Sports Medicine

, Volume 49, Issue 7, pp 1079–1094 | Cite as

Is Muscular Fitness Associated with Future Health Benefits in Children and Adolescents? A Systematic Review and Meta-Analysis of Longitudinal Studies

  • Antonio García-HermosoEmail author
  • Rodrigo Ramírez-Campillo
  • Mikel Izquierdo
Systematic Review



No previous systematic review has quantitatively examined the association between muscular fitness during childhood and adolescence and health parameters later in life.


The aim was to systematically review and meta-analyze the current evidence for a prospective association between muscular fitness in childhood and adolescence and future health status.


Two authors systematically searched MEDLINE, EMBASE and SPORTDiscus electronic databases and conducted manual searching of reference lists of selected articles. Relevant articles were identified by the following criteria: apparently healthy children and adolescents aged 3–18 years with muscular fitness assessed at baseline (e.g., handgrip, standing long jump, sit-ups, among others), and a follow-up period of ≥ 1 year. The outcome measures were anthropometric and adiposity measurements and cardiometabolic, bone and musculoskeletal health parameters. Two authors independently extracted data.


Thirty studies were included in the meta-analysis, yielding a total of 21,686 participants. The meta-analysis found a significant, moderate-large (p < 0.05) effect size between muscular fitness at baseline and body mass index (r = − 0.14; 95% confidence interval (CI) − 0.21 to − 0.07), skinfold thickness (r = − 0.32; 95% CI − 0.40 to − 0.23), homeostasis model assessment estimated insulin resistance (r = − 0.10; 95% CI − 0.16 to − 0.05), triglycerides (r = − 0.22; 95% CI − 0.30 to − 0.13), cardiovascular disease risk score (r = − 0.29; 95% CI − 0.39 to − 0.18), and bone mineral density (r = 0.166; 95% CI 0.086 to 0.243) at follow-up.


A prospective negative association was observed between muscular fitness in childhood/adolescence and adiposity and cardiometabolic parameters in later life, together with a positive association for bone health. There is inconclusive evidence for low back pain benefits.


Compliance with Ethical Standards


AGH is a Miguel Servet Fellow (Instituto de Salud Carlos III—CP18/0150). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

Antonio García-Hermoso, Rodrigo Ramírez-Campillo, and Mikel Izquierdo declare that they have no conflicts of interest relevant to the content of this review.

Supplementary material

40279_2019_1098_MOESM1_ESM.docx (226 kb)
Supplementary material 1 (DOCX 226 kb)


