Cardiorespiratory fitness relates more strongly than physical activity to cardiovascular disease risk factors in healthy children and adolescents: the European Youth Heart Study
Restricted accessResearch articleFirst published online August, 2007
Cardiorespiratory fitness relates more strongly than physical activity to cardiovascular disease risk factors in healthy children and adolescents: the European Youth Heart Study
Physical activity and cardiorespiratory fitness are closely related to health variables in adults, especially those considered to be among risk factors for cardiovascular diseases. The possible tracking of cardiovascular disease risk factors from childhood to adulthood makes it important to increase our understanding of the complex relationships between physical activity, cardiorespiratory fitness and cardiovascular risk factors early in life.
Design
A cross-sectional, school-based study on healthy children and adolescents, aged 9-10 years (295 girls, 295 boys) and 15-16 years (302 girls, 233 boys) was performed during a school year in Sweden and Estonia, as part of the European Youth Heart Study.
Methods
Total physical activity, and minutes spent in inactivity and activity of moderate or higher intensity were measured by accelerometry. A maximal ergometer bike test was used for estimation of cardiorespiratory fitness. The risk factors included blood pressure and fasting blood levels of insulin, glucose, triglycerides, total cholesterol and high-density lipoprotein cholesterol.
Results
Canonical correlations between physical activity and cardiorespiratory fitness versus cardiovascular disease risk factors showed significant associations in both age and sex groups (rc=0.46-0.61, P < 0.0001). The cardiorespiratory fitness was found to be the strongest contributor to these relationships. In girls high values of the physical activity variables were also associated with a favourable cardiovascular profile.
Conclusions
Cardiorespiratory fitness relates more strongly to cardiovascular risk factors than components of objectively measured physical activity in children and adolescents. Physical activity becomes more important in the 15-year-old adolescents, indicating that these modifiable lifestyle factors increase in importance with age.
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2.
StrongWMalinaRBlimkieCDanielsSDishmanRGutinB. Evidence based physical activity for school-age youth. J Pediatr2005; 146:732–737.
3.
LaMonteMBlairS.Physical activity, cardiorespiratory fitness, and adiposity: contributions to disease risk. Curr Opin Clin Nutr Metab Care2006; 5: 540–546.
4.
RuizJRRizzoNSHurtig-WennlofAOrtegaFBWarnbergJSjöströmM.Relations of total physical activity and intensity to fitness and fatness in children: the European Youth Heart Study. Am J Clin Nutr2006; 84: 299–303.
5.
RuizJRRizzoNSVillaLHurtig-WennlöfAOrtegaFBHarroM. High Cardiorespiratory Fitness is Associated with Low Metabolic Risk Score in Children; The European Youth Heart Study. Pediatric Research (in press).
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BrageSWedderkoppNEkelundUFranksPWWarehamNJAndersenLB. Features of the metabolic syndrome are associated with objectively measured physical activity and fitness in Danish children: the European Youth Heart Study (EYHS). Diabetes Care2004; 27:2141–2148.
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MesaJLRuizJROrtegaFBWarnbergJGonzalez-LamunoDMorenoLA. Aerobic physical fitness in relation to blood lipids and fasting glycaemia in adolescents: influence of weight status. Nutr Metab Cardiovasc Dis2006; 16:285–293.
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AndersenLHarroMSardinhaLFrobergKEkelundUBrageS. Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study). Lancet2006; 368: 299–304.
10.
FreedmanDSByersTSellKKuesterSNewellELeeS.Tracking of serum cholesterol levels in a multiracial sample of preschool children. Pediatrics1992; 90:80–86.
11.
FuentesRMNotkolaILShemeikkaSTuomilehtoJNissinenA.Tracking of systolic blood pressure during childhood: a 15-year follow-up population-based family study in eastern Finland. J Hypertens2002; 20:195–202.
12.
PorkkaKVViikariJSAkerblomHK.Tracking of serum HDL-cholesterol and other lipids in children and adolescents: the Cardiovascular Risk in Young Finns Study. Prev Med1991; 20:713–724.
13.
NicklasTAvon DuvillardSPBerensonGS.Tracking of serum lipids and lipoproteins from childhood to dyslipidemia in adults: the Bogalusa Heart Study. Int J Sports Med2002; 23 (suppl 1):S39–S43.
