Cardiovascular disease (CVD) continues to be the leading cause of death in both the developed and developing countries.1 Its root causes are clear. They begin in childhood and include genetic susceptibility as well as modifiable risk factors such as obesity, poor nutrition and lack of physical activity.2 Since over 30% of school children are overweight or obese, a large fraction of children enter adulthood with at least one major risk factor for CVD and a shortened lifespan. While there is some regional variation, lack of physical activity also plays a major role.3 In a recent Global Summit in which 15 countries were graded using the Active Healthy Kids Canada Report Card, the grades overall were low or poor.4 In a global study of 39 countries, less than a quarter of children achieved recommended levels of physical activity. Thus, national and international efforts to address the issue of obesity and physical inactivity in childhood are of the highest priority.

In 2010, the American Heart Association (AHA) developed a scheme of seven metrics to describe ideal cardiovascular health with four health behaviours (physical activity, body mass index, diet and smoking) and three health factors (blood glucose, cholesterol and blood pressure).5 In their study entitled ‘Cardiorespiratory Fitness and Ideal Cardiovascular Health in European Adolescents,’ Ruiz and colleagues explored whether fitness as measured by a …