Cardiovascular health behavior and cardiorespiratory fitness in adolescents: a longitudinal study

Eur J Pediatr. 2022 Dec;181(12):4091-4099. doi: 10.1007/s00431-022-04623-4. Epub 2022 Oct 6.


Cardiorespiratory fitness has been substantially associated with health status. However, longitudinal studies on cardiorespiratory fitness and ideal cardiovascular health behavior (ICHB) in adolescents are scarce. The aim of this study was to evaluate the longitudinal association between ICHB (at baseline) and cardiorespiratory fitness (at follow-up). This is a 2-year prospective analysis of 445 adolescents (232 girls) aged 12-18 years. The ICHB was developed by the American Heart Association as meeting the ideal health behaviors for a healthy diet, physical activity, smoking status, and body mass index. ANCOVAS adjusted by age, sex, pubertal stage, socioeconomic status, and cardiorespiratory fitness showed that the higher the number of ICHB metrics accumulated at baseline (from 1 to 4), the higher the cardiorespiratory fitness levels over a 2-year period (p = 0.038). In logistic regressions, after adjusting for potential confounders, the odds ratios for having high cardiorespiratory fitness at follow-up was 4.9 (95% CI, 1.2-20.1, p = 0.02) for those who accumulated all four metrics of ICHB, when compared to those with 1 or less metrics of ICHB. In addition, the higher the number of ICHB metrics accumulated, the higher the likelihood of having a high cardiorespiratory fitness level over a 2-year period (p for trend = 0.01).

Conclusion: We identified a significant association between ICBH and cardiorespiratory fitness in adolescents. Therefore, improving ICBH in adolescence is likely to benefit the cardiorespiratory fitness.

What is known: • Smoking status, body mass index, physical activity, and diet are associated to cardiorespiratory fitness in adulthood. • Lifestyle behaviors such as physical activity, smoking, body weight, and healthy diet are individually linked with cardiorespiratory fitness and, however, have not been examined jointly, as combined health behaviors.

What is new: • Accumulation of cardiovascular health behavior metrics was positively associated with cardiorespiratory fitness at a 2-year follow-up, in adolescents. • Meeting all the four metrics of ideal cardiovascular health behavior seems important for healthy cardiorespiratory fitness during adolescence.

Keywords: Aerobic fitness; Metabolic health; Youth; Cardiovascular health behavior; Physical activity.

MeSH terms

  • Adolescent
  • Adult
  • Body Mass Index
  • Cardiorespiratory Fitness*
  • Female
  • Health Behavior
  • Health Status
  • Humans
  • Longitudinal Studies
  • Physical Fitness