Association between body mass index and cardiorespiratory fitness as predictor of health status in schoolchildren

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Medicina

del

Deporte

Original

Association

between

body

mass

index

and

cardiorespiratory

ﬁtness

as

predictor

of

health

status

in

schoolchildren

S.S.

De

Araujo

a,∗

_,

_R.

_{Miguel-dos-Santos}

a,b

_,

_R.J.S.

_Silva

a,b

_,

_A.C.

_{Cabral-de-Oliveira}

a,b

a_Physiology_Department,_Federal_University_of_Sergipe,_Brazil

b_Nucleus_Postgraduate_in_Physical_Education,_Federal_University_of_Sergipe,_Brazil

a

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Articlehistory: Received8August2013 Accepted18February2014 Keywords: Cardiorespiratoryﬁtness Bodycomposition Bodymassindex Fitnessgram®

Schoolchildren

a

b

s

t

r

a

c

t

Objective:Evaluatethecardiorespiratoryﬁtness(CRF)andthebodymassindex(BMI)ofschoolchildren accordingtothecutoffpointsestablishedbytheFitnessgram®.JustasdeterminetheinﬂuenceofBMIon CRFinchildrenandproposeanequationforpredictingVO2maxfromthebodycomposition.

Method:Thesampleconsistedof288studentsofbasiclevelofpubliceducationinthecityofAracaju– Sergipe–Brazil,agedbetween10and14years,ofthese,142werefemale.ToevaluatetheCRFthe20-m shuttleruntestwaschosen.Theresultsofthevariablewereclassiﬁedinaccordancewiththecriteria establishedbytheFitnessgram®.

Results:Itwasevidencedthatthecardiorespiratoryﬁtnessonmaleswashigherthanfemales.Relativeto BMI,therewerenodifferencesbetweenthegroups,whilemorethan80%oftheentiresamplebehaved withincriteriaestablishedbytheFitnessgram®.Ontheotherhand,57%ofthefemalegrouppresented VO2maxbelowcriterion.ItwasconﬁrmedaninverserelationshipbetweenVO2maxandBMIonchildren

andadolescents.

Conclusion:ThestudentsinthisstudyshowedadequatelevelsofbodycompositionandCRFbelowthe arearelatedtohealth,accordingtothecriteriaoftheFitnessgram®_._The_proposition_of_a_linear

regres-sionequationtoestimateVO2maxwithoutexercisepointedoutaninverserelationshipbetweenboth

variables.

Asociación

entre

el

índice

de

masa

corporal

y

la

capacidad

cardiorrespiratoria

como

predictor

del

estado

de

salud

de

escolares

Palabrasclave:

Aptitudcardiorrespiratoria Composicióncorporal Índicedemasacorporal Fitnessgram® Escolares

r

e

s

u

m

e

n

Objetivo:Evaluarlaaptitudcardiorrespiratoriayelíndicedemasacorporal(IMC)deescolaresmediante lospuntosdecorteestablecidosporlabateríainternacionaldetestFitnessgram®_._Así_como_determinar_la

inﬂuenciadelIMCenlaaptitudcardiorrespiratoria(CRF)enni ˜nosyproponerunaecuacióndepredicción delVO2máxapartirdelacomposicióncorporal.

Método:Lamuestraestuvoconformadapor288estudiantesdenivelbásicodelaeducaciónpúblicade laciudaddeAracaju-Sergipe-Brasil,deedadescomprendidasentre10-14a ˜nos,deloscuales,142eran mujeres.ParaevaluarelCRFfueutilizadalapruebade20-mshuttleruntest(PCN).Losresultadosdela variableseclasiﬁcarondeacuerdoconloscriteriosdeaplicaciónestablecidosporeltestinternacional Fitnessgram®.

Resultados:SeevidencióquelaCRFenvaronesfuemayorqueenlasmujeres.RelativoalIMC,nohubo diferenciasentrelosgrupos,mientrasquemásde80%detodalamuestrasecomportódentrodelos criteriosestablecidosporlaFitnessgram®.Porotrolado,el57%delgrupofemeninopresentóVO2máxpor

debajodelosniveles.SeconﬁrmóunarelacióninversaentreelVO2máxyelIMCenni ˜nosyadolescentes.

Conclusión:Losescolares,enesteestudio,mostraronnivelesadecuadosdecomposicióncorporalyCRFpor debajodelárearelacionadaconlasaluddeacuerdoconloscriteriosdeFitnessgram®.Laproposiciónde ∗ Correspondingauthor.

