Cardiorespiratory Fitness In Children Research Articles

Effects of rope skipping exercise on working memory and cardiorespiratory fitness in children with attention deficit hyperactivity disorder

IntroductionChildren with Attention Deficit Hyperactivity Disorder (ADHD) exhibit deficits in working memory (WM) and cardiorespiratory fitness (CRF), both of which are closely associated with the core symptoms of ADHD. This study aimed to investigate the effects of rope skipping exercise (RSE) on the WM and CRF of children with ADHD, to provide a theoretical foundation for the optimization of exercise intervention programs tailored to children with ADHD.MethodsThis study recruited 55 children (age range 6–12 years) and randomly assigned them into three groups: the ADHD with RSE (AWRSE, n=22, mean age: 10.18 ± 1.10 years), the ADHD with sports game (SG) (AWSG, n=16, mean age: 9.38 ± 0.96 years), and the typically developing (TD) control group (CG, n=17, mean age: 8.94 ± 0.56 years). The AWRSE underwent a RSE intervention, while the other two groups participated in SG. The exercise intervention lasted for 8 weeks, with sessions held twice a week for 60 minutes each, at a moderate-to-vigorous-intensity (64–95% HRmax). All children in each group underwent pre-test and post-test, including height, weight, BMI, n-back, and 20mSRT. One-way analysis of variance (Ony-way ANOVA) and paired sample t-test were used to analyze inter- and intra-group differences respectively.ResultsBefore the intervention, children with ADHD exhibited a significantly lower VO2max compared to the TD children (p<0.05), and there was no significant difference in the other indicators between the groups (p>0.05). After the intervention, no significant inter-group differences were found across all indices for the three groups of children (p > 0.05). The AWRSE had significant improvements in the accuracy of 1-back task, Pacer (laps), and VO2max (p<0.05), with the level of CRF approaching that of TD children. A significant decrease in response time for the 1-back task was observed in the CG.ConclusionAn 8-week RSE intervention is an effective therapeutic approach for children with ADHD, significantly enhancing their WM and CRF.

Reliability and validity of the modified shuttle test-paeds to measure cardiorespiratory fitness in children

BackgroundThe Modified Shuttle Test-Paeds (Paeds), a recently developed 10-meter Shuttle run test for aerobic capacity in children. This study aims to investigate the construct validity (known-group and convergent validity) and test-retest reliability of the recently developed test for cardiorespiratory fitness, the Modified Shuttle Test-Paeds (Paeds).MethodsA total of 144 participants (6–12 y) were tested on the Paeds test, and 84 children were tested on the 20-meter Shuttle Run test (20 m-SRT) to assess construct validity. To evaluate test-retest reliability, 46 children were tested twice on the Paeds.ResultsNo sex differences were found, but there was an age effect. A strong correlation was found between Paeds and the 20 m-SRT (rs=0.78, p < 0.001). The test-retest reliability was good (ICC 0.84; 95% CI 0.74–0.91).ConclusionPaeds appears to be a reliable and valid tool for estimating cardiorespiratory fitness in typically developing children aged 6–12 years and has the advantages of being shorter, needing less space, not requiring pacing and being self-motivational. More studies are needed to assess whether children reach an aerobic steady state in three minutes and how much of the results of the Paeds test can be explained by the agility component of the task (turning and grasping or aiming a bean bag). For clinical use, psychometric properties should be studied in various patient groups (e.g., ADHD, DCD, and children with intellectual disabilities).

Cardiorespiratory fitness attenuates the association between fatness and cardiometabolic risk in Chinese children.

Childhood obesity tends to persist into adulthood, predisposing individuals to cardiometabolic risk (CMR). This study aims to investigate the mediating role of cardiorespiratory fitness (CRF) in the associations between multiple fatness indicators and individual CMR markers and clustered CMR-score, and explore sex differences. We recruited 1,557 children (age: 8 to 10, male/female: 52.7%/47.3%) in September 2022 in Ningbo, China. Physical examinations, overnight fasting blood test, and CRF was evaluated. The CMR-score was calculated by summing age- and sex-specific z scores of four CMR markers, including mean arterial blood pressure, triglycerides, the total cholesterol to high-density lipoprotein cholesterol ratio, and homeostatic model assessment for insulin resistance. Generalized linear mixed models were used to identify the associations, mediation analyses were performed to dissect the function of CRF. Partial correlation analyses revealed positive associations between high fatness indicators (including body mass index [BMI], BMI z score, body fat mass index [BFMI] and waist-to-height ratio [WHtR]) and increased CMR markers, whereas high CRF was associated with decreased CMR markers (all P < 0.05). In the mediation analyses, CRF emerged as a partial mediator, attenuating the relationship between four fatness indicators and CMR-score. Specifically, CRF mediated 6.5%, 7.7%, 5.3%, and 12.5% of the association between BMI, BMI z score, BFMI, WHtR and CMR-score (all P < 0.001). And the mediating effects of CRF between WHtR and four individual CMR markers was particularly robust, ranging from 10.4% to 21.1% (all P < 0.05). What's more, CRF mediates the associations between WHtR and CMR-score more pronounced in girls than boys with a mediation effect size of 17.3% (P < 0.001). In Chinese children, CRF partially mitigates the adverse effects of fatness on CMR, underscoring the significance of enhancing CRF in children.