14.
RaitakariOTJuonalaMKahonenMTaittonenLLaitinenTMaki-TorkkoN. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA2003; 290:2277–2283.
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KohlHWFultonJCaspersenC.Assessment of physical activity among children and adolescents: a review and synthesis. Prev Med2000; 31: S54–S76.
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McGillHCJrMcMahanCAHerderickEEMalcomGTTracyREStrongJP.Origin of atherosclerosis in childhood and adolescence. Am J Clin Nutr2000; 72:1307S–1315S.
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21.
TrostSGPateRRSallisJFFreedsonPSTaylorWCDowdaM. Age and gender differences in objectively measured physical activity in youth. Med Sci Sports Exerc2002; 34:350–355.
22.
HansenHSFrobergKNielsenJRHyldebrandtN.A new approach to assessing maximal aerobic power in children: the Odense School Child Study. Eur J Appl Physiol Occup Physiol1989; 58:618–624.
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29.
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30.
MahonAVaccaroP.Cardiovascular adaptations in 8-to 12-year-old boys following a 14-week running program. Can J Appl Physiol1994; 19:139–150.
31.
KatzmarzykPTMalinaRMSongTMBouchardC.Physical activity and health-related fitness in youth: a multivariate analysis. Med Sci Sports Exerc1998; 30:709–714.
32.
KatzmarzykPTMalinaRMBouchardC.Physical activity, physical fitness, and coronary heart disease risk factors in youth: the Quebec Family Study. Prev Med1999; 29:555–562.
33.
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34.
McMurrayRGBaumanMJHarrellJSBrownSBangdiwalaSI.Effects of improvement in aerobic power on resting insulin and glucose concentrations in children. Eur J Appl Physiol2000; 81:132–139.
GoranMIBallGDCruzML.Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents. J Clin Endocrinol Metab2003; 88:1417–1427.
37.
FerreiraITwiskJvan MechelenWKemperHSeidellJStehouwerC.Current and adolescent body fatness and fat distribution: relationships with carotid intima-media thickness and large artery stiffness at the age of 36 years. J Hypertens2004; 22:145–155.
38.
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39.
GutinBYinZHumphriesMBarbeauP.Relations of moderate and vigorous physical activity to fitness and fatness in adolescents. Am J Clin Nutr2005; 81:746–750.
40.
EisenmannJCWickelEEWelkGJBlairSN.Relationship between adolescent fitness and fatness and cardiovascular disease risk factors in adulthood: the Aerobics Center Longitudinal Study (ACLS). Am Heart J2005; 149:46–53.
41.
TwiskJWKemperHCvan MechelenW.The relationship between physical fitness and physical activity during adolescence and cardiovascular disease risk factors at adult age. The Amsterdam Growth and Health Longitudinal Study. Int J Sports Med2002; 23 (Suppl 1):S8–S14.
42.
LewingtonSClarkeRQizilbashNPetoRCollinsR.Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet2002; 360:1903–1913.
43.
Klasson-HeggeboLAndersenLBWennlofAHSardinhaLBHarroMFrobergK. Graded associations between cardiorespiratory fitness, fatness, and blood pressure in children and adolescents. Br J Sports Med2006; 40:25–29.
44.
BrageSWedderkoppNEkelundUFranksPWWarehamNJAndersenLB. Objectively measured physical activity correlates with indices of insulin resistance in Danish children. The European Youth Heart Study (EYHS). Int J Obes Relat Metab Disord2004; 28:1503–1508.
45.
MesaJOrtegaFRuizJCastilloMHurtig-WennlöfASjöströmM. The importance of cardiorespiratory fitness for healthy metabolic traits in children and adolescents: the AVENA Study. J Public Health2006.
46.
RibeiroJCGuerraSOliveiraJTeixeira-PintoATwiskJWDuarteJA. Physical activity and biological risk factors clustering in pediatric population. Prev Med2004; 39:596–601.
47.
StrongWMalinaRBlimkieCDanielsSDishmanRGutinB. Evidence based physical activity for school-age youth. J Pediatr2005; 146:732–737.
48.
