Nearly 60% of American children lack healthy cardiorespiratory fitness


Date:
July 20, 2020
Source:
American Heart Association
Summary:
Cardiorespiratory fitness (CRF) measurement provides insight into
cardiovascular and overall health, including cognitive and academic
functions, among children and teens. Healthy CRF is linked to better
heart and blood vessel health, academic achievement, mental health
and many other positive outcomes in youth. Most pediatric health
care offices do not have the facilities to conduct CRF testing
routinely in children.



FULL STORY ========================================================================== Nearly 60% of American children do not have healthy cardiorespiratory
fitness (CRF), a key measure of physical fitness and overall health,
according to "Cardiorespiratory Fitness in Youth -- An Important Marker of Health," a new Scientific Statement from the American Heart Association, published today in the Association's flagship journal Circulation.


==========================================================================
CRF, also referred to as aerobic fitness, refers to the body's ability to supply oxygen to muscles during physical activity. Children with healthy
CRF are more likely to live longer and be healthier as adults. Children
with low or unhealthy CRF at higher risk for developing premature heart disease, type 2 diabetes (T2D) and high blood pressure at younger ages,
and they are at increased risk for premature death from heart disease
and stroke as adults.

Children with obesity are the most likely to have poor CRF.

In addition, studies have linked better CRF in children with improved
academic achievement, clearer thinking, better mental health and a higher
sense of self- worth and life satisfaction, according to studies cited
in the statement. Since the 1980s, studies have demonstrated a downward
trend for CRF among youth both in the U.S. and internationally.

"CRF is a single measure that shows how strong the heart, lungs and
blood circulation are in children. Whereas measuring body weight, blood pressure, cholesterol and blood sugar levels tell us about each of
these individual risk factors, measuring CRF provides a comprehensive assessment of a child's overall health," said Geetha Raghuveer, M.D.,
M.P.H., FAHA, chair of the writing committee for the new scientific
statement, a cardiologist at Children's Mercy Hospital and professor of pediatrics at the University of Missouri, both in Kansas City, Missouri.

According to the statement, one of the biggest contributors to low CRF in children is the decline in physical activity among young people. Children
play fewer physically active games and are exercising less.

Children are also more sedentary than they were in the past, although
it is not clear if the sedentary time itself or the resultant lack of
physical activity is correlated with lower CRF in young people. Studies (conducted prior to the COVID-19 pandemic) show that children are spending
more time using their electronic devices for recreation and entertainment
in addition to education needs -- sedentary activities have replaced
physical activity. However, a recent meta-analysis that combines the
results of multiple studies found that increased sedentary time was
correlated with lower levels of CRF in children, yet not among teens.



==========================================================================
CRF in youth can be improved by spending more time doing repeated bursts
of vigorous physical activity otherwise called high-intensity interval training, such as regular sprint running sessions coupled with periods of
rest or low- intensity exercise. Sports that include periods of vigorous physical activity such as basketball, soccer, tennis, swimming among
others should be encouraged.

"Cardiorespiratory fitness is crucial for good heart and overall health
both in childhood and as children become adults," said Raghuveer. "We've
got to get kids moving and engaged in regular physical activity, such as
in any sports they enjoy. The best activity is the activity a child or
teen likes and that is sustained for a longer period. The habits they
learn when they're young will directly benefit their health as they
become adults," said Raghuveer.

However, there are many challenges for parents who may want to help
children be more physically active. Social determinants of health,
such as socioeconomic status and neighborhood characteristics, greatly
affect children's CRF. Studies cited in the statement have found that lower-income families tend to have children with lower or unhealthy CRF, possibly because they do not have access to safe places to exercise,
play sports and be physically active. In many communities, physical
education is not provided in schools, and outdoor recess opportunities
have been reduced or eliminated.

In addition, many lower-income families live in food deserts, making it difficult to find or afford healthy foods, factors which contribute to
obesity in young people and adults.

"Every child would benefit from CRF testing as part of a yearly physical
and doing so may identify children who would benefit from lifestyle interventions that can help improve health," said Raghuveer. Currently,
CRF is not routinely measured by health care professionals, except
in children with specific conditions such as congenital heart disease,
asthma or cystic fibrosis. There are a wide variety of tests and protocols
that can be used to measure CRF, some of which can be administered in
a pediatric health care office.



==========================================================================
The most accurate measure of CRF in children is the cardiopulmonary
exercise test, which is conducted while a participant is exercising
to exhaustion, typically on a treadmill or cycle ergometer (specially
adapted stationary bike).

Other office-based tests include: the PWC170 test (Physical Work
Capacity Corresponding to a Heart Rate of 170 beats per minute), which is conducted with a cycle ergometer; a six-minute walk test that measures
the distance achieved in six minutes; however, this is only considered
useful for children with already suspected low CRF; and step tests,
where a participant steps up and down on a 12-inch bench in an effort to
engage larger muscle mass, with a goal of 24 steps/minute for a duration
of three minutes. (Step tests can be a good alternative when space is
limited; they can be conducted in office settings with minimal equipment
or on school bleachers for groups of children.) Patient questionnaires
to assess the level of physical activity for a child or teen tend to
be unreliable and not effective for measuring CRF because they are self-reported and do not include testing.

Although the CRF tests noted above can be implemented in a pediatric
health care office, many professionals don't have enough time, space or personnel to administer the tests.

In many cases, schools provide a great avenue for CRF testing, because
they widely administer the 20-meter Shuttle Run, which is an effective
measure of CRF and is the most widely used CRF test in the world. During
this test, a student runs between lines set 20 meters apart until a
facilitator sounds a "beep." The intervals between beeps accelerate
towards the end of the test, and the student must run faster. Students
are scored on the number of laps run.

Many schools also measure body mass index (BMI), weight, abdominal
strength, upper-body strength and flexibility through a group of tests
called Fitness Gram, which is administered in all 50 states.

The other field-based test is a run test where the participant is given
a set distance or a maximum duration time and instructed to complete the
test in the shortest amount of time or the greatest distance as possible
during that time.

"As is current practice for immunization records that health care
professionals share with schools with parental consent, schools
could share CRF testing results with health care professionals. This bidirectional communication will result in health care professionals
knowing more about their young patients, so interventions and counseling
can begin," said Raghuveer. "As so happens now, there are important
pieces of information regarding a child's health that are not easy to
access because they are in a silo." "Our hope is that this statement
will also inspire research into finding valid, lower-cost alternative
options for traditional cardiopulmonary exercise testing to assess CRF
in all children, and improved CRF tests that can be done in an office
with limited space and without the need for formally trained exercise physiology personnel." "In the meantime, requiring physical activity
for every grade level through high school would be a step in the right direction," said Raghuveer.


========================================================================== Story Source: Materials provided by American_Heart_Association. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Geetha Raghuveer, Jacob Hartz, David R. Lubans, Timothy Takken,
Jennifer
L. Wiltz, Michele Mietus-Snyder, Amanda M. Perak,
Carissa Baker-Smith, Nicholas Pietris, Nicholas
M. Edwards. Cardiorespiratory Fitness in Youth: An Important
Marker of Health: A Scientific Statement From the American Heart
Association. Circulation, 2020; DOI: 10.1161/ CIR.0000000000000866 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/07/200720093247.htm

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