Cardiorespiratory Fitness in Children with Obesity and Respiratory Symptoms

Study Objective: Physical fitness (i.e., VȮ2max in ml/min/kg) is decreased in children with obesity. However, cardiorespiratory fitness (i.e., VȮ2max as a percent of predicted based on ideal body mass) is preserved in children with obesity. Unfortunately, many children with obesity suffer from obesity-related respiratory symptoms such as exertional dyspnea, which could make them reluctant to exercise and thus decrease both their physical fitness and cardiorespiratory fitness. Thus, we hypothesized that both physical fitness and cardiorespiratory fitness will be decreased in children with obesity and respiratory symptoms. Methods: Body composition (DXA) was measured on children aged 8-12yrs without obesity (‘CWOO’; n=25; 15th≤BMI≤85th percentile), with obesity (‘CWO’; n=49; BMI≥95th percentile), and with obesity and respiratory symptoms (‘CWORS’; n=14; BMI≥95th percentile). On a separate day, participants completed an incremental exercise test to volitional exhaustion. After 15min of seated rest, participants then performed a constant-load supramaximal verification test at 105% of the peak work rate. The highest VȮ2 from the incremental or verification test was recorded as VȮ2max. BMI-for-age data from the CDC were used to calculate ‘ideal’ body mass (BM) at the 50th percentile for CWO, CWORS, and CWOO who were above the 50th BMI percentile. Percent predicted VȮ2max was calculated using sex-specific prediction equations developed by Cooper et al. (2016). A one-way ANOVA with post hoc tests was used to determine differences among groups (i.e., CWOO, CWO, and CWORS). Significance was set at p &lt; 0.05. Results: Age in years was slightly but significantly greater in CWOO (11.0±1.1) vs. CWORS (10.2±1.1), but similar between CWO (10.4±1.3) and the other two groups. Height was not significantly different between groups. BM in kg was similar between CWO (60.18±15.65) and CWORS (63.16±13.10), and significantly higher than CWOO (39.18±7.11). There were no significant differences in BMI (% of the 95th percentile), fat mass, % fat, or circumference measures between CWO and CWORS. VȮ2max in L/min was not different between groups (CWOO, 1.48±0.35; CWO, 1.59±0.32; CWORS, 1.57±0.30). VȮ2max in % predicted was not different between groups (CWOO, 97±12; CWO, 96±12; CWORS, 91±12). VȮ2max in ml/min/kg was similar between CWO (27.0±3.7) and CWORS (25.2±3.5), but significantly greater in CWOO (37.9±7.1) vs. the other two groups. Conclusion: Cardiorespiratory fitness is not affected in children with obesity and respiratory symptoms. Thus, the origin of symptoms in children with obesity and respiratory symptoms is probably not related to deconditioning. These findings are important to inform healthcare providers who examine fitness and associations with chronic disease in children with obesity. NIH R01 HL136643, King Charitable Foundation Trust, Cain Foundation, unrestricted gift from Dr. Pepper Snapple, and Texas Health Presbyterian Hospital Dallas. Dr. Daniel Wilhite was funded by an NIH Administrative Supplement to Promote Diversity in Health-Related Research (HL136643-01S1). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Curvilinear association between waist-to-height ratio and cardiorespiratory fitness: a cross-sectional study based on nationwide data from Chinese children and adolescents