LaMonteMBlairS.Physical activity, cardiorespiratory fitness, and adiposity: contributions to disease risk. Curr Opin Clin Nutr Metab Care2006; 5: 540–546.
49.
RuizJRRizzoNSHurtig-WennlofAOrtegaFBWarnbergJSjöströmM.Relations of total physical activity and intensity to fitness and fatness in children: the European Youth Heart Study. Am J Clin Nutr2006; 84: 299–303.
50.
RuizJRRizzoNSVillaLHurtig-WennlöfAOrtegaFBHarroM. High Cardiorespiratory Fitness is Associated with Low Metabolic Risk Score in Children; The European Youth Heart Study. Pediatric Research (in press).
51.
BrageSWedderkoppNEkelundUFranksPWWarehamNJAndersenLB. Features of the metabolic syndrome are associated with objectively measured physical activity and fitness in Danish children: the European Youth Heart Study (EYHS). Diabetes Care2004; 27:2141–2148.
52.
MesaJLRuizJROrtegaFBWarnbergJGonzalez-LamunoDMorenoLA. Aerobic physical fitness in relation to blood lipids and fasting glycaemia in adolescents: influence of weight status. Nutr Metab Cardiovasc Dis2006; 16:285–293.
53.
ReedKWarburtonDLewanczukRHaykowskyMScottJWhitneyC. Arterial compliance in young children: the role of aerobic fitness. Eur J Cardiovasc Prev Rehabil2005; 12:492–497.
54.
AndersenLHarroMSardinhaLFrobergKEkelundUBrageS. Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study). Lancet2006; 368: 299–304.
55.
FreedmanDSByersTSellKKuesterSNewellELeeS.Tracking of serum cholesterol levels in a multiracial sample of preschool children. Pediatrics1992; 90:80–86.
56.
FuentesRMNotkolaILShemeikkaSTuomilehtoJNissinenA.Tracking of systolic blood pressure during childhood: a 15-year follow-up population-based family study in eastern Finland. J Hypertens2002; 20:195–202.
57.
PorkkaKVViikariJSAkerblomHK.Tracking of serum HDL-cholesterol and other lipids in children and adolescents: the Cardiovascular Risk in Young Finns Study. Prev Med1991; 20:713–724.
58.
NicklasTAvon DuvillardSPBerensonGS.Tracking of serum lipids and lipoproteins from childhood to dyslipidemia in adults: the Bogalusa Heart Study. Int J Sports Med2002; 23 (suppl 1):S39–S43.
59.
RaitakariOTJuonalaMKahonenMTaittonenLLaitinenTMaki-TorkkoN. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA2003; 290:2277–2283.
60.
AndersenLHasselstrømHGronfeldtVHansenSFrobergK.The relationship between physical fitness and clustered risk, and tracking of clustered risk from adolescence to young adulthood: eight years follow-up in the Danish Youth and Sport Study. Int J Behav Nutr Phys Act2004; 1:6.
61.
FerreiraIHenryRMTwiskJWvan MechelenWKemperHCStehouwerCD.The metabolic syndrome, cardiopulmonary fitness, and subcutaneous trunk fat as independent determinants of arterial stiffness: the Amsterdam Growth and Health Longitudinal Study. Arch Intern Med2005; 165: 875–882.
62.
BlairSNChengYHolderJS.Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports Exerc2001; 33:S379–S399; discussion S419-S420.
63.
KohlHWFultonJCaspersenC.Assessment of physical activity among children and adolescents: a review and synthesis. Prev Med2000; 31: S54–S76.
64.
McGillHCJrMcMahanCAHerderickEEMalcomGTTracyREStrongJP.Origin of atherosclerosis in childhood and adolescence. Am J Clin Nutr2000; 72:1307S–1315S.
65.
RiddochCEdwardsDPageAFrobergKAnderssenSWedderkoppN. The European Youth Heart Study-Cardiovascular disease risk factors in children: rationale, aims, study design, and validation of methods. J Phys Act Health2005; 2:115–129.
66.
TrostSGPateRRSallisJFFreedsonPSTaylorWCDowdaM. Age and gender differences in objectively measured physical activity in youth. Med Sci Sports Exerc2002; 34:350–355.
