Comparison of different VO2max equations in the ability to discriminate the metabolic risk in Portuguese adolescents

doi:10.1016/j.jsams.2010.07.003

Journal of Science and Medicine in Sport

Volume 14, Issue 1, January 2011, Pages 79-84

https://doi.org/10.1016/j.jsams.2010.07.003 Get rights and content

Abstract

There is increasing evidence that cardiorespiratory fitness (CRF) is an important health marker already in youth. This study aimed to determine the ability of five VO_2max equations to discriminate between low/high Metabolic Risk in 450 Portuguese adolescents aged 10–18. We measured waist and hip circumferences, fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and blood pressure. For each of these variables, a Z-score was computed. The HDL-cholesterol was multiplied by −1. A metabolic risk score was constructed by summing the Z scores of all individual risk factors. High risk was considered when the individual had ≥1 SD of this score. Cardiorespiratory fitness (CRF) was measured with the 20-m shuttle run test. We estimated VO_2max from the CRF tests using five equations. ROC analyses showed a significant discriminatory accuracy for the Matsuzaka and Barnett(a) equations in identifying the low/high metabolic risk in both genders (Matsuzaka girls: AUC = 0.654, 95%CI: 0.591–0.713, p < 0.001, VO_2max = 39.5 mL kg⁻¹ min⁻¹; boys: AUC = 0.648, 95%CI: 0.576–0.716, p < 0.001, VO_2max = 41.8 mL kg⁻¹ min⁻¹; Barnett(a) girls: AUC = 0.620, 95%CI: 0.557–0.681, p < 0.001, VO_2max = 46.4 mL kg⁻¹ min⁻¹; boys: AUC = 0.628, 95%CI: 0.555–0.697, p = 0.04, VO_2max = 42.6 mL kg⁻¹ min⁻¹), and the Ruiz equation in boys (AUC = 0.638, 95%CI: 0.565–0.706, p < 0.001, VO_2max = 47.1 mL kg⁻¹ min⁻¹). The VO_2max values found require further testing in other populations as well as in longitudinal studies; the identification of adolescents who have low CRF levels can help detect youth with an increased risk of metabolic disease.

Introduction

The maximal rate of oxygen uptake (VO_2max) is considered the gold standard for measurement of CRF, which is a direct marker of physiological status and reflects the overall capacity of the cardiovascular and respiratory systems and the ability to carry out prolonged exercise.¹

VO_2max can be measured using direct (laboratory tests) and indirect (field-based tests) methods. The use of direct measures in school settings and in population based studies is limited due to their high cost, necessity of sophisticated instruments, qualified technicians and time constraints.² Field-tests provide a practical alternative since they are time efficient, low in cost and equipment requirements, and can be easily administered to a large number of people simultaneously.2, 3

One of the most common field-tests for assessing CRF among children and adolescents is the 20-m shuttle run test (20mSRT).3, 4, 5 The 20mSRT is a feasible fitness test, since a large number of subjects can be tested at the same time, it involves minimal equipment and low cost and it can be conducted indoors, outdoors, and on different surfaces in a relatively small area.⁶ This test is also valid and reliable for use in children and adolescents.3, 7 However, as the 20mSRT is an indirect method, some error might always be present when estimations of CRF are done.

Recent reports suggest that CRF is also an important health marker in young individuals.7, 8 High CRF has been associated with a lower clustering of metabolic risk factors in young people,9, 10, 11 and results from longitudinal studies indicate that high CRF in childhood and adolescence is associated with a healthier cardiovascular profile disease later in life.¹²

Several equations have been developed to estimate VO_2max from maximal speed attained during the 20mSRT (Table 1).

The validity of these equations against a gold standard has been tested in several studies, with varying results. Most studies have used the Léger's equation to estimate VO_2max but, the equation reported by Léger does not seem to be the most valid one.⁶ To the best of our knowledge, it is undetermined whether the association between CRF and cardiovascular disease risk factors varies depending on the equation used to estimate VO_2max.

The aim of the present study was to determine the ability of five different VO_2max equations (Léger,¹³ Barnett,¹⁴ Matsuzaka,¹⁵ and Ruiz¹⁶) to discriminate between low and high metabolic risk in Portuguese adolescents.