BackgroundWaist-to-height ratio (WHtR) is considered an important summary indicator for assessing the health of children and adolescents. However, there are fewer studies addressing the association between WHtR and cardiorespiratory fitness (CRF). Deriving an optimal WHtR would play an important role in promoting CRF in children and adolescents. Our aim was to analyze the association between WHtR and CRF and determine the optimal value of WHtR.MethodsIn this study, 37,081 (19,125 boys, 51.6%) children and adolescents aged 7–18 years in five regions of China were tested for WHtR and 20-m shuttle run test (20 m SRT). One-way ANOVA was used to compare maximum oxygen uptake (VO2max) among children and adolescents with different WHtRs and effect sizes were used to analyze differences between groups. Curvilinear regression was used to analyse the curvilinear relationship that exists between WHtR and VO2max.ResultsIn Chinese children and adolescents, the WHtR of boys was higher than that of girls by 0.01, and the difference was statistically significant (P < 0.001). Overall, in the age groups of 7–9, 10–12, 13–15, and 16–18 years old, the differences in VO2max comparisons between different WHtR groups were statistically significant (P < 0.001). In Chinese children and adolescents in the age groups of 7–9, 10–12, 13–15, and 16–18 years old, VO2max levels were highest when the WHtR was 0.34, 0.32, 0.39, and 0.41, respectively.ConclusionsThere is a curvilinear association between WHtR and CRF in Chinese children and adolescents. Both lower and higher WHtR led to a decrease in VO2max in children and adolescents.

Cardiorespiratory and Muscular Fitness in Children and Adolescents with Obesity.

Examine the current state of literature related to the impact of obesity in children and adolescents on health-related physical fitness and the resultant cardiometabolic disease risk. Cardiorespiratory fitness of children and adolescents has declined over the past few decades which corresponds with an increase in obesity rates. Children with obesity are more likely to have low cardiorespiratory fitness which is associated with higher cardiometabolic disease risk and poorer mental health. The impact of obesity on muscular fitness in children and adolescents is more difficult to ascertain, but in general measures of physical function are lower in children with obesity which has also been associated with higher cardiometabolic disease risk. Components of health-related physical fitness are trending negatively in children and adolescents and appear to be related to the increase in prevalence of obesity. The resultant cardiometabolic disease risk has also risen which suggests a greater disease burden in the future. These disparaging findings highlight the need for aggressive interventions to improve physical fitness in children and adolescents.

Telehealth Movement-to-Music With Arm-Based Sprint-Intensity Interval Training to Improve Cardiometabolic Health and Cardiorespiratory Fitness in Children With Cerebral Palsy: Protocol for a Pilot Randomized Controlled Trial.

Children with mobility disabilities, including those with cerebral palsy, have limited options and limited time to exercise to manage their cardiometabolic health and cardiorespiratory fitness. Regular cardiovascular exercise during childhood is a critical health behavior for preventing health decline in adulthood. Thus, there is an urgent need for accessible, age-appropriate, convenient exercise modalities in this group. Sprint-intensity interval training (SIT), combined with telehealth procedures, may be ideal for children with disabilities. SIT includes repetitive bouts of maximal exercise effort combined with rest periods, which can be effective in eliciting comparable results to moderate-exercise training with very short training durations. This phase 1 pilot feasibility randomized controlled trial aims to investigate the potential effects of a 12-week SIT program on indicators of cardiorespiratory fitness and cardiometabolic health among children with cerebral palsy. An ancillary aim is to evaluate the feasibility of the program through several process feasibility metrics. This study uses a 2-armed parallel group design. A total of 50 physically inactive children with cerebral palsy (aged 6-17 years) will be randomly allocated into 1 of 2 groups: a 12-week SIT or a waitlist control group that continues habitual activity for 12 weeks. The SIT prescription includes 3 tele-supervised sessions per week with 30 repeated sequences of 4 seconds of maximal arm exercise, with active recovery, warm-up, and cooldown periods (for an approximately 20-minute total session). SIT includes guided videos with child-themed arm routines and music. The exercise sessions will be remotely supervised through a web-based videoconference application and include safety monitoring equipment. Outcomes are measured at pre- and postintervention (weeks 0 and 13, respectively). Health outcome measures include peak oxygen consumption (VO2 peak), measured by a graded exercise test; high-sensitivity C-reactive protein and blood insulin, hemoglobin A1c, triglycerides, and cholesterol using a finger stick dried blood spot test; blood pressure, using a sphygmomanometer; and body composition (total mass, total lean mass, tissue % lean, and tissue % fat) using dual x-ray absorptiometry. Feasibility will be evaluated by the following metrics: adverse events or problems experienced throughout the intervention related to participant safety; perceived enjoyment; and recruitment, enrollment, and attrition rates. Recruitment procedures started in November 2023. All data are anticipated to be collected by February 2025. Full trial results are anticipated to be analyzed and submitted for publication by March 2025. Secondary analyses of data will be subsequently published. This trial tests an accessible and low-cost exercise program that leverages principles of high-intensity exercise to provide a convenient program for children with physical disabilities. Knowledge obtained from this study will inform the development of a larger trial for improving the cardiometabolic health, cardiorespiratory fitness, and well-being of children with physical disabilities. ClinicalTrials.gov NCT05619211; https://clinicaltrials.gov/study/NCT05619211. DERR1-10.2196/56499.