E-mailaddress:silvan.ssa@gmail.com(S.S.DeAraujo).

http://dx.doi.org/10.1016/j.ramd.2014.02.003

1888-7546/©2013ConsejeríadeEducación,CulturayDeportedelaJuntadeAndalucía.PublishedbyElsevierEspaña,S.L.U.ThisisanopenaccessarticleundertheCC BY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/4.0/).

CORE Metadata, citation and similar papers at core.ac.uk

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unaecuaciónderegresiónlineal,paraestimarelVO2máxsinejerciciose ˜nalóunarelacióninversaentre

ambasvariables.

Palavras-chave:

Aptidãocardiorrespiratória Composic¸ãocorporal Índicedemassacorporal Fitnessgram®

Escolares

Associac¸

ão

entre

índice

de

massa

corporal

e

aptidão

cardiorrespiratória

como

preditor

de

status

de

saúde

em

escolares

r

e

s

u

m

o

Objetivo:Avaliaraaptidãocardiorrespiratóriaeíndicedemassacorporal(IMC)deescolaresdeacordo comospontosdecorteestabelecidospelabateriadetesteinternacionalFitnessgram®.Alémde determi-narainfluênciadoIMCsobreaaptidãocardiorrespiratóriaemcriançaseproporumaequaçãodepredição doVO2máxapartirdacomposiçãocorporal.

Método:Aamostraconsistiude288estudantesdoensinobásicodaeducac¸ãopúblicanacidadede Ara-caju(Sergipe,Brasil),comidadeentre10-14anos,dosquais142erammeninas.Paraavaliaraaptidão cardiorrespiratóriaoptou-sepelo20-mshuttleruntest.Osresultadosdasvariáveisforamclassiﬁcados deacordocomoscritériosestabelecidospeloFitnessgram®.

Resultados:Constatou-sequeaaptidãocardiorrespiratóriadosmeninosfoimaiordoquedasmeninas. ComrelaçãoaoIMC,nãohouvediferençasentreosgrupos,enquantomaisde80%detodaaamostrase comportoudentrodoscritériosestabelecidospeloFitnessgram®.Poroutrolado,57%dogrupofeminino apresentouVO2máxabaixodoscritérios.Confirmou-seumarelaçãoinversaentreVO2máxeoIMCem

crianc¸aseadolescentes.

Conclusão:Osalunosdesteestudoapresentaramníveisdecomposiçãocorporaladequadosedeaptidão aeróbiaabaixodaárearelacionadaàsaúde,deacordocomoscritériosdoFitnessgram®.Aproposição deumaequaçãoderegressãolinearparaestimaroVO2máxsemexercícioapontouumarelaçãoinversa

entreas2variáveis.

Introduction

Thedecreaseintheamountofmotoractivityobservedon chil-drenandadolescentsindifferentsocioeconomicspectra1_has_raised

interestintheknowledgeofphysicalﬁtnessandhealth,inorderto classifyitfromscoresbasedonreferencedcriteriabothnationally andinternationally,whichinvolvephysicalqualitiesabletoreﬂect patternsofbehaviorandenvironmental.

Closelyrelated tothehealth,thelow levelsof cardiorespira-toryﬁtness(CFR)onchildhoodandadolescenceareassociatedwith anincreasedearlydeathriskduetoanycause,especially cardio-vasculardiseases.2,3_So_the_prevention_of_{cardiovascular}_diseases

shouldbeginstillduringtheschoolstage,giventhattheadoptionof healthyattitudesonthatagerangeisperpetuatedintoadulthood. Inthiswayitisimportanttodetectinadvance,evenwithin theschoolenvironment,childrenandadolescentswitha predis-positionto low aerobic ﬁtness. In this sense, thedevelopment ofmathematicalmodelsforpredictingCRFwithoutexercisetest couldbefeasibleinepidemiologicalstudies4 _and_very_useful_for

physicaleducationteachers.

Fromthisperspective,thepresentedstudyaimedtoevaluatethe CRFandtheBMIofschoolchildrenofbothsexesaccordingtothe cutoffpointsestablishedbytheFitnessgram®,aswellasdetermine theinﬂuenceofBMIonCRFofchildrenandproposeanequation forpredictingVO2maxfromthebodycomposition.

Method

Participants

Datacollectionwasperformedinacross-sectionalmode,and thetargetpopulationofthisstudyconsistedonstudentsofboth gendersenrolledin eightelementary schools distributed inthe urbanareaofAracaju,acitylocatedonthecoastofthestateof

Sergipe,Brazil.It liesbetweenthecapitalswithlower socioeco-nomicinequalitiesandcontributesgreatlytothesecondhighest HumanDevelopingIndex(HDI)amongthestatesinnortheastern region.Theinterventiontookplacebetweenthemonthsof Septem-berandNovember2005,inobediencetotheschoolcalendarofthe season.