Section snippets

Methods

This was a cross-sectional assessment performed in two secondary schools in the North of Portugal. The sample comprised 450 adolescents (255 girls) apparently healthy and free of medical treatment, aged 10–18 years old. Adolescents were evaluated during school physical education classes by physical education teachers specially trained for this data collection. All participants were informed about the study's aim and parents provided written informed consent, along with the adolescents’ verbal

Results

The 450 adolescents included 255 boys (43.3%) and 195 girls (57.6%). Their mean age was 13.9 ± 1.9 years. The mean waist and hip circumferences were 74.6 ± 8.4 and 90.1 ± 8.4 cm, respectively. The mean WHR was 0.82 ± 0.06. Boys had lower levels of TC (144.8 vs 150.1 mg/dl), HDL-C (42.8 vs 46.1 mg/dl), TG (53.7 vs 58.9 mg/dl) and hip circumference (87.8 vs 91.8 cm) than girls (p < 0.05), whereas girls had lower WHR (0.82 ratio vs 0.84 ratio, p < 0.05). Girls had lower plasma glucose values than boys (83.9 vs 86.1

Discussion

The results of this study indicate that a high number of adolescents did not meet the healthy zone criteria. Our data also showed that Matsuzaka and Barnett(a) equations seem to have the best trade-off between sensitivity and specificity for the VO_2max equation to screen for MRS in both genders, and the Ruiz equation is the best-performing equation for boys. Linear regression analyses showed that VO_2max estimated from these equations is negatively and significantly associated with MRS scores in

Conclusion

In conclusion, the present study indicates that Matsuzaka and Barnett(a) equations seem to have the best trade-off between sensitivity and specificity for the VO_2max equation to screen for MRS in both genders, and the Ruiz equation is the best for boys. The VO_2max values calculated via the ROC curve analyses for these equations are somewhat similar to those suggested by worldwide recognized organizations. However, the VO_2max values found require further testing in other populations as well as

Practical implications

•
The identification of adolescents with low cardiorespiratory fitness levels can help detect youth with an increased risk of metabolic diseases.
•
The use of the FITNESSGRAM program in school settings is a very helpful tool to measure physical fitness.
•
Public health organizations, schools and parents should encourage the population to be more physically active.

Acknowledgement

This study was supported by FCT (BD/44422/2008).