Effect of high-intensity interval training on cardiorespiratory in children and adolescents with overweight or obesity: a meta-analysis of randomized controlled trials.

This meta-analysis aimed to examine the effect of high-intensity interval training on cardiorespiratory fitness in children and adolescents with overweight or obesity, and to explore the optimal dose of high-intensity interval training to improve cardiorespiratory fitness in children and adolescents with overweight or obesity. Randomized controlled trials on the effects of HIIT on cardiorespiratory fitness in children and adolescents with overweight or obesity were retrieved from six electronic databases, including PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP. The quality assessment of the included studies was conducted following the revised quality evaluation method based on the PRISMA principles. Keywords for literature search mainly include high-intensity interval, cardiorespiratory fitness, overweight, obese, children, and adolescent, etc. (1) A total of 18 studies, comprising 581 participants (288 in the intervention group and 293 in the control group), were included and all of them were of moderate to high quality. (2) HIIT had a positive effect on the cardiorespiratory fitness levels of in children and adolescents with overweight or obesity (SMD = 0.91; 95% CI: 0.66, 1.15; p < 0.00001). (3) The improvement in cardiorespiratory fitness was more significant when the HIIT intervention lasted for more than 10 weeks (SMD = 1.04; 95% CI: 0.74, 1.34; p < 0.00001), was conducted 3 times per week, with 2 to 8 sets per session (SMD = 1.13; 95% CI: 0.71, 1.55; p < 0.00001), and maintained a ratio of approximately 1:1 between exercise and rest intervals (SMD = 1.11; 95% CI: 0.73, 1.50; p < 0.00001). (1) Long-term HIIT can improve cardiorespiratory fitness in children and adolescents with overweight or obesity. (2) To achieve significant improvements in cardiorespiratory fitness in a short period, children and adolescents with overweight or obesity can engage in HIIT programs lasting for more than 10 weeks, conducted 3 times per week, with 2 to 8 sets per session, and a ratio of approximately 1:1 between exercise and rest intervals. Identifier: INPLASY202350033.

Which indices of cardiorespiratory fitness are more strongly associated with brain health in children with overweight/obesity?

To compare the strength of associations between different indices of cardiorespiratory fitness (CRF) and brain health outcomes in children with overweight/obesity. Participants were 100 children aged 8-11 years. CRF was assessed using treadmill exercise test (peak oxygen uptake [V̇O2peak ], treadmill time, and V̇O2 at ventilatory threshold) and 20-metre shuttle run test (20mSRT, laps, running speed, estimated V̇O2peak using the equations by Léger etal., Mahar etal., and Matsuzaka etal.). Intelligence, executive functions, and academic performance were assessed using validated methods. Total gray matter and hippocampal volumes were assessed using structural MRI. V̇O2peak /body mass (β = 0.18, 95% CI = 0.01-0.35) and treadmill time (β = 0.18-0.21, 95% CI = 0.01-0.39) were positively associated with gray matter volume. 20mSRT laps were positively associated with executive functions (β = 0.255, 95% CI = 0.089-0.421) and academic performance (β = 0.199-0.255, 95% CI = 0.006-0.421), and the running speed was positively associated with executive functions (β = 0.203, 95% CI = 0.039-0.367). Estimated V̇O2peak/Léger etal. was positively associated with intelligence, executive functions, academic performance, and gray matter volume (β = 0.205-0.282, 95% CI = 0.013-0.500). Estimated V̇O2peak/Mahar etal. and V̇O2peak/Matsuzaka etal. (speed) were positively associated with executive functions (β = 0.204-0.256, 95% CI = 0.031-0.436). Although V̇O2peak is considered the gold standard indicator of CRF in children, peak performance (laps or running speed) and estimated V̇O2peak/Léger etal. derived from 20mSRT had stronger and more consistent associations with brain health outcomes than other indices of CRF in children with overweight/obesity.

