Cardiorespiratory Fitness Cut Points to Avoid Cardiovascular Disease Risk in Children and Adolescents; What Level of Fitness Should Raise a Red Flag? A Systematic Review and Meta-Analysis

Br J Sports Med. 2016 Dec;50(23):1451-1458. doi: 10.1136/bjsports-2015-095903. Epub 2016 Sep 26.


Background: Poor cardiorespiratory fitness is associated with cardiovascular disease risk factors.

Aim: To perform a systematic review and meta-analysis of the relationship between poor cardiorespiratory fitness and cardiovascular disease risk in children and adolescents.

Methods: Systematic literature search (1980 to 11 April 2015) for studies that determined a cardiorespiratory fitness cut point that predicted cardiovascular disease risk in children and adolescents.

Results: We identified 7 studies that included 9280 children and adolescents (49% girls) aged 8-19 years from 14 countries. Cardiovascular disease risk was already present in boys (6-39%) and girls (6-86%). Boys with low fitness (<41.8 mL/kg/min) had a 5.7 times greater likelihood of having cardiovascular disease risk (95% CI 4.8 to 6.7). The comparable diagnostic OR for girls with low fitness (<34.6 mL/kg/min) was 3.6 (95% CI 3.0 to 4.3). The 95% confidence region of cardiorespiratory fitness associated with low cardiovascular disease risk ranges, 41.8-47.0 mL/kg/min in boys (eg, stages 6-8 for a boy aged 15 years) and 34.6-39.5 mL/kg/min in girls (eg, stages 3-5 for a girl aged 15 years). The cardiorespiratory fitness cut point to avoid cardiovascular disease risk ranged 41.8 mL/kg/min in boys and was 34.6 mL/kg/min in girls.

Summary: Fitness levels below 42 and 35 mL/kg/min for boys and girls, respectively, should raise a red flag. These translate to 6 and 3 stages on the shuttle run test for a boy and a girl, both aged 15 years, respectively. These cut points identify children and adolescents who may benefit from primary and secondary cardiovascular prevention programming.

Keywords: Adolescent; Aerobic fitness; Cardiovascular; Children; Exercise testing.

Publication types

  • Review