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Comparison of Different Maximal Oxygen Uptake Equations to Discriminate the Cardiometabolic Risk in Children and Adolescents
2018, Journal of Pediatrics
Citation Excerpt :
The ROC curves displayed acceptable AUC and 95% CI limits, suggesting the resultant cutoffs were not due to chance (all AUC >0.75) and effectively distinguished between low/high cardiometabolic risk on the basis of 20mSRT performance. The cutoffs found in children and adolescents participating in the FUPRECOL study (47.9 mL⋅kg−1⋅min−1 in boys and 34.4 mL⋅kg−1⋅min−1 in girls age 9-12 years and 48.0 mL⋅kg−1⋅min−1 in boys and 33.8 mL⋅kg−1⋅min−1 in girls aged 13-17 years) are similar to those reported in previous studies conducted in past generations of children and adolescents from the US, Japan,22 and different European countries with diverse environmental, cultural, and social factors.12-15,23 However, our values for girls are lower than those suggested by Sasayama et al22 in 9- to 10-year-old Japanese children, showing that the 20mSRT level in this population is higher than that reported in 50 countries worldwide.7
To determine the ability of 8 different maximal oxygen uptake (VO_2max) equations to discriminate between low and high cardiometabolic risk, and to determine cardiorespiratory fitness (CRF) cutoffs associated with a more favorable cardiometabolic risk profile in Colombian children and adolescents.
In a cross-sectional study, CRF was estimated using the 20-m shuttle run test in 2870 schoolchildren (54.5% girls) from Bogota, Colombia. We computed a metabolic syndrome score (MetScore) as the sum of the age- and sex-standardized scores of waist circumference, triglycerides, high-density lipoprotein cholesterol, glucose, and systolic and diastolic blood pressure.
Linear regression analyses showed that the Barnett et al (b) and Mahar equations were negatively associated with MetScore, showing the highest discriminatory accuracy for identifying the low/high cardiometabolic risk in both sexes and both age groups (9-12 years and 13-17 years).
We propose that the Barnett et al (b) equation for boys and girls, VO_2max = 25.8 × (6.6 × G × 0.2 × (body mass + 3.2 × (final speed))), where G is gender (male = 0; female = 1), be used to classify youths at metabolic risk. The CRF cutoffs can serve as a quantitative marker of a healthier cardiovascular profile in Colombian children and adolescents.
Cardiorespiratory Fitness Cutoff Points for Early Detection of Present and Future Cardiovascular Risk in Children: A 2-Year Follow-up Study
2017, Mayo Clinic Proceedings
To examine the association between cardiorespiratory fitness (CRF) at baseline and cardiovascular disease (CVD) risk in 6- to 10-year-olds (cross-sectional) and 2 years later (8- to 12-year-olds [longitudinal]) and whether changes with age in CRF are associated with CVD risk in children aged 8 to 12 years.
Spanish primary schoolchildren (n=236) aged 6 to 10 years participated at baseline. Of the 23 participating primary schools, 22% (n=5) were private schools and 78% (n=18) were public schools. The dropout rate at 2-year follow-up was 9.7% (n=23). The 20-m shuttle run test was used to estimate CRF. The CVD risk score was computed as the mean of 5 CVD risk factor standardized scores: sum of 2 skinfolds, systolic blood pressure, insulin/glucose, triglycerides, and total cholesterol/high-density lipoprotein cholesterol.
At baseline, CRF was inversely associated with single CVD risk factors (all P<.05) and CVD risk score at baseline and follow-up (P<.001). Cardiorespiratory fitness cutoff points of 39.0 mL/kg per minute or greater in boys and 37.5 mL/kg per minute or greater in girls are discriminative to identify CVD risk in childhood (area under the curve, >0.85; P<.001) and to predict CVD risk 2 years later (P=.004). Persistent low CRF or the decline of CRF from 6-10 to 8-12 years of age is associated with increased CVD risk at age 8 to 12 years (P<.001).
During childhood, CRF is a strong predictor of CVD risk and should be monitored to identify children with potential CVD risk.
Utility of Body Mass Index, Waist-to-Height-Ratio and cardiorespiratory fitness thresholds for identifying cardiometabolic risk in 10.4–17.6-year-old children
2017, Obesity Research and Clinical Practice
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Whilst our findings appear to suggest that a high BMI, a high WHtR and a low cardiorespiratory fitness is associated with increased cardiometabolic risk it is prudent to note that the AUC’s from the ROC analysis were far from excellent. Yet, the reported AUC’s are similar to previous studies that have examined the predictive utility of BMI and WHtR [6,26] and cardiorespiratory fitness [21,27] for identifying increased cardiometabolic risk using apparently healthy participants. It may be that the magnitude of associations and accuracy of the thresholds may have increased in a population with underlying cardiovascular conditions.
To examine the utility of Body Mass Index (BMI), Waist-to-Height-Ratio (WHtR) and cardiorespiratory fitness thresholds to identify cardiometabolic risk in youth.
Cross-sectional cardiometabolic risk factor variables on 534 children aged 10.4–17.6 years of age (52% boys) from the United Kingdom were used. Binary logistic regression and receiver operating characteristic curves were used to examine the utility of established age and gender specific thresholds for BMI, WHtR and cardiorespiratory fitness to identify individuals with increased cardiometabolic risk (increased clustered triglycerides, HDL-cholesterol, systolic blood pressure and glucose).
A WHtR ≥ 0.5 increased the odds by 11.4 (95% confidence interval 4.7, 27.4, P < 0.001) of having increased cardiometabolic risk in boys and by 2.5 (1.2, 5.3, P = 0.020) for girls. Similar associations were observed for BMI and cardiorespiratory fitness in both boys and girls with increased cardiometabolic risk. BMI-z, WHtR and cardiorespiratory fitness all showed a significant ability in identifying individuals for increased cardiometabolic risk in boys and girls (P < 0.05) despite poor area under the curve (AUC) values (<0.70). Combining anthropometrical variables did improve the diagnostic accuracy for identifying cardiometabolic risk in boys, evidenced by an increased AUC of 0.74 (0.64, 0.85, P < 0.001), but not in girls.
The magnitude of associations was broadly similar for BMI, WHtR and cardiorespiratory fitness in identifying individuals at increased cardiometabolic risk. Yet, combining BMI with WHtR in boys may provide a more accurate method for identifying those at increased cardiometabolic risk.
