BMI in adolescence was observed. Mortality among men whose baseline BMI was between the 85th and 95th percentiles and above the 95th percentile in the US reference population was 30% and 80% higher, respectively, than that among those whose baseline BMI was between the 25th and 75th percentiles. The corresponding rates among women were 30% and 100%
Quality score 5to
Body compositionFranks et al48∼916045–19BMI and WCIncidence of type 2 diabetesBoys and girls
Quality score 5toIn 5–9-year-old subjects, WC was the strongest and single significant modifiable predictor of diabetes. In 10–14-year-old subjects, the strongest independent modifiable predictors were 2-h glucose, BMI and A1C, whereas in the 15–19-year-old subjects, the strongest predictors were 2-h glucose, WC and A1C. When the age groups were combined (ie, 5–19 years) the independent modifiable predictors were BMI, fasting glucose, 2-h glucose and HDLc
Body compositionGunnell et al5157Boys 11652–14 toBMIMortalityBoys and girls
The Boyd Orr CohortGirls 123459–71All-cause and cardiovascular mortality were associated with higher childhood BMI. Compared with those with BMI between the 25th and 49th centiles, the HR (95% CI) for all-cause mortality in those above the 75th BMI centile for their age and sex was 1.5 (1.1 to 2.2) and for ischaemic heart disease it was 2.0 (1.0 to 3.9). There was also a suggestion of a non-linear association with overall mortality; those in the 25–49th centile of the BMI distribution had the lowest mortality rates
Quality score 5
Body compositionJuonala et al412110813–18BMICarotid artery ITM and obesityBoys and girls
The Cardiovascular Risk in Young Finns Studyto 24–39Being overweight or obese in adolescence carried about a 4-fold increased risk of being obese in adulthood. Subjects who had been overweight/obese in youth had significantly higher carotid IMT values in adulthood compared with subjects who had been lean in youth. Subjects who had been obese in youth but were non-obese as adults had comparable IMT values as subjects who had remained consistently non-obese. On the other hand, gaining weight and being consistently obese/overweight from youth to adulthood were both associated with increased IMT in adulthood
Quality score 5
Body compositionJuonala et al4021225510.7Skinfold thicknessCarotid artery compliance, Young’s elastic modulus and stiffness indexBoys and girls
The Cardiovascular Risk in Young Finns Studyto 37.1Childhood obesity (above age and sex-specific 80th percentile for skinfold thickness) predicted decreased carotid artery compliance, increased Young’s elastic modulus and increased stiffness index in adulthood
Quality score 5
Body compositionLawlor and Leon452311 1064.9BMIRisk of CHD and strokeBoys and girls
Aberdeen Children of the 1950s Prospective Cohort Study1981–2004to 28There was no association between childhood BMI and CHD risk. There was no linear association between childhood BMI and stroke risk, but those who were obese in childhood (top 2.5% of the BMI distribution) compared with all others had an increased risk of stroke; the adjusted (for gender, father’s occupational social class at birth, no of siblings and birth weight) HR was 2.41 (95% CI 1.00 to 5.86)
Quality score 5
Body compositionLawlor et al46∼16Boyd Orr Cohort2–15BMIRisk of adult ischaemic heart disease and strokeBoys and girls
Boys 1344
Girls 1242
Boyd Orr cohort Christ’s Hospital Glasgow Alumni∼1988–2004Christ’s Hospital9–18BMI was not associated with future risk of ischaemic heart disease or stroke in any cohort. The pooled (all three cohorts) adjusted HR per SD of early life BMI was 1.09 (95% CI 1.01 to 1.19) for ischaemic heart disease and 0.94 (95% CI 0.82 to 1.08) for stroke. The pooled HR of ischaemic heart disease when participants who were overweight or obese for their age were compared with all other participants was 1.34 (95% CI 0.95 to 1.91), and no association was found between overweight or obesity and stroke risk. The effects of BMI did not vary by cohort or by age
Boys 1440
Quality score 5Glasgow Alumni16–22
Boys 2637
Girls 7918
