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

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Abstract

Background

Cardiorespiratory fitness (CRF), which reflects the overall aerobic capacity of the cardiovascular, respiratory, and muscular systems, is significantly related to health among youth.

Objective

The aim of this systematic review was to identify health-related criterion-referenced cut-points for CRF among youth aged 5–17 years.

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 CRF among youth were eligible provided they included (1) youth aged 5–17 years from the general population; (2) at least one quantitative assessment of CRF (e.g., peak oxygen uptake [\({V}\)O2peak]); (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 CRF. A narrative synthesis was used to describe the results of the included studies.

Results

Collectively, 29 included studies developed health-related criterion-referenced cut-points for CRF among 193,311 youth from 23 countries. CRF cut-points, expressed as \({V}\)O2peak, estimated using the 20-m shuttle run test, demonstrated high discriminatory ability (median area under the curve [AUC] ≥ 0.71) for both cardiometabolic and obesity risk. Cut-points derived from maximal cycle-ergometer tests demonstrated moderate discriminatory ability (median AUC 0.64–0.70) for cardiometabolic risk, and low discriminatory ability for early subclinical atherosclerosis (median AUC 0.56–0.63). Cut-points for CRF using submaximal treadmill exercise testing demonstrated high discriminatory ability for cardiometabolic risk, but only moderate discriminatory ability for obesity risk. CRF cut-points estimated using submaximal step testing demonstrated high discriminatory ability for cardiometabolic risk and moderate discriminatory ability for high blood pressure, while those for the 9-min walk/run test demonstrated moderate-to-high discriminatory ability for obesity risk. Collectively, CRF cut-points, expressed as \({V}\)O2peak, demonstrated moderate-to-high discriminatory ability (median AUC ≥ 0.64) for cardiometabolic risk, obesity risk, and high blood pressure.

Conclusions

Currently, there is too wide a range of health-related criterion-referenced cut-points for CRF among youth to suggest universal age- and sex-specific thresholds. To further inform the development of universal cut-points, there is a need for additional research, using standardized testing protocols and health-risk definitions, that examines health-related criterion-referenced cut-points for CRF that are age, sex, and culturally diverse.

Clinical Trials Registration

PROSPERO registration number: CRD42020207458.

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Acknowledgements

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

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Authors and Affiliations

  1. Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada

    Scott Rollo, Nick Seguin, Margaret Sampson, Justin J. Lang & Mark S. Tremblay

  2. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Scott Rollo & Mark S. Tremblay

  3. Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia

    Brooklyn J. Fraser

  4. Department of Health Sciences, Carleton University, Ottawa, ON, Canada

    Nick Seguin & Mark S. Tremblay

  5. Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada

    Justin J. Lang

  6. Department of Education, Health and Behavior Studies, University of North Dakota, Grand Forks, ND, USA

    Grant R. Tomkinson

  7. Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, SA, Australia

    Grant R. Tomkinson

  8. Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Mark S. Tremblay

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  1. Scott Rollo
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Correspondence to Scott Rollo.

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Funding

This systematic review was funded by the Public Health Agency of Canada (#4500414210).

Conflict of interest

Scott Rollo, Brooklyn J. Fraser, Nick Seguin, Margaret Sampson, Justin J. Lang, Grant R. Tomkinson, and Mark S. Tremblay declare they have no conflicts of interest.

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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

SR screened the records, extracted the data and took responsibility for the integrity of the data, synthesized the results, and co-wrote the manuscript. BJF screened the records, checked the data for accuracy and took responsibility for the integrity of the data, contributed to the interpretation of the results, and critically reviewed the manuscript for important intellectual content. NS assisted with extracting the data and synthesizing the results, checked the data for accuracy and took responsibility for the integrity of the data, 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. JJL developed the research question, designed the systematic review, contributed to the interpretation of the results, and critically reviewed the manuscript for important intellectual content. GRT developed the research question, designed the systematic review, contributed to the interpretation of the results, and critically reviewed the manuscript for important intellectual content. MST developed the research question, designed the systematic review, had full access to the data, contributed to the interpretation of the results, and critically reviewed the manuscript for important intellectual content. 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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Rollo, S., Fraser, B.J., Seguin, N. et al. Health-Related Criterion-Referenced Cut-Points for Cardiorespiratory Fitness Among Youth: A Systematic Review. Sports Med 52, 101–122 (2022). https://doi.org/10.1007/s40279-021-01537-3

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