Todeterminethesurveyedschools,thecitywasdividedinto threeregions:north,centerandsouth,andbymeansofadrawthree schoolswerechosenbyregion.Schoolsshouldhavetheminimum physicalstructureforthetests(e.g.multi-sportscourt).Thesample, selectedrandomlyduringphysical educationclasses, composed by288children(142females)withagerangebetween9.50and 14.49years.WeusedthedecimalagechildrenasRossand Marfell-Jones,5_which_accurately_represents_the_interval_between_the_date

ofbirthanddateofthetest.

The present study adopted the following inclusion criteria: belongtothepresetagegroup,attendschoolregularlyandtake partinphysicaleducationclassesonthedayandtimescheduled. Theexclusioncriteriawere:experienceanyclinicalsymptomsthat preventedtemporarilyorpermanentlybesubjectedtothetestsand donotagreewiththetermsofconsentbytheresponsibleperson.

Twoprofessionalsandfourphysicaleducationacademics car-riedouttestsandmeasurements.Toavoiddiscrepanciesbetween measurements,each teammemberperformedthesameactivity duringtheintervention.Beforedatacollection,atrainingprogram wasconductedinthetestbattery.

Proceduresandmeasures

Anthropometricmeasurements

AnthropometricvariableswhosevaluesarepresentedinTable1, were body mass (kg) and height (m), as well as measures of skinfolds,inconformitywithstablishedstandards.5_The_body_fat

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Table1

Descriptiveproﬁleofthesample(meanandstandarddeviation)forthe anthropom-etryandcardiorespiratoryﬁtness.

Variables Allgroup(n=288) Male(n=142) Female(n=146) Age(years) 12.2(1.1) 12.2(1.2) 12.1(1.1) Height(cm) 149.6(10.2) 149.2(11.1) 150.0(9.2) Bodymass(kg) 41.6(10.3) 41.5(10.7) 41.8(9.9) BMI(kg/m2₎ _18.4_(3.0) _18.3_(2.8) _18.4_(3.2) BF% 17.1(8.3) 14.4(7.9) 19.9(7.7)* VO2max 38.0(3.7) 38.8(3.8) 37.1(3.4)*

BMI:bodymassindex;BF%,bodyfatpercentage;VO2max:maximaloxygenuptake. *_p_<_0.05,_{statistically}_signiﬁcant_difference_between_male_and_female.

the caliper skinfold Cescorf® (CSC). The CSCpresents identical designandmobilitytotheHarpendenmodel,providesapressure ofapproximately10g/mm2_,_measures_to_an_accuracy_of_0.1_mm,_up

toajawwidthof88mm.7_Skinfolds_considered_for_the_study_were:

tricepsandsubscapularis.

Thebodymassindex(BMI)wascalculatedastheratioofthe bodymass(kg)andthesquaredheight(m2_)._Therefore,_the_cutoff

pointsoftheFitnessgram®wereusedtocalculatetheprevalence ofchildrenandadolescentslocatedintherecommendedrangeand intherangeofriskofoverweightandobesity.

Cardiorespiratoryﬁtness(CRF)

ToevaluatetheCRFfromthemaximaloxygenuptake(VO2max),

weoptedforthe20-mshuttleruntest,accordingtowhatLéger et al.8 _determine. _This _test _was _chosen _because _of _its

afford-ableimplementationandcompliancewiththemotortestsrelated tohealthcontainedintheFitnessgram® battery,createdbythe CooperInstitutefor AerobicsResearch9 _and _because_of _its

reli-abilityandvalidityonchildrenandadolescentshasbeenwidely documented.8,10,11_VO

2maxwascalculatedbythefollowing

equa-tion,thatcoverstheagerangeofthisstudy.Anrvalueof0.71was obtained:

y=31.025+3.238x1−3.248x2+0.1536x1x2,where:

y=VO2max(ml/kg/min)

x1=maximalspeedattained(km/h)

x2=age(y)

Fitnessgram®criteria

Toclassifytheperformancelevelregardingthecriteria estab-lished by the Fitnessgram® (VO2max: male 37.4–42.4, female

37.4–39.3;BMI:male14.5–23.0, female14.3–23.6),9 _the_results

werecategorize inthree performance levels,“below”,“normal” and“above”.ThefollowingcutoffpointswerepostedbyCooper InstituteforAerobicsResearchin2013.

Ethicsinresearch

ThisstudywasconductedaftertheapprovaloftheMunicipal Educationandaccordingtothelaws inforceandincompliance withtheGuidelinesandStandardsforResearchInvolvingHumans, itwasapprovedbytheEthicsCommitteeoftheFederalUniversity ofSergipeunderregistration1138.0.000.107-06.

