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Int J Obes (Lond). 2016 Jul;40(7):1119-25. doi: 10.1038/ijo.2016.22. Epub 2016 Feb 9.

Influence of physical fitness on cardio-metabolic risk factors in European children. The IDEFICS study.

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Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Institute for Public Health and Nursing Research, Faculty for Human and Health Sciences, University of Bremen, Bremen, Germany.
Leibniz Institute for Prevention Research and Epidemiology BIPS, Bremen, Germany.
Department of Pediatrics, Medical Faculty, University of Pécs, Pécs, Hungary.
Research and Education Institute of Child Health, Strovolos, Cyprus.
Public Health Epidemiology Unit (EPI), Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Chronic Diseases, Centre of Behavioural and Health Sciences, National Institute for Health Development, Tallinn, Estonia.
Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy.
GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.



The aim of the study was to assess the associations of individual and combined physical fitness components with single and clustering of cardio-metabolic risk factors in children.


This 2-year longitudinal study included a total of 1635 European children aged 6-11 years. The test battery included cardio-respiratory fitness (20-m shuttle run test), upper-limb strength (handgrip test), lower-limb strength (standing long jump test), balance (flamingo test), flexibility (back-saver sit-and-reach) and speed (40-m sprint test). Metabolic risk was assessed through z-score standardization using four components: waist circumference, blood pressure (systolic and diastolic), blood lipids (triglycerides and high-density lipoprotein) and insulin resistance (homeostasis model assessment). Mixed model regression analyses were adjusted for sex, age, parental education, sugar and fat intake, and body mass index.


Physical fitness was inversely associated with clustered metabolic risk (P<0.001). All coefficients showed a higher clustered metabolic risk with lower physical fitness, except for upper-limb strength (β=0.057; P=0.002) where the opposite association was found. Cardio-respiratory fitness (β=-0.124; P<0.001) and lower-limb strength (β=-0.076; P=0.002) were the most important longitudinal determinants. The effects of cardio-respiratory fitness were even independent of the amount of vigorous-to-moderate activity (β=-0.059; P=0.029). Among all the metabolic risk components, blood pressure seemed not well predicted by physical fitness, while waist circumference, blood lipids and insulin resistance all seemed significantly predicted by physical fitness.


Poor physical fitness in children is associated with the development of cardio-metabolic risk factors. Based on our results, this risk might be modified by improving mainly cardio-respiratory fitness and lower-limb muscular strength.

[Indexed for MEDLINE]

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