School-based high-intensity interval exercise program in children with overweight induce a greater improvements in body composition and physical fitness than moderate-intensity continuous exercise

BackgroundHigh-intensity interval running exercise (HIIE) is emerging as a time-efficient exercise modality for improving body composition and fitness in comparison with moderate-intensity continuous aerobic exercise (MICE); however, existing evidence is still unclear in children with overweight and thus we compared the effects of HIIE and MICE on body composition, muscular, and cardiorespiratory fitness in children with overweight.MethodsIn this randomized study, 40 male children with overweight aged 7–10 years were divided into an 8-week exercise regime: (1) HIIE group [n = 20; 2 sets of 15 × 20s at 85–95% maximal aerobic speed (MAS) separated by 15 × 20s recovery at 50% MAS, 3 days per week] and (2) MICE group [n = 20; 30 min at 60–70% MAS, 3 days per week]. Body composition, muscular and cardiorespiratory fitness were assessed before and after the 8-week intervention at similar times and conditions of the day.ResultsFollowing the 8-week HIIE protocol, weight, BMI, and fat mass decreased significantly (weight: − 1.4% vs. 0.2%, p < 0.05; BMI: − 3.1% vs. − 0.7%, p < 0.05; fat mass: − 7.7% vs. − 1.6%, p < 0.01) as compared with MICE; while the VO2peak and MAS increased significantly in both groups, the increase in HIIE group was significantly greater than that of MICE group (VO2peak: 10.3% vs. 3.5%, p < 0.01; MAS:7.7% vs. 4.5%, p < 0.05). Although significant improvements in muscular fitness were observed in HIIE and MICE groups [counter movement jump (CMJ): 7.8% vs. 5.4%; sprinting ability: − 3.7% vs. − 1.7%], no significant differences were seen between them (p > 0.05).ConclusionOur findings suggested that school-based HIIE intervention was highly in improving body composition and cardiorespiratory fitness of children with overweight than the MICE regime; however, MICE still provided improvements over time that were just not to the same magnitude of HIIE.

Distribution of cardiorespiratory fitness in children and adolescents at different latitudes.

To explore the differences and characteristics of cardiorespiratory fitness (CRF) among children and adolescents in regions with different latitudes in China. A total of 9892 children and adolescents aged 7-22 years were selected from seven administrative regions in China by the stratified cluster random sampling method. CRF was measured by performance on the 20 m shuttle run test (20mSRT) and estimated maximal oxygen consumption (VO2max ). One-way ANOVA, one-way ANCOVA, and the Lambda Mu and Sigma methods were used to analyze the data. Overall, the VO2max of children and adolescents at high latitudes was significantly lower than that of children at low and middle latitudes. The P10 , P50 , and P90 20mSRT values for children and adolescents of most age groups in high latitudes were less than those in low and middle latitudes. The 20mSRT-Z and VO2max -Z scores among children and adolescents aged 7-22 in high latitudes were lower than those in middle and low latitudes after adjusting for age, per capita gross domestic product (GDP), and per capita disposable income. In general, the CRF of children and adolescents at high latitudes was less than that at low and middle latitudes. Effective measures should be taken to improve CRF in children and adolescents at high latitudes.

Impact of Motor Competence Profiles on Adolescents' Physical Activity and Cardiorespiratory Fitness across Four Years.

Physical activity levels have decreased over past decades with most adolescents neither meeting the current physical activity recommendations nor demonstrating adequate cardiorespiratory fitness. Motor competence (MC) is foundational for a physically active lifestyle; however, children demonstrate significant differences in their levels of MC in a broad foundation of movement skills. This study investigated developmental patterns of physical activity and cardiorespiratory fitness in children across 4 years based on their longitudinal MC profiles. The data included annual measurements of MC, accelerometry-measured moderate-to-vigorous physical activity (MVPA), and cardiorespiratory fitness over 4 years from the age 11 to 15 (n = 1147, girls 582, boys 565). Latent profile analysis was used to identify longitudinal MC profiles and latent growth curve modeling to examine intercepts and slopes (s) of MVPA and cardiorespiratory fitness in these MC profiles. Three different longitudinal MC profiles were identified: low, moderate, and high. The MC profiles showed significant differences in intercepts of cardiorespiratory fitness and MVPA. The high MC profile showed the highest intercepts for both, but also a statistically significant decline in MVPA over time (s = -3.36, p < .001). Cardiorespiratory fitness increased similarly in all three profiles over time: low (s = 1.20, p < .01), moderate (s = 1.28, p < .001), high (s = 2.21, p < .001). These results highlight the long-term associations between different MC profiles and development of MVPA and cardiorespiratory fitness. Adolescents with lower MC demonstrated lower levels of MVPA and cardiorespiratory fitness, indicating decreased participation in physical activities that can optimally enhance cardiorespiratory fitness. However, significant differences in MVPA levels between MC profiles faded over time in adolescence, whereas significant differences in cardiorespiratory fitness remained.