  1. 1.
    Ortega F, Ruiz J, Castillo M, et al. Physical fitness in childhood and adolescence: a powerful marker of health. Int J Obes (Lond). 2008;32(1):1.CrossRefGoogle Scholar
  2. 2.
    Mintjens S, Menting MD, Daams JG, et al. Cardiorespiratory fitness in childhood and adolescence affects future cardiovascular risk factors: a systematic review of longitudinal studies. Sports Med. 2018;48(11):2577–605.CrossRefGoogle Scholar
  3. 3.
    Ruiz JR, Castro-Piñero J, Artero EG, et al. Predictive validity of health-related fitness in youth: a systematic review. Br J Sports Med. 2009;43(12):909–23.CrossRefGoogle Scholar
  4. 4.
    Garcia-Hermoso A, Vegas-Heredia ED, Fernández-Vergara O, et al. Independent and combined effects of handgrip strength and adherence to a Mediterranean diet on blood pressure in Chilean children. Nutrition. 2019;60:170–4.CrossRefGoogle Scholar
  5. 5.
    Ramírez-Vélez R, Peña-Ibagon JC, Martínez-Torres J, et al. Handgrip strength cutoff for cardiometabolic risk index among Colombian children and adolescents: the FUPRECOL Study. Sci Rep. 2017;7:42622.CrossRefGoogle Scholar
  6. 6.
    Committee PAGA. Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: US Department of Health and Human Services; 2018.Google Scholar
  7. 7.
    World Health Organization. Global health estimates: deaths by cause, age, sex and country, 2000–2012. Geneva: WHO; 2014. p. 9.Google Scholar
  8. 8.
    Sandercock GR, Cohen DD. Temporal trends in muscular fitness of English 10-year-olds 1998–2014: an allometric approach. J Sci Med Sport. 2019;22(2):201–5.CrossRefGoogle Scholar
  9. 9.
    Moliner-Urdiales D, Ruiz J, Ortega F, et al. Secular trends in health-related physical fitness in Spanish adolescents: the AVENA and HELENA studies. J Sci Med Sport. 2010;13(6):584–8.CrossRefGoogle Scholar
  10. 10.
    García-Hermoso A, Cavero-Redondo I, Ramírez-Vélez R, et al. Muscular strength as a predictor of all-cause mortality in apparently healthy population: a systematic review and meta-analysis of data from approximately 2 million men and women. Arch Phys Med Rehabil. 2018;99(10):2100–13.CrossRefGoogle Scholar
  11. 11.
    Steene-Johannessen J, Anderssen SA, Kolle E, et al. Low muscle fitness is associated with metabolic risk in youth. Med Sci Sports Exerc. 2009;41(7):1361–7.CrossRefGoogle Scholar
  12. 12.
    Fraser BJ, Schmidt MD, Huynh QL, et al. Tracking of muscular strength and power from youth to young adulthood: longitudinal findings from the Childhood Determinants of Adult Health Study. J Sci Med Sport. 2010;20(10):927–31.CrossRefGoogle Scholar
  13. 13.
    Smith JJ, Eather N, Morgan PJ, et al. The health benefits of muscular fitness for children and adolescents: a systematic review and meta-analysis. Sports Med. 2014;44(9):1209–23.CrossRefGoogle Scholar
  14. 14.
    Green S, Higgins J. Cochrane handbook for systematic reviews of interventions. Version; 2005.Google Scholar
  15. 15.
    Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151(4):65–94.CrossRefGoogle Scholar
  16. 16.
    Aires L, Andersen LB, Mendonça D, et al. A 3-year longitudinal analysis of changes in fitness, physical activity, fatness and screen time. Acta Paediatr. 2010;99(1):140–4.PubMedGoogle Scholar
  17. 17.
    Grøntved A, Ried-Larsen M, Ekelund U, et al. Independent and combined association of muscle strength and cardiorespiratory fitness in youth with insulin resistance and β-cell function in young adulthood: the European Youth Heart Study. Diabetes Care. 2013;36(9):2575–81.CrossRefGoogle Scholar
  18. 18.
    Grøntved A, Ried-Larsen M, Møller NC, et al. Muscle strength in youth and cardiovascular risk in young adulthood (the European Youth Heart Study). Br J Sports Med. 2015;49(2):90–4.CrossRefGoogle Scholar
  19. 19.
    Toriola OO, Monyeki MA, Toriola AL. Two-year longitudinal health-related fitness, anthropometry and body composition status amongst adolescents in Tlokwe Municipality: the PAHL Study. Afr J Prim Health Care Fam Med. 2015;7(1):896.CrossRefGoogle Scholar
  20. 20.
    Wells G, Shea B, O’Connell D, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Accessed Oct 20, 2018.
  21. 21.
    Skrede T, Steene-Johannessen J, Anderssen S, et al. The prospective association between objectively measured sedentary time, moderate-to-vigorous physical activity and cardiometabolic risk factors in youth: a systematic review and meta-analysis. Obes Rev. 2019;20(1):55–74.CrossRefGoogle Scholar
  22. 22.
    Nieminen P, Lehtiniemi H, Vähäkangas K, et al. Standardised regression coefficient as an effect size index in summarising findings in epidemiological studies. Epidemiol Biostat Public Health. 2013;10(4):1–15.Google Scholar
  23. 23.
    Peterson RA, Brown SP. On the use of beta coefficients in meta-analysis. J Appl Psychol. 2005;90(1):175.CrossRefGoogle Scholar
  24. 24.
    Hardy RJ, Thompson SG. A likelihood approach to meta-analysis with random effects. Stat Med. 1996;15(6):619–29.CrossRefGoogle Scholar
  25. 25.
    Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Erlbaum; 1988.Google Scholar
  26. 26.
    Higgins J, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.CrossRefGoogle Scholar
  27. 27.
    Higgins J, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.CrossRefGoogle Scholar
  28. 28.
    Egger M, Smith GD, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.CrossRefGoogle Scholar
  29. 29.
    Agostinis-Sobrinho C, Ruiz JR, Moreira C, et al. Changes in muscular fitness and its association with blood pressure in adolescents. Eur J Pediatr. 2018;177(7):1101–9.CrossRefGoogle Scholar
  30. 30.
    Barnekow-Bergkvist M, Hedberg G, Janlert U, et al. Adolescent determinants of cardiovascular risk factors in adult men and women. Scand J Public Health. 2001;29(3):208–17.CrossRefGoogle Scholar
  31. 31.
    Barnekow-Bergkvist M, Hedberg G, Pettersson U, et al. Relationships between physical activity and physical capacity in adolescent females and bone mass in adulthood. Scand J Med Sci Sports. 2006;16(6):447–55.CrossRefGoogle Scholar
  32. 32.
    Cheng J, Maffulli N, Leung S, et al. Axial and peripheral bone mineral acquisition: a 3-year longitudinal study in Chinese adolescents. Eur J Pediatr. 1999;158(6):506–12.CrossRefGoogle Scholar
  33. 33.
    Delvaux K, Lefevre J, Philippaerts R, et al. Bone mass and lifetime physical activity in Flemish males: a 27-year follow-up study. Med Sci Sports Exerc. 2001;33(11):1868–75.CrossRefGoogle Scholar
  34. 34.
    Feldman DE, Shrier I, Rossignol M, et al. Risk factors for the development of low back pain in adolescence. Am J Epidemiol. 2001;154(1):30–6.CrossRefGoogle Scholar
  35. 35.
    Foley S, Quinn S, Dwyer T, et al. Measures of childhood fitness and body mass index are associated with bone mass in adulthood: a 20-year prospective study. J Bone Miner Res. 2008;23(7):994–1001.CrossRefGoogle Scholar
  36. 36.
    Fraser BJ, Blizzard L, Schmidt MD, et al. Childhood cardiorespiratory fitness, muscular fitness and adult measures of glucose homeostasis. J Sci Med Sport. 2018;21(9):935–40.CrossRefGoogle Scholar
  37. 37.
    Fraser BJ, Huynh QL, Schmidt MD, et al. Childhood muscular fitness phenotypes and adult metabolic syndrome. Med Sci Sports Exerc. 2016;48(9):1715–22.CrossRefGoogle Scholar
  38. 38.
    Freitas D, Beunen G, Maia J, et al. Tracking of fatness during childhood, adolescence and young adulthood: a 7-year follow-up study in Madeira Island, Portugal. Ann Hum Biol. 2012;39(1):59–67.CrossRefGoogle Scholar
  39. 39.
    Hasselstrøm H, Hansen S, Froberg K, et al. Physical fitness and physical activity during adolescence as predictors of cardiovascular disease risk in young adulthood. Danish Youth and Sports Study. An eight-year follow-up study. Int J Sports Med. 2002;23(1):27–31.CrossRefGoogle Scholar
  40. 40.
    Hruby A, Chomitz VR, Arsenault LN, et al. Predicting maintenance or achievement of healthy weight in children: the impact of changes in physical fitness. Obesity. 2012;20(8):1710–7.CrossRefGoogle Scholar
  41. 41.
    Janz K, Dawson J, Mahoney L. Increases in physical fitness during childhood improve cardiovascular health during adolescence: the Muscatine study. Int J Sports Med. 2002;23(S1):15–21.CrossRefGoogle Scholar
  42. 42.
    Jekal Y, Kim Y, Yun JE, et al. The association of adolescent fatness and fitness with risk factors for adult metabolic syndrome: a 22-year follow-up study. J Phys Act Health. 2014;11(4):823–30.CrossRefGoogle Scholar
  43. 43.
    Kim J, Must A, Fitzmaurice GM, et al. Relationship of physical fitness to prevalence and incidence of overweight among schoolchildren. Obes Res. 2005;13(7):1246–54.CrossRefGoogle Scholar
  44. 44.
    Lopes VP, Maia JA, Rodrigues LP, et al. Motor coordination, physical activity and fitness as predictors of longitudinal change in adiposity during childhood. Eur J Sport Sci. 2012;12(4):384–91.CrossRefGoogle Scholar
  45. 45.
    Mikkelsson LO, Nupponen H, Kaprio J, et al. Adolescent flexibility, endurance strength, and physical activity as predictors of adult tension neck, low back pain, and knee injury: a 25 year follow up study. Br J Sports Med. 2006;40(2):107–13.CrossRefGoogle Scholar
  46. 46.
    Minck M, Ruiter L, Van Mechelen W, et al. Physical fitness, body fatness, and physical activity: the Amsterdam Growth and Health Study. Am J Hum Biol. 2000;12(5):593–9.CrossRefGoogle Scholar
  47. 47.
    Newcomer K, Sinaki M. Low back pain and its relationship to back strength and physical activity in children. Acta Paediatr. 1996;85(12):1433–9.CrossRefGoogle Scholar
  48. 48.
    Peterson MD, Gordon PM, Smeding S, et al. Grip strength is associated with longitudinal health maintenance and improvement in adolescents. J Pediatr. 2018;202:226–30.CrossRefGoogle Scholar
  49. 49.
    Salminen JJ, Erkintalo M, Laine M, et al. Low back pain in the young. A prospective three-year follow-up study of subjects with and without low back pain. Spine. 1995;20(19):2101–7.CrossRefGoogle Scholar
  50. 50.
    Sjölie AN, Ljunggren AE. The significance of high lumbar mobility and low lumbar strength for current and future low back pain in adolescents. Spine. 2001;26(23):2629–36.CrossRefGoogle Scholar
  51. 51.
    Wang Q, Alén M, Nicholson P, et al. Weight-bearing, muscle loading and bone mineral accrual in pubertal girls—a 2-year longitudinal study. Bone. 2007;40(5):1196–202.CrossRefGoogle Scholar
  52. 52.
    Zaqout M, Michels N, Bammann K, et al. Influence of physical fitness on cardio-metabolic risk factors in European children. The IDEFICS study. Int J Obes (Lond). 2016;40(7):1119–25.CrossRefGoogle Scholar
  53. 53.
    Welten D, Kemper H, Post G, et al. Weight-bearing activity during youth is a more important factor for peak bone mass than calcium intake. J Bone Miner Res. 1994;9(7):1089–96.CrossRefGoogle Scholar
  54. 54.
    Castro-Piñero J, Perez-Bey A, Cuenca-Garcia M, et al. Muscle fitness cut points for early assessment of cardiovascular risk in children and adolescents. J Pediatr. 2019;206:134–41.CrossRefGoogle Scholar
  55. 55.
    Monyeki K, Kemper H, Makgae P. Relationship between fat patterns, physical fitness and blood pressure of rural South African children: Ellisras Longitudinal Growth and Health Study. J Hum Hypertens. 2008;22(5):311.CrossRefGoogle Scholar
  56. 56.
    Garcia-Hermoso A, Correa-Bautista JE, Olloquequi J, et al. Health-related physical fitness and weight status in 13-to 15-year-old Latino adolescents. A pooled analysis. J Pediatr (Rio J). 2018. Scholar
  57. 57.
    Cattuzzo MT, dos Santos Henrique R, Ré AHN, et al. Motor competence and health related physical fitness in youth: a systematic review. J Sci Med Sport. 2016;19(2):123–9.CrossRefGoogle Scholar
  58. 58.
    Castelli DM, Valley JA. Chapter 3: The relationship of physical fitness and motor competence to physical activity. J Teach Phys Educ. 2007;26(4):358–74.CrossRefGoogle Scholar
  59. 59.
    Zurlo F, Larson K, Bogardus C, et al. Skeletal muscle metabolism is a major determinant of resting energy expenditure. J Clin Investig. 1990;86(5):1423–7.CrossRefGoogle Scholar
  60. 60.
    Moliner-Urdiales D, Ruiz JR, Vicente-Rodriguez G, et al. Associations of muscular and cardiorespiratory fitness with total and central body fat in adolescents: the HELENA study. Br J Sports Med. 2011;45(2):101–8.CrossRefGoogle Scholar
  61. 61.
    García-Hermoso A, Ramírez-Vélez R, Ramírez-Campillo R, et al. Concurrent aerobic plus resistance exercise versus aerobic exercise alone to improve health outcomes in paediatric obesity: a systematic review and meta-analysis. Br J Sports Med. 2018;52(3):161–6.CrossRefGoogle Scholar
  62. 62.
    Moran J, Sandercock G, Ramirez-Campillo R, et al. A meta-analysis of resistance training in female youth: its effect on muscular strength, and shortcomings in the literature. Sports Med. 2018;48(7):1661–71.CrossRefGoogle Scholar
  63. 63.
    Holten MKZM, Gaster M, Juel C, et al. Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes Care. 2004;53(2):294–305.CrossRefGoogle Scholar
  64. 64.
    Álvarez C, Ramírez-Campillo R, Ramírez-Vélez R, et al. Metabolic effects of resistance or high-intensity interval training among glycemic control-nonresponsive children with insulin resistance. Int J Obes (Lond). 2018;42(1):79.CrossRefGoogle Scholar
  65. 65.
    Hind K, Burrows M. Weight-bearing exercise and bone mineral accrual in children and adolescents: a review of controlled trials. Bone. 2007;40(1):14–27.CrossRefGoogle Scholar
  66. 66.
    Theintz G, Buchs B, Rizzoli R, et al. Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. J Clin Endocrinol Metab. 1992;75(4):1060–5.PubMedGoogle Scholar
  67. 67.
    Kelly P, Eisman J, Sambrook P. Interaction of genetic and environmental influences on peak bone density. Osteoporos Int. 1990;1(1):56–60.CrossRefGoogle Scholar
  68. 68.
    Babaroutsi E, Magkos F, Manios Y, et al. Body mass index, calcium intake, and physical activity affect calcaneal ultrasound in healthy Greek males in an age-dependent and parameter-specific manner. J Bone Miner Metab. 2005;23(2):157–66.CrossRefGoogle Scholar
  69. 69.
    Vicente-Rodriguez G, Dorado C, Perez-Gomez J, et al. Enhanced bone mass and physical fitness in young female handball players. Bone. 2004;35(5):1208–15.CrossRefGoogle Scholar
  70. 70.
    Gilsanz V, Roe TF, Mora S, et al. Changes in vertebral bone density in black girls and white girls during childhood and puberty. N Engl J Med. 1991;325(23):1597–600.CrossRefGoogle Scholar
  71. 71.
    Ramirez-Campillo R, Álvarez C, García-Hermoso A, et al. Methodological characteristics and future directions for plyometric jump training research: a scoping review. Sports Med. 2018;48(5):1059–81.CrossRefGoogle Scholar
  72. 72.
    Vlachopoulos D, Barker AR, Ubago-Guisado E, et al. A 9-month jumping intervention to improve bone geometry in adolescent male athletes. Med Sci Sports Exerc. 2018;50(12):2544–54.CrossRefGoogle Scholar
  73. 73.
    Vos T, Allen C, Arora M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545–602.CrossRefGoogle Scholar
  74. 74.
    Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a US national survey. Spine. 1995;20(1):11–9.CrossRefGoogle Scholar
  75. 75.
    Ma VY, Chan L, Carruthers KJ. Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain. Arch Phys Med Rehabil. 2014;95(5):986–95.CrossRefGoogle Scholar
  76. 76.
    Wewege M, Booth J, Parmenter B. Aerobic vs. resistance exercise for chronic non-specific low back pain: a systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2018;35:889–99.CrossRefGoogle Scholar
  77. 77.
    Timpka S, Petersson IF, Zhou C, et al. Muscle strength in adolescent men and future musculoskeletal pain: a cohort study with 17 years of follow-up. BMJ Open. 2013;3(5):e002656.CrossRefGoogle Scholar
  78. 78.
    Hill AB. The environment and disease: association or causation? J R Soc Med. 1965;58:295–300.CrossRefGoogle Scholar
  79. 79.
    Moran J, Sandercock GR, Ramírez-Campillo R, et al. A meta-analysis of maturation-related variation in adolescent boy athletes’ adaptations to short-term resistance training. J Sports Sci. 2017;35(11):1041–51.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Navarrabiomed, IdiSNaPamplonaSpain
  2. 2.Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias MédicasUniversidad de Santiago de Chile, USACHSantiagoChile
  3. 3.Laboratory of Human Performance, Quality of Life and Wellness Research Group, Department of Physical Activity SciencesUniversidad de Los Lagos (University of Los Lagos)OsornoChile
  4. 4.Department of Health SciencesPublic University of Navarre, CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos IIIPamplonaSpain

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