Body compositionMust et al52∼6050813–18BMIRisk of mortality from all causes and disease-specific mortalityBoys and girls
Quality score 51922–35,toOverweight in adolescents was associated with an increased risk of mortality from all causes and disease-specific mortality among men, but not among women. The relative risks among men were 1.8 (95% CI 1.2 to 2.7; p = 0.004) for mortality from all causes and 2.3 (95% CI 1.4 to 4.1; p = 0.002) for mortality from CHD. The risk of morbidity from CHD and atherosclerosis was increased among men and women who had been overweight in adolescence
Body compositionOren et al47∼1575012–16BMICarotid IMTBoys and girls
The Atherosclerosis Risk in Young Adults Studyto 27–30One SD increase in adolescent BMI was associated with 2.3 mm (95% CI 1.3 to 3.3) increase in mean common carotid IMT in young adults after adjustment for gender, adolescent age, adolescent BP, puberty stage and lumen diameter. Further adjustment for adult CVD risk factors did not change the relationship, whereas adjustment for adult BMI attenuated the association. Subjects who remained in the upper BMI distribution from adolescence into young adulthood had a significantly higher common carotid IMT compared with those who showed relative weight loss over time
Quality score 5
Body compositionRaitakari et al42135963–18BMICarotid artery IMTBoys and girls
Cardiovascular Risk in Young Finns Study1980228324–39In multivariable models adjusted for age and sex, IMT in adulthood was significantly associated with childhood BMI (p = 0.007) and with adult BMI (p<0.001). High levels (ie, extreme age and sex-specific 80th percentile) of BMI in 12–18-year-old adolescents was directly related to carotid IMT measured in young adults at ages 33–39 years (p<0.001 for both men and women), and remained significant after adjustment for contemporaneous risk variables
Quality score 52001–2
Body compositionvan Lenthe et al4223Boys 8413–27S/T and sum of four skinfoldsBP, TC, HDLc and TC/HDLcBoys and girls
The Amsterdam Growth and Health Longitudinal Study1977–91Girls 98to 36–50Increase in the S/T ratio was significantly associated with increase in SBP. After adjustment for sum of skinfolds and the behavioural variables (physical activity, smoking and alcohol intake), the association remained statistically significant
Quality score 5In men, the increase of the S/T was significantly associated with a decrease in TC level. However, after adjustment for sum of skinfolds, this association no longer remained statistically significant. The increase in the S/T ratio was statistically significantly associated with decrease in level of HDLc, also after adjustment for confounders
Body compositionSivanandam et al431423113BMI, FFM and BF (measured with DXA)Left ventricular massBoys and girls
Quality score 51985–6132to 27BMI at 13 years was highly correlated with LVMI at 13 and 27 years. The cross-sectional correlation of LVMI and BMI at 13 years (r  =  0.38, p<0.001) had strengthened considerably by 27 years (r  =  0.55, p<0.001)
1999–2000A BMI increase >5.5 kg/m2 from 13 to 27 years was associated with a significantly greater increase in the LVMI (p<0.001) than a BMI change <5.5 kg/m2, and this relation was similar in children who were thin and heavy at baseline. In young adulthood, the relation of LVMI to FFM was weaker than that of LVMI to BF
  • BF, body fat; %BF, percentage of body fat; BMI, body mass index; BP, blood pressure; CHD, coronary heart disease; CRF, cardiorespiratory fitness (also refers to maximum oxygen consumption (Vo2max)); CVD, cardiovascular disease; DBP, diastolic blood pressure; DXA, dual energy x ray absorptiometry; FFM, fat-free mass; HDLc, high-density lipoprotein cholesterol; HR, hazard ratio; IMT, intima media thickness; LDLc, low-density lipoprotein cholesterol; LVMI, left ventricular mass index; OR, odds ratio; SS/SSF, subscapular plus supraespinale skinfold/subscapular plus supraespinale lus biceps plus triceps skinfolds; S/T, subscapular/triceps skinfolds ratio; TC, total cholesterol; TG, triglycerides; 20 mSRT; 20 m shuttle run test; WC, waist circumference; W/H, waist to hip ratio.