Secular trends of cardiorespiratory fitness in children and adolescents over a 35-year period: Chronicle of a predicted foretold.

In the context of concerns regarding the cardiorespiratory fitness (CRF) of youth populations, the aims of this study were: (1) to update reference values for the VO2max for school-aged Canadians and (2) to document secular trends in CRF after a 35-year interval. Between September 2014 and April 2017, the CRF of 3725 students (53.2% boys; 6.0 to 17.9 yrs) was determined using the 20-m shuttle run test. The sample was collected in 36 different schools from six cities of Québec (Canada). Median values of VO2max decreased with age in both sexes (p ≤ 0.05). By the age of 10, more than 20% of boys showed VO2max values below the recommended value (42 ml·kg-1·min-1). At the age of 17, that proportion reached 56.8%. A similar proportion of 12 yrs girls (20%) were under the recommended minimal value (37 ml·kg-1·min-1) and that value reached 69.9% at the age of 17. Compared to 1982, the VO2max at age 17 has declined by 18% for boys and 12% for girls. The situation is worse in terms of functional capacity (number of stages completed) with an overall decrease of more than 30%. This study demonstrates that, compared to data obtained using the same methodology 35 years ago, the CRF and functional capacity of children and adolescents has declined to levels that should raise concerns from a public health perspective. Thus, the development of strategies to promote a physically active lifestyle in youth is more relevant than ever.

Cardiac Rehabilitation and Cardiopulmonary Fitness in Children and Young Adults With Congenital Heart Diseases: A Critically Appraised Topic.

Public health guidelines and a myriad of studies have proven that exercise is beneficial in the alleviation of various cardio-metabolic diseases. Congenital heart disease (ConHD) is one of the most frequently occurring congenital structural malfunctions in the pediatric population, affecting nine of every 1,000 live births. Only a few studies have established the impact of a structured exercise program on cardiopulmonary fitness in diverse groups of patients with ConHD. It is also alarming to know that a substantial number of these patients and their caregivers often remain very wary of exercise. Anxiety about exercise may increase the risk of developing morbid obesity and other long-term health complications of ConHD. The present review of a critically appraised topicis undertaken to answer the question, "Does structured exercise intervention (cardiac rehabilitation) improve cardiorespiratory fitness in children and young adults with ConHD?" Exercise science and the medical literature were searched for studies that engaged the use of aerobic exercise in patients with different ConHD diagnoses. The search yielded four studies after screening with the inclusion and exclusion criteria, which were further narrowed to three studies after a full-text review. These studies yielded results showing significant increments in peak exercise workload, duration, power output, peak oxygen uptake, or improved tissue oxygenation and muscle strength after an exercise training intervention. It is noteworthy that a group identified as "cyanotic palliated" exhibited the most significant impairment both at baseline and after the exercise intervention. This review provides level 1b medical evidence that a structured exercise program may improve cardiopulmonary fitness in patients with ConHD, which is likely to be beneficial to their overall physical, motor, and psychosocial development. The results of this review may be useful for alleviating the anxiety of patients and their caregivers about participation in structured exercise programs. This review should also motivate future research investigations to develop clinical guidelines for the management of patients with ConHD by adding exercise prescriptions to their daily therapeutic regimens.

Cross-sectional and longitudinal relationships between cardiorespiratory fitness and health-related quality of life in primary school children in England: the mediating role of psychological correlates of physical activity.

