Table 3

Health criterion-reference standards for cardiorespiratory fitness in children and adolescents

Study/institution	Methodology	Outcome variable	Cardiorespiratory fitness test	Sex	Age (years)	N	Cardiorespiratory fitness (mL/kg/min)	AUC (95%CI)
Bell et al5 European Group of Pediatric Work Physiology	Expert judgement		–	Boys	Adolescents		40	–
			–	Girls	Adolescents		35	–
FITNESSGRAM6 The Cooper Institute for Aerobics Research	Regressions	Linked to adult mortality/chronic disease risk	–	Boys	12–19		42	–
				Girls	12		37	–
					13		36	–
					≥14		35	–
FITNESSGRAM, The Cooper Institute, Revision 8.6 and 9.x 20087		Healthy fitness zone linked to adult mortality/chronic disease risk	–	Boys	10–11		40.2
					12		40.3	–
					13		41.1	–
					14		42.5	–
					15		43.6	–
					16		44.1	–
					17		44.2	–
					>17		44.3	–
			–	Girls	10–11		40.2	–
					12		40.1	–
					13		39.7	–
					14		39.4	–
					15		39.1	–
					16		38.9	–
					17		38.8	–
					>17		38.6	–
Mesa et al12 (AVENA)	ROC curve	TG, HDLc, LDLc, glucose	20 m shuttle run test VO₂max estimated	Boys	13–18.5	248	45–47	0.716 (0.650 to 0.783)
Mesa et al12 (AVENA)	ROC curve	TG, HDLc, LDLc, glucose	20 m shuttle run test VO₂max estimated	Girls	13–18.5	212	–	0.506 (0.422 to 0.591)
Ruiz et al8 (EYHS)	ROC curve	Cardiovascular risk factors (insulin, glucose, HDLc, TG, sum of five skinfolds, BP)	Maximal cycle ergometer test. VO₂max estimated	Boys	9–10	429	42	0.67 (0.61 to 0.73)
Ruiz et al8 (EYHS)	ROC curve		Maximal cycle ergometer test. VO₂max estimated	Girls	9–10	444	37	0.68 (0.62 to 0.73)
Lobelo et al9 (NHANES 1999–2002)	ROC curve	Cardiovascular risk factors (systolic BP, triceps and subscapular skinfolds, HOMA, TG, TC/HDLc)	Submaximal walking treadmill test. VO₂max estimated	Boys	12–15	308	44	0.769 (0.678 to 0.860)
				Boys	16–19	369	40	0.715 (0.639 to 0.791)
				Girls	12–15	315	36	0.538 (0.415 to 0.662)
				Girls	16–19	255	36	0.539 (0.382 to 0.696)
Adegboye et al10 (EYHS)	ROC curve	Cardiovascular risk factors (systolic BP, TG, TC/HDLc, HOMA, sum of four skinfolds)	Maximal cycle ergometer test. VO₂max estimated	Boys	8–11	1219	43.6	0.68
				Boys	14–17	1049	46.0	0.55
				Girls	8–11	1181	37.4	0.67
				Girls	14–17	1051	33.0	0.69
Moreira et al 13	ROC curve	Cardiovascular risk factors (waist and hip circumference, glucose, TC, HDLc, LDLc, TG, BP)	20 m shuttle run test. VO₂max estimated	Boys	10–18	195	41.8	0.648 (0.576 to 0.716)
Moreira et al 13	ROC curve		20 m shuttle run test. VO₂max estimated	Girls	10–18	255	39.5	0.654 (0.591 to 0.713)
Welk et al14 (NHANES 1999–2002)	ROC curve	Waist circumference, systolic blood pressure/diastolic BP, HDLc, TG, and glucose	Submaximal walking treadmill test. VO₂max estimated	Boys Girls	12–18 12–18	649 591	40–44 38–40	0.831 0.772
Boddy et al11 (SportsLinx)	ROC curve	BMI	20 m shuttle run test. VO₂max estimated	Boys	9–10	6810	46.6	0.782 (0.770 to 0.794)
		Waist circumference				3771	46.6	0.736 (0.720 to 0.753)
		%BF				6252	46.6	0.800 (0.787 to 0.813)
		BMI		Girls	9–10	6676	41.9	0.582 (0.740 to 0.764)
		Waist circumference				3843	41.9	0.720 (0.704 to 0.736)
		%BF				6149	41.9	0.772 (0.758 to 0.787)
Present study (HELENA study)	ROC curve	Ideal cardiovascular health15 (smoking, BMI, physical activity, diet, TC, BP, glucose)	20 m shuttle run test. VO₂max estimated	Boys	12.5–17.5	251	43.8	0.805 (0.726 to 0.883)
Present study (HELENA study)	ROC curve			Girls	12.5–17.5	259	34.6	0.694 (0.605 to 0.784)

AUC, area under the curve; AVENA, Alimentación y Valoración del Estado Nutricional de los Adolescentes; %BF, per cent body fat; BMI, body mass index; BP, blood pressure; CRF, cardiorespiratory fitness; EYHS, European Youth Heart Study; HDLc, high-density lipoprotein cholesterol; HELENA, Healthy Lifestyle in Europe by Nutrition in Adolescence; HOMA, homeostasis model assessment; LDLc, low-density lipoprotein cholesterol; NHANES, National Health and Nutrition Examination Survey; ROC, receiver operating characteristic; TC, total cholesterol; TG, triglycerides; WC, waist circumference.