67.
HansenHSFrobergKNielsenJRHyldebrandtN.A new approach to assessing maximal aerobic power in children: the Odense School Child Study. Eur J Appl Physiol Occup Physiol1989; 58:618–624.
68.
LohmanTRocheAMartorellR.Anthropometric standardization reference manual. Champaign, Illinois: Human Kinetics; 1988.
69.
ParkMKMenardSM.Accuracy of blood pressure measurement by the Dinamap monitor in infants and children. Pediatrics1987; 79:907–914.
BouchardCPerusseL.Heredity, activity level, fitness and health. In: BouchardCShepheardRStephensR, editors. Physical activity, fitness and health: international proceedings and concensus statement. Champaign, Illinois: Human Kinetics; 1994. pp. 1994–106.
74.
IgnicoAMahonA.The effects of a physical fitness program on low-fit children. Res Q Exerc Sport1995; 66:85–90.
75.
MahonAVaccaroP.Cardiovascular adaptations in 8-to 12-year-old boys following a 14-week running program. Can J Appl Physiol1994; 19:139–150.
76.
KatzmarzykPTMalinaRMSongTMBouchardC.Physical activity and health-related fitness in youth: a multivariate analysis. Med Sci Sports Exerc1998; 30:709–714.
77.
KatzmarzykPTMalinaRMBouchardC.Physical activity, physical fitness, and coronary heart disease risk factors in youth: the Quebec Family Study. Prev Med1999; 29:555–562.
78.
MalinaR.Physical activity: Relations to Growth, Maturation, and Physical Fitness. In: BouchardCShepheardRStephensR, editors. Physical activity, fitness and health: international proceedings and consensus statement. Champaign, Illinois: Human Kinetics; 1994. pp. 1994–918.
79.
McMurrayRGBaumanMJHarrellJSBrownSBangdiwalaSI.Effects of improvement in aerobic power on resting insulin and glucose concentrations in children. Eur J Appl Physiol2000; 81:132–139.
GoranMIBallGDCruzML.Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents. J Clin Endocrinol Metab2003; 88:1417–1427.
82.
FerreiraITwiskJvan MechelenWKemperHSeidellJStehouwerC.Current and adolescent body fatness and fat distribution: relationships with carotid intima-media thickness and large artery stiffness at the age of 36 years. J Hypertens2004; 22:145–155.
83.
EkelundUNeoviusMLinneYBrageSWarehamNRossnerS.Associations between physical activity and fat mass in adolescents: the Stockholm Weight Development Study. Am J Clin Nutr2005; 81:355–360.
84.
GutinBYinZHumphriesMBarbeauP.Relations of moderate and vigorous physical activity to fitness and fatness in adolescents. Am J Clin Nutr2005; 81:746–750.
85.
EisenmannJCWickelEEWelkGJBlairSN.Relationship between adolescent fitness and fatness and cardiovascular disease risk factors in adulthood: the Aerobics Center Longitudinal Study (ACLS). Am Heart J2005; 149:46–53.
86.
TwiskJWKemperHCvan MechelenW.The relationship between physical fitness and physical activity during adolescence and cardiovascular disease risk factors at adult age. The Amsterdam Growth and Health Longitudinal Study. Int J Sports Med2002; 23 (Suppl 1):S8–S14.
87.
LewingtonSClarkeRQizilbashNPetoRCollinsR.Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet2002; 360:1903–1913.
88.
Klasson-HeggeboLAndersenLBWennlofAHSardinhaLBHarroMFrobergK. Graded associations between cardiorespiratory fitness, fatness, and blood pressure in children and adolescents. Br J Sports Med2006; 40:25–29.
89.
BrageSWedderkoppNEkelundUFranksPWWarehamNJAndersenLB. Objectively measured physical activity correlates with indices of insulin resistance in Danish children. The European Youth Heart Study (EYHS). Int J Obes Relat Metab Disord2004; 28:1503–1508.
90.
MesaJOrtegaFRuizJCastilloMHurtig-WennlöfASjöströmM. The importance of cardiorespiratory fitness for healthy metabolic traits in children and adolescents: the AVENA Study. J Public Health2006; DOI 10.1007/s10389-006-0033-9.