The aims were (1) to analyse the cross-sectional and longitudinal associations between children's cardiorespiratory fitness (CRF) and health-related quality of life (HRQoL) and (2) to examine whether these associations were mediated by physical activity self-efficacy and physical activity enjoyment. This study involved 383 children (10.0 ± 0.5 years) recruited from 20 primary schools in northwest England. Data were collected on two occasions 12 weeks apart. The number of laps completed in the 20-m Shuttle Run Test was used as the CRF indicator. HRQoL was assessed using the KIDSCREEN-10 questionnaire. Physical activity self-efficacy and enjoyment were assessed with the social-cognitive and Physical Activity Enjoyment Scale questionnaires, respectively. Linear mixed models with random intercepts (schools) assessed associations between CRF and HRQoL cross-sectionally, and longitudinally. Boot-strapped mediation procedures were performed, and indirect effects (IE) with 95% confidence intervals (CI) not including zero considered as statistically significant. Analyses were adjusted for sex, time of the year, socioeconomic status, waist-to-height ratio, maturation, and physical activity. CRF was cross-sectionally associated with HRQoL (β = 0.09, 95% CI = 0.02, 0.16; p = .015). In the longitudinal analysis, CRF at baseline was associated with HRQoL at 12 weeks after additionally controlling for baseline HRQoL (β = 0.08, 95% CI = 0.002; p = .15, p = .045). Cross-sectionally, physical activity self-efficacy and enjoyment acted individually as mediators in the relationship between CRF and HRQoL (IE = 0.069, 95% CI = 0.038; p = .105 and IE = 0.045, 95% CI = 0.016; p = .080, respectively). In the longitudinal analysis, physical activity self-efficacy showed a significant mediating effect (IE = 0.025, 95% CI = 0.004; p = .054). Our findings highlight the influence of CRF on children's psychological correlates of physical activity and their overall HRQoL.

The Multistage 20-Meter Shuttle Run Test Reference Values for Tibetan Children and Adolescents in Tibet, China.

Objective: Cardiorespiratory fitness (CRF) reference data for Tibetan (Zang ethnicity) children and adolescents at high altitudes in Tibet of China are lacking. The present study aimed to develop sex- and age-specific 20mSRT norms for Chinese Tibetan children and adolescents at high altitudes. Method: A total of 4667 participants from Lhasa (3650 m), Nagqu (4500 m), and Amdo (4700 m) were selected by a stratified random cluster sampling method in two stages. The 20 m SRT test was used to estimate cardiorespiratory fitness. The 20 m SRT norms were developed by the lambda, mu, and sigma method (LMS). Results: The 20 m SRT laps, completed stages/minutes, and the speed at the last complete stage of Chinese Tibetan children and adolescents aged 7–18 years increased with age. Conclusion: Given the importance of CRF for children and adolescents’ health, the government should strengthen the monitoring of the CRF of Tibetan children and adolescents in high-altitude areas, strengthen physical education curriculum reform, and increase the level of physical activity in order to improve the level of CRF in children and adolescents.

Effect of Excessive Screen Time on Cardiorespiratory Fitness in Children: A Longitudinal Study.

Background: This study investigated the effect of different components of screen time (mobile phone use, TV/video viewing, and video gaming) on cardiorespiratory fitness (CRF) development in children aged 9–12 years. Methods: This was a two-year longitudinal study conducted with 175 children (49.7% girls, mean age = 9.5) in Japan. CRF was assessed using a 20 m shuttle run test conducted at baseline and again at follow-up. Children were categorized as “Good” or “Poor” based on the change in CRF scores for each gender. Screen time was assessed using a self-reported questionnaire at baseline and termed as “high” if children reported ≥ 2 h/day. Univariate and multivariate logistic regression analyses were performed after adjusting for gender, physical activity, and time of data collection. Results: Children scoring “high” on mobile phone use had lower odds of being categorized as “Good” in CRF change (crude odds ratio (OR): 0.34; 95% confidence interval (CI): 0.15–0.90 (adjusted OR: 0.33; 95% CI: 0.12–0.91)). There were no significant effects of TV/video viewing (crude OR: 1.54; 95% CI: 0.84–2.81) and video gaming (crude OR: 0.98; 95% CI: 0.48–1.97) on changes in CRF. Conclusions: Limiting excessive mobile phone usage might be important for ensuring healthy development of CRF in children.

The Impact of Obesity on the Fitness Performance of School-Aged Children Living in Rural Areas-The West Attica Project.

