For the sake of public health, better measures of cardiorespiratory fitness (CRF) in able-bodied youth are needed, the American Heart Association (AHA) said in a scientific statement.
Traditional cardiopulmonary exercise tests (CPETs) require expensive equipment and well-trained staff. Moreover, differences in equipment can make comparisons between participants and studies difficult, and activities performed during testing may not be the ones that children and teenagers typically perform, according to an AHA council chaired by Geetha Raghuveer, MD, MPH, of Children’s Mercy Hospitals and Clinics in Kansas City, Missouri.
“An explicit purpose of this statement is to explore valid, low-cost alternatives to traditional CPETs to assess CRF in otherwise healthy youth in office settings with limited space that can be performed by personnel not formally trained in exercise physiology,” Raghuveer’s group said in the statement, published online in Circulation.
Current alternatives to the CPET include the 20-m shuttle run test, other run tests, the treadmill walking test, cycle ergometer tests, the 6-minute walk test, and step tests.
“Although several tests beyond CPETs are currently available to measure CRF in office and field settings in youth, there is a pressing need for standardization of testing protocols, uniform interpretation of tests, and data harmonization. Tests such as the step test may be a suitable alternative to CPETs in the office setting but need further study,” the authors noted.
They added that “with future research, a practical, widely applicable test to estimate CRF in office settings may become a reality and an essential part of health assessment in all youth during office visits.”
The AHA group said CRF assessment is helpful because it is an objective measurement of one’s capacity to perform aerobic physical activity. CRF is also linked to cardiovascular health in children and teenagers. Moreover, CRF is associated with mental health, particularly cognitive function, academic performance, improved self-worth, and life satisfaction in youth.
Yet these brain and body benefits of CRF may be threatened by school closures in the fall due to COVID-19.
Without physical education classes, opportunities for physical activity, and adult-led physical activity participation, it is highly likely that a large percentage of youth will not get their 60 minutes of moderate to vigorous physical activity recommended per day, according to Charles Hillman, PhD, of Northeastern University’s Center for Cognitive and Brain Health in Boston.
“In brief, many children rely on schools to provide more than just a formal education. Accordingly, I suspect that the inability of children to be in school will have implications for their health,” he said.
“Parents and pediatricians can work together to help kids increase time being physically active and work to reduce sedentary time,” suggested Aaron Carrel, MD, of the University of Wisconsin American Family Children’s Hospital in Madison. “The AHA Scientific Statement is extremely important to raise pediatricians’ awareness of the importance of cardiovascular fitness in predicting future health. As fitness levels decrease, mortality increases (and vice versa). It also highlights the importance of schools and physical education programs in improving children’s cardiovascular fitness level.”
After all, suboptimal CRF was a problem for youth around the world well before the COVID-19 outbreak started.
“Unfortunately, only 40% of 12- to 15-year-olds in the United States currently are believed to have healthy CRF,” Raghuveer and co-authors wrote. “In addition, over the past 6 decades, CRF has declined, both in the United States and internationally. Although the reasons for this decline are not well understood, an increase in obesity, increased sedentary time, decreased levels of moderate to vigorous physical activity, and social and economic changes may have contributed.”
Researchers should investigate the reasons behind this decline in CRF, the AHA group suggested, adding that more investigation is also due in the potential interventions to improve CRF and the study of the CRF thresholds that would require intervention.
Last Updated July 20, 2020
Disclosures
Raghuveer had no relevant disclosures.