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Muscular Fitness and Cardiometabolic Variables in Children and Adolescents: A Systematic Review

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Abstract

Background

The importance of muscular fitness (MF) in the performance of activities of daily living is unequivocal. Additionally, emerging evidence has shown MF can reduce cardiometabolic risk in children and adolescents.

Objectives

The purpose of this study was to examine and summarize the evidence regarding the relationship between MF phenotypes (i.e., maximum muscular strength/power, muscular endurance, and maximum muscular strength/power/endurance) and cardiometabolic variables (obesity, blood pressure, lipids, glucose homeostasis, inflammatory markers, and clustered cardiometabolic variables) in children and adolescents.

Design

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered with PROSPERO, number CRD42020179273.

Data Sources

A systematic review was performed on five databases (PubMed, EMBASE, SciELO, Scopus, and Web of Knowledge) from database inception to May 2020, with complementary searches in reference lists.

Eligibility Criteria for Selecting Studies

Eligibility criteria included (1) a study sample of youth aged ≤ 19 years, (2) an assessment of MF with individual or clustered cardiometabolic variables derived from adjusted models (regardless of test/measurement adopted or direction of reported association), and (3) a report of the association between both, using observational studies. Only original articles published in peer-reviewed journals in English, Portuguese, and Spanish languages were considered. The quality of the included studies was assessed by using the National Heart, Lung, and Blood Institute checklist. The percentage of results reporting a statistically significant inverse association between each MF phenotype and cardiometabolic variables was calculated.

Results

Of the 23,686 articles initially identified, 96 were included (77 cross-sectional and 19 longitudinal), with data from children and adolescents from 35 countries. The score for the quality of evidence ranged from 0.33 to 0.92 (1.00 maximum). MF assessed by maximum muscular strength/power was inversely associated with lower obesity (64/113 total results (56.6%)) and reduction in clustered cardiometabolic risk (28/48 total results (58.3%)). When assessed by muscular endurance, an inverse association with obesity (30/44 total results (68.1%)) and cardiometabolic risk (5/8 total results (62.5%)) was identified. Most of the results for the relationship between MF phenotypes with blood pressure, lipids, glucose homeostasis, and inflammatory markers indicated a paucity of evidence for these interrelationships (percentage of results below 50.0%).

Conclusion

MF assessed by maximum muscular strength/power or muscular endurance is potentially associated with lower obesity and lower risk related to clustered cardiometabolic variables in children and adolescents. There is limited support for an inverse association between MF with blood pressure, lipids, glucose homeostasis biomarkers, and inflammatory markers in children and adolescents.

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Acknowledgements

The authors would like to thank the team of the Clinical Analysis Laboratory of the University Hospital “Professor Polydoro Ernani de São Thiago” at Federal University of Santa Catarina, Florianópolis, Brazil, for assisting the research. Dr. Silva was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001 and Dr. Silva is supported in part by CNPq (302028/2018-8).

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Authors and Affiliations

  1. Research Center in Kinanthropometry and Human Performance, Sports Center, Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, Santa Catarina, 88010-970, Brazil

    Tiago Rodrigues de Lima, Priscila Custódio Martins & Diego Augusto Santos Silva

  2. Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil

    Yara Maria Franco Moreno

  3. Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada

    Jean-Philippe Chaput & Mark Stephen Tremblay

  4. Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Xuemei Sui

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  1. Tiago Rodrigues de Lima
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Correspondence to Tiago Rodrigues de Lima.

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Tiago Rodrigues de Lima, Priscila Custódio Martins, Yara Maria Franco Moreno, Jean-Philippe Chaput, Mark Tremblay, Xuemei Sui and Diego Augusto Santos Silva declare that they have no conflicts of interest relevant to the content of this review.

Authorship contributions

TRL conceived the review, wrote and edited significant sections of the manuscript, carried out the literature search, screened all identifed studies based on title and abstract, and assisted with the full text screening, the risk-of-bias assessment, and the data extraction process. PCM assisted with the title and abstract screening, the full text screening, and the risk-of-bias assessment. YMFM wrote and edited significant sections of the manuscript. JPC wrote and edited significant sections of the manuscript. MST wrote and edited significant sections of the manuscript. XS revised and edited significant sections of the manuscript and assisted with the risk-of-bias assessment. DASS revised and edited significant sections of the manuscript and assisted with the risk-of-bias assessment. All authors reviewed and approved the final manuscript.

Data availability statement

The material analyzed in this study (including the strategies and descriptors used in each database, the detailed risk-of-bias assessment, and the totality of information analyzed) are available in the Electronic Supplementary Materials.

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de Lima, T.R., Martins, P.C., Moreno, Y.M.F. et al. Muscular Fitness and Cardiometabolic Variables in Children and Adolescents: A Systematic Review. Sports Med 52, 1555–1575 (2022). https://doi.org/10.1007/s40279-021-01631-6

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