Statisticalanalysis

Descriptivestatisticswasusedasﬁrststeptodataanalysis.A t-testforindependentsampleswaschosentocomparemeansand theChi-squaredtestwasusedtocompareproportions.The rela-tionshipbetweenVO2maxandBMIwasveriﬁedusingthePearson

linearcorrelationandthelinealregressionanalysis.Levelof sig-niﬁcancewassetatp<0.05.Theresultswereanalysedbyusing GraphPadPrism5orSPSSsoftwarewhennecessary.

Below Normal Above 0 20 40 60 80 100 BMI (kg/m2₎ % Male Female

Fig.1. Relativevaluesbysex,followingtheFitnessgramcutoffsestablishedforthe BodyMassIndex,BMI(kg/m2_).

Results

TheresultsofanthropometricvariablesobservedinTable1were similarwhencomparingbothsexes,regardingage,height,body mass(BM)andBMI.Intermsofpercentageofbodyfat,femaleshad highervalues(t=6.049,p<0.0001),andtheboysshowedhigher valuesformaximumoxygenconsumption(t=−4.106,p<0.0001). RegardingthebehaviorofBMIinbothsexes(Fig.1),itmaybe notednodifferencesbasedonestablishedcriteria.Consideringthe cutoffpointsfortheFitnessgram®,9.2%ofgirlswereclassiﬁedas “below”,80.3%“normal,”and10.5%“above”,thevaluesconsidered inthesamewayformaleswererespectively,8.2%,79.5%and12.3%. InrelationtoVO2max(Fig.2),thepercentageofboysclassiﬁed

as‘above’,accordingtothecutoffsoftheFitnessgram®,washigher (41.8%)than thepercentage ofgirls(19.7%). Nostatistically sig-niﬁcantdifferencewasfoundbetweengirlsandboysintheother

Below Normal Above 0 20 40 60 80 100

*

VO₂ max % Male Female

Fig.2. Relativevaluesbysex,followingtheFitnessgramcutoffsestablishedforthe VO2max(mlkgmin–1).*p<0.05:statisticallysigniﬁcantdifferencebetweenmale

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16 18 20 22 25 30 35 40 45 50 BMI (kg/m2₎ VO 2 max

Fig.3. SimplelinearregressioncurvefortherelationshipbetweenBMIandVO2max

inmales(R2₌_0.850)._VO

2max:maximaloxygenuptake;BMI:bodymassindex.

16 18 20 22 25 30 35 40 45 50 VO 2 max BMI (kg/m2₎

Fig.4. SimplelinearregressioncurvefortherelationshipbetweenBMIandVO2max

infemales(R2₌_0.907)._VO

2max:maximaloxygenuptake;BMI:bodymassindex.

classifications.Thepercentageofboysandgirlsclassifiedas‘below’ were44.5%and57.1%,respectively.Thepercentageofboysandgirls classifiedas‘normal’were13.7%and23.2%,respectively.

BothFigs.3and4showthecorrelationbetweenthetwo vari-ables,aswellastheinﬂuenceof theindependentvariable,BMI exertsonthedependent,VO2max,bydeterminingthesimple

lin-earregressionandtheR2_value._This_behavior_was_evaluated_in_both

sexesandasmanygirls(R2₌_0.907)_as_boys_(R2₌_0.850)_presented

strongcorrelation.

AnalyzingTable2,itwasfoundinthestudygroupastrong rela-tionshipinbothsexesbetweenthedependentandindependent variables.

Table2

SimplelinearregressionanalysistodetermineVO2maxbasedonBMI.

Pearson R2 _p

Male

VO2max=−2.59(BMI)+86.57 −0.922 0.850 0.026

Female

VO2max=−0.39(BMI)+32.86 −0.953 0.907 0.012

Linearregression;VO2max:maximaloxygenuptake;BMI:bodymassindex.

Discussion

Thepresentstudyaimedtoevaluatethecardiorespiratory ﬁt-nessandtheBMIofschoolchildrenofbothsexesaccordingtothe cutoffpointsestablishedbytheFitnessgram®,aswellasdetermine theinﬂuenceofBMIonCRFofchildrenandproposeanequation forpredictingVO2maxfromthebodycomposition.

TherewasalowcompliancetotheFitnessgram®criteria asso-ciatedwithriskofobesity(Fig.1).Theseresultswerebetterthan thosefoundbyBergmannetal.,12_in_a_study_with_students_of_13–

14yearsoldinthecityofCanoas(RioGrandedoSul,Brazil).In thatoccasiontheauthorsdetected19%ofboysand15%ofgirls outsidethehealthcriteriarecommendedbyProjetoEsporteBrasil (PROESP