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Original article
Cardiorespiratory fitness and ideal cardiovascular health in European adolescents
  1. Jonatan R Ruiz1,2,
  2. Inge Huybrechts3,4,
  3. Magdalena Cuenca-García5,
  4. Enrique G Artero6,
  5. Idoia Labayen7,
  6. Aline Meirhaeghe8,
  7. German Vicente-Rodriguez9,10,
  8. Angela Polito11,
  9. Yannis Manios12,
  10. Marcela González-Gross13,14,
  11. Ascensión Marcos15,
  12. Kurt Widhalm16,
  13. Denes Molnar17,
  14. Anthony Kafatos18,
  15. Michael Sjöström2,
  16. Luis A Moreno9,19,
  17. Manuel J Castillo5,
  18. Francisco B Ortega1,2,
  19. on behalf of the HELENA study group
  1. 1Department of Physical Education and Sports, Faculty of Sport Sciences, PROmoting FITness and Health through physical activity research group (PROFIT), University of Granada, Granada, Andalucia, Spain
  2. 2Department of Biosciences and Nutrition at NOVUM, Unit for Preventive Nutrition, Karolinska Institutet, Huddinge, Sweden
  3. 3Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
  4. 4International Agency for Research on Cancer (IARC/WHO), Lyon, France
  5. 5Department of Medical Physiology, School of Medicine, University of Granada, Granada, Spain
  6. 6Department of Education, Area of Physical Education and Sport, University of Almería, Almería, Spain
  7. 7Department of Nutrition and Food Science, University of the Basque Country, UPV/EHU, Vitoria, Spain
  8. 8Inserm, UMR744; Institut Pasteur de Lille; Lille, Univ Lille Nord de France, Lille; UDSL, Lille, France
  9. 9GENUD “Growth, Exercise, NUtrition and Development” Research Group, Universidad de Zaragoza, Spain
  10. 10Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, Universidad de Zaragoza, Ronda Misericordia 5, 22001-Huesca, Spain
  11. 11Agricultural Research Council—Research Center on Food and Nutrition—(C.R.A. NUT formerly INRAN), Rome, Italy
  12. 12Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
  13. 13ImFine Research Group. Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
  14. 14CIBER: CB12/03/30038 Fisiopatología de la Obesidad y la Nutrición, CIBERobn, Instituto de Salud Carlos III (ISCIII), Spain
  15. 15Immunonutrition Research Group, Department of Metabolism and Nutrition, Instituto del Frio, Institute of Food Science, Technology and Nutrition, Spanish National Research Council, Madrid, Spain
  16. 16Department of Pediatrics, Division of Clinical Nutrition, Medical University of Vienna, Vienna, Austria
  17. 17Department of Pediatrics, University of Pecs, Pecs, Hungary
  18. 18Preventive Medicine and Nutrition Unit, School of Medicine, University of Crete, Crete, Greece
  19. 19Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
  1. Correspondence to Dr Jonatan R Ruiz, Department of Physical Education and Sport, Faculty of Sport Sciences. University of Granada, Ctra de Alfacar s/n CP, Granada 18011, Spain; ruizj{at}


Objective We studied in European adolescents (i) the association between cardiorespiratory fitness and ideal cardiovascular health as defined by the American Heart Association and (ii) whether there is a cardiorespiratory fitness threshold associated with a more favourable cardiovascular health profile.

Methods Participants included 510 (n=259 girls) adolescents from 9 European countries. The 20 m shuttle run test was used to estimate cardiorespiratory fitness. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviours (smoking, body mass index, physical activity and diet) and three factors (total cholesterol, blood pressure and glucose).

Results Higher levels of cardiorespiratory fitness were associated with a higher number of ideal cardiovascular health components in both boys and girls (both p for trend ≤0.001). Levels of cardiorespiratory fitness were significantly higher in adolescents meeting at least four ideal components (13% higher in boys, p<0.001; 6% higher in girls, p=0.008). Receiver operating characteristic curve analyses showed a significant discriminating accuracy of cardiorespiratory fitness in identifying the presence of at least four ideal cardiovascular health components (43.8 mL/kg/min in boys and 34.6 mL/kg/min in girls, both p<0.001).

Conclusions The results suggest a hypothetical cardiorespiratory fitness level associated with a healthier cardiovascular profile in adolescents. The fitness standards could be used in schools as part of surveillance and/or screening systems to identify youth with poor health behaviours who might benefit from intervention programmes.

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