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 [\({V}\)O_2peak]); (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 \({V}\)O_2peak, 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 \({V}\)O_2peak, 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.

中文翻译：

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青少年心肺健康的健康相关标准参考切点：系统评价

背景

心肺适能 (CRF) 反映了心血管、呼吸和肌肉系统的整体有氧能力，与青少年的健康密切相关。

客观的

本系统评价的目的是确定 5-17 岁青年的 CRF 与健康相关的标准参考切点。

方法

2020 年 9 月对两个电子数据库（MEDLINE 和 SPORTDiscus）进行了系统搜索。只有在青年中为 CRF 制定了与健康相关的标准参考切点的同行评审研究才有资格，前提是它们包括 (1) 5 岁至17岁的普通人群；(2) 至少一项 CRF 的定量评估（例如，峰值摄氧量 [ \({V}\) O _2peak ]）；(3) 至少一项健康的定量评估（例如，心脏代谢风险）；(4) 健康标准；(5) 对 CRF 的至少一个与健康相关的切点进行定量分析（例如，受试者工作特征 [ROC] 曲线）。叙述性综合用于描述纳入研究的结果。

结果

总共有 29 项研究在来自 23 个国家的 193,311 名青年中为 CRF 制定了与健康相关的标准参考切点。CRF 切点，表示为\({V}\) O _2peak，使用 20 米穿梭跑测试估计，显示出对心脏代谢和肥胖风险的高辨别能力（曲线下面积 [AUC] ≥ 0.71）。来自最大循环测力计测试的切点显示对心脏代谢风险的区分能力中等（中位 AUC 0.64-0.70），对早期亚临床动脉粥样硬化的区分能力低（中位 AUC 0.56-0.63）。使用次最大跑步机运动测试的 CRF 切点显示出对心脏代谢风险的高辨别能力，但对肥胖风险的辨别能力只有中等。使用次最大步长测试估计的 CRF 切点显示出对心脏代谢风险的高辨别能力和对高血压的中等辨别能力，而那些进行 9 分钟步行/跑步测试的人则表现出对肥胖风险的中度至高度识别能力。总的来说，CRF 切点，表示为\({V}\) O _2peak，表现出对心脏代谢风险、肥胖风险和高血压的中度至高度区分能力（中位 AUC ≥ 0.64）。

结论

目前，青年 CRF 的健康相关标准参考切点范围太广，无法建议通用的年龄和性别特定阈值。为了进一步了解通用切点的发展，需要使用标准化测试协议和健康风险定义进行额外研究，以检查年龄、性别和文化等 CRF 的健康相关标准参考切点各种各样的。

临床试验注册

PROSPERO 注册号：CRD42020207458。