This study aimed to investigate the relationship of body mass index (BMI) with muscle and cardiorespiratory fitness in children living within rural areas (regional unit of West Attica) in Greece. Participants included 399 students (187 boys, 212 girls), ages 8–12 years old, and were evaluated in physical performance tests. The point prevalence of overweight and obesity was 21.39% and 26.20% in boys, and 19.90% and 23.79% in girls. Significant differences were observed in all physical performance tests (handgrip, long jump, shuttle run, trunk flexors, and extensors endurance) between normal weight and obese participants. BMI was positively correlated with handgrip (r = 0.442−0.462, p < 0.001). There was a negative association with long jump (r = −0.206, p < 0.001), 20 m shuttle run (r = −0.394, p < 0.001), trunk flexors (r = −0.403, p < 0.001) and trunk extensors endurance (r = −0.280, p < 0.001). The regression analysis showed that 20–30% of the overall variation for physical performance assessments could be accounted for by BMI, age, and sex. With the exception of the long jump and the endurance of the trunk extensors, BMI alone may explain more than 10% of the outcome of most tests. This study highlights the determinant of BMI on muscle and cardiorespiratory fitness. The management of obesity should begin early in childhood to prevent adult chronic cardiovascular and metabolic diseases.

Assessment of Cardiorespiratory Fitness in 8-to-15-Year-Old Children with Overweight/Obesity by Three-Minute Step Test: Association with Degree of Obesity, Blood Pressure, and Insulin Resistance.

To assess cardiorespiratory fitness in children and adolescents with overweight/obesity using the Kasch pulse recovery (KPR) test, and its correlation with severity of obesity, insulin resistance, and blood pressure (BP). This is a retrospective analysis of baseline data from a study evaluating the efficacy of yoga for reduction of body mass index (BMI) in children aged 8-15 y with overweight/obesity. KPR three-minute step test was done. Children were classified into cardiorespiratory fitness categories based on the post-KPR heart rate (HR); the maximal oxygen consumption (VO2 max) was calculated, and the correlation analysis was done. One hundred fifty-five children with mean age of 11.6 ± 1.8 y and mean BMI of 26.2 ± 4.1kg/m2 were included. Mean post-KPR-HR and calculated VO2 max were 119 ± 14 per minute and 48.7 ± 5.6mL/kg/min, respectively. In children < 13 y, cardiorespiratory fitness was excellent or very good in 28%, good or sufficient in 58%, and poor or very poor in 14%. BMI, waist circumference (WC), resting HR, systolic BP, and homeostatic model of insulin resistance (HOMA-IR) were higher among those with poor/very poor fitness, with WC z score being statistically significant (p = 0.015). Post-KPR-HR showed positive correlation with BMI z score (r = 0.16, p = 0.044), WC z score (r = 0.21, p = 0.011), and HOMA-IR (r = 0.22, p = 0.012). In children with overweight/obesity, 14% had poor cardiorespiratory fitness. Post-KPR-HR and calculated VO2 max had good correlation with measures of obesity and HOMA-IR. Further studies evaluating cardiorespiratory fitness and normative data of VO2 max for Indian children are warranted.

Associations between Sedentary Time and Sedentary Patterns and Cardiorespiratory Fitness in Chinese Children and Adolescents.

The increase in sedentary behavior in children and adolescents has become a worldwide public health problem. This study aimed to explore the associations between sedentary time (ST) and sedentary patterns (SP) and the cardiorespiratory fitness (CRF) of Chinese children and adolescents. The CRF of 535 participants was determined using a 20-m shuttle run test. ST and SP were measured with accelerometers. Questionnaires were used to investigate the different types of ST. Multiple linear regression models were used to test the associations between ST and SP and CRF. In this study, only some ST and SP indicators were found to be significantly associated with CRF in girls. With each additional 10 min of screen time or passive traffic time, VO2max decreases by 0.06 mL/kg/min (B = −0.006, 95% CI: −0.010~−0.001) and 0.31 mL/kg/min (B = −0.031, 95% CI: −0.061~−0.002), respectively, with MVPA control. With each additional 10 min of breaks in ST or duration of breaks in ST, VO2max increases by 0.41 mL/kg/min (B = 0.041, 95% CI: 0.007~0.076) and 0.21 mL/kg/min (B = 0.021, 95% CI: 0.007~0.035), respectively, with control total ST. Breaks in ST (B = 0.075, 95% CI: 0.027~0.123) and the duration of breaks in ST (B = 0.021, 95% CI: 0.012~0.146) were positively correlated with CRF when controlling for LPA, but these associations were not significant when controlling for MVPA (B = 0.003, 95% CI: −0.042~0.048; B = 0.001, 95% CI: −0.024~0.025). The total ST of children and adolescents was found to not be correlated with CRF, but when ST was divided into different types, the screen time and passive traffic time of girls were negatively correlated with CRF. More breaks in ST and the duration of breaks in ST were positively associated with higher CRF in girls. MVPA performed during breaks in ST may be the key factor affecting CRF. Schools and public health departments should take all feasible means to actively intervene with CRF in children and adolescents.