Evaluation of cardiorespiratory fitness using three field tests in obese adolescents: Validity, sensitivity and prediction of peak V̇O2
2014, Journal of Science and Medicine in Sport
Evaluation of cardiorespiratory fitness in obese adolescents is necessary to develop personalised retraining programmes. We aimed to measure cardiorespiratory fitness using 3 field tests, and to evaluate their validity and sensitivity compared to values obtained by laboratory tests.
Longitudinal interventional study in obese adolescents admitted to a rehabilitation centre for a 9-month programme of obesity management.
A 12-min walk/run test, an adapted 20 m shuttle walk-run test (starting speed 4 km h⁻¹, increments of 0.5 km h⁻¹ min⁻¹) and a 4-level submaximal cycle ergometer test were performed to estimate respectively distance covered in 12 min, maximum speed and maximal aerobic power.
Thirty adolescents aged 14.2 ± 1.6 years were included. After 9 months intervention, we observed a significant reduction in body mass index, and an increase in peak $\dot{V} O_{2}$ and field test results. We observed significant correlations between pre- and post-intervention values of peak $\dot{V} O_{2}$ and distance covered in 12 min (r = 0.70 pre; r = 0.82 post), maximum speed (r = 0.80 pre; r = 0.83 post) and maximal aerobic power (r = 0.71 pre; r = 0.84 post). Multiple linear regression made it possible to estimate peak $\dot{V} O_{2}$ based on results from the 3 field tests using prediction equations specific to a population of obese adolescents.
These field tests, including the adapted 20 m shuttle walk-run test, adequately assess cardiorespiratory fitness in obese adolescents, and are sensitive to changes over time. Predictive equations including BMI are useful in clinical practice to predict peak $\dot{V} O_{2}$ in these patients.
20 meters shuttle run test with stages of one minute. An original idea that has lasted for 30 years
2014, Apunts Medicina de l'Esport
A 30 años de su publicación, el test course navette de 20 metros con etapas de un minuto (20m-SRT) sigue siendo el test más utilizado mundialmente, tanto en las áreas de salud, como en la escolar y deportiva. Esto se debe a la practicidad de medición, validez en un amplio rango de edades y poblaciones, fiabilidad y sensibilidad. Sin embargo, el principal motivo de su aplicabilidad se debe a la idea original de correr en un espacio reducido de 20 m, sin la necesidad de utilizar una pista de atletismo. El presente artículo tiene como objetivo revisar los trabajos de investigación más relevantes del 20m-SRT publicados en los últimos 30 años y su aplicabilidad en el campo.
To 30 years of their publication, the course navette test of 20 meters with stages of one minute (20m-SRT) continues being the test but used worldwide, so much in the area of health, school and sport. This is due to the feasibility, validity in a wide range of ages and populations, reliability and sensibility. However the main reason of its applicability is due to the original idea of running in a reduced space of 20 meters, without the necessity of using an athletics track. The present article has as objective to revise the most outstanding investigation works in the 20m-SRT published in the last 30 years and its applicability in the field.
Evaluation of metabolic risk in prepubertal girls versus boys in relation to fitness and physical activity
2012, Gender Medicine
Citation Excerpt :
Nonetheless, these sex-related differences were noticeably absent in the HCRF groups (Table I) and in the PPA groups (Table II). Several studies with adolescents found lower CRF levels and higher lipid marker levels in girls, even when the prevalence of overweight is lower than in boys.28 Overall, HDL-c was higher in girls, probably due to other factors such as sex, age, and eating habits.
Low levels of cardiorespiratory fitness (CRF) and physical activity (PA) are associated with a risk of the development of metabolic syndrome. Contradictory findings are reported in the literature regarding the influence of sex and CRF and PA on metabolic changes.
The aim of this study was to analyze the effects of CRF and PA on lipid and carbohydrate metabolism biomarkers in boys and girls.
A total of 82 prepubertal boys and 55 girls (7–12 years of age) were classified according to sex, low or high CRF, and performance or nonperformance of PA. Anthropometric and blood pressure (BP) measurements, plasma lipid profile values, glucose and insulin levels, and homeostasis model assessment for insulin resistance were analyzed.
The percentage of boys with high CRF and performance of PA was higher than that of girls (P < 0.05). When children of the same sex were compared, higher values for body mass index and waist circumference z-scores were found for boys with low CRF compared with boys with high CRF (P < 0.001) without differences between girls, and in all groups classified by PA. Systolic and diastolic BPs were higher in boys than in girls, in both CRF and PA groups (P < 0.05). In the low CRF and no PA groups, girls had higher plasma glucose, total cholesterol, and low-density lipoprotein cholesterol levels than boys, with higher high-density lipoprotein cholesterol and apolipoprotein A levels (P < 0.05).
Sex in relation to CRF and PA could affect the plasma lipid profile. These changes in girls are associated with low CRF and low levels of PA. Considering these results, we suggest the need to improve CRF and promote PA, especially in girls, to reduce metabolic risk.

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Original ResearchComparison of different VO2max equations in the ability to discriminate the metabolic risk in Portuguese adolescents

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Practical implications

Acknowledgement

Lancet

Artif Intell Med

Nutr Metab Cardiovasc Dis

Maximal oxygen intake as an objective measure of cardio-respiratory performance

J Appl Physiol

Fitnessgram/activitygram reference guide

Capacity aerobic des Quebecois de 6 a 17 ans—test Navette de 20 metres avec paliers de 1 min

Can J Appl Sport Sci

Secular trends in the performance of children and adolescents (1980–2000): an analysis of 55 studies of the 20 m shuttle run test in 11 countries

Sports Med

Criterion-related validity of the 20-m shuttle run test in youths aged 13–19 years

J Sports Sci

Reliability of health-related physical fitness tests in European adolescents. The HELENA Study

Int J Obes (Lond)