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Health-Related Criterion-Referenced Cut-Points for Musculoskeletal Fitness Among Youth: A Systematic Review

Abstract

Background

Musculoskeletal fitness is an excellent functional measure that is significantly related to health among youth.

Objective

Our objective was to identify health-related criterion-referenced cut-points for musculoskeletal fitness (MSF) among youth.

Methods

A systematic search of two electronic databases (MEDLINE and SPORTDiscus) was conducted in September 2020. Only peer-reviewed studies that developed health-related criterion-referenced cut-points for MSF among youth were eligible provided they included (1) youth aged 5–17 years from the general population, (2) at least one quantitative assessment of MSF (e.g., muscular strength), (3) at least one quantitative assessment of health (e.g., cardiometabolic risk), (4) a criterion for health, and (5) a quantitative analysis [e.g., receiver operating characteristic (ROC) curve] of at least one health-related cut-point for MSF. A narrative synthesis was used to describe the results of included studies.

Results

Collectively, 13 studies that developed health-related criterion-referenced cut-points for MSF among 14,476 youth from 15 countries were included. Muscular strength demonstrated high discriminatory ability [median area under the curve (AUC) ≥ 0.71] for cardiometabolic risk/metabolic syndrome, sarcopenic obesity risk and bone health, and moderate discriminatory ability (median AUC 0.64–0.70) for asthma. Muscular power also demonstrated high discriminatory ability for bone health but only moderate discriminatory ability for cardiometabolic risk/metabolic syndrome and low discriminatory ability (median AUC 0.56–0.63) for cognition/academic performance. Both muscular endurance and flexibility demonstrated low discriminatory ability for musculoskeletal pain. Health-related cut-points for MSF that demonstrated significant discriminatory ability were generally higher for boys than for girls (for muscular strength and power) and generally increased with age for muscular strength and power but remained stable for flexibility.

Conclusions

Data remain insufficient to establish universal health-related cut-points for MSF among youth. Despite variations in the health-related discriminatory ability of different MSF tests, handgrip strength and standing broad jump emerged as the two tests with the highest discriminatory ability. More research, using standardized testing protocols and health-risk definitions, is required to better triangulate universal health-related cut-points for MSF among youth.

PROSPERO registration number

CRD42020207458.

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Acknowledgements

The authors thank Katie O'Hearn (Children’s Hospital of Eastern Ontario Research Institute) for methodological assistance. We also acknowledge the help of the authors of the included studies who provided additional details.

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Correspondence to Grant R. Tomkinson.

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Funding

This systematic review was funded by the Public Health Agency of Canada (#4500414578).

Conflict of interest

Brooklyn J. Fraser, Scott Rollo, Margaret Sampson, Costan G. Magnussen, Justin J. Lang, Mark S. Tremblay, and Grant R. Tomkinson have no conflicts of interest that are directly relevant to the content of this article.

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The content and views expressed in this article are those of the authors and do not necessarily reflect those of the Government of Canada.

Availability of data and material

The datasets analyzed in this review are available from the corresponding authors on reasonable request.

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Author contributions

BJF screened the records, extracted and took responsibility for the integrity of the data, synthesized the results, and co-wrote the manuscript. ASR screened the records, checked the data for accuracy and took responsibility for the integrity of the data, contributed to the interpretation of results, and critically reviewed the manuscript for important intellectual content. MS designed and executed the systematic search strategy and critically reviewed the manuscript for important intellectual content. CGM contributed to the interpretation of results and critically reviewed the manuscript for important intellectual content. JJL developed the research question, designed the systematic review, contributed to the interpretation of results, and critically reviewed the manuscript for important intellectual content. MST developed the research question, designed the systematic review, contributed to the interpretation of results, and critically reviewed the manuscript for important intellectual content. GRT developed the research question, designed the systematic review, had full access to the data, synthesized the results, and co-wrote the manuscript. All authors have read and approved the final version of the manuscript, agree to be accountable for all aspects of the work, and agree with the order of presentation of the authors.

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Fraser, B.J., Rollo, S., Sampson, M. et al. Health-Related Criterion-Referenced Cut-Points for Musculoskeletal Fitness Among Youth: A Systematic Review. Sports Med 51, 2629–2646 (2021). https://doi.org/10.1007/s40279-021-01524-8

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  • DOI: https://doi.org/10.1007/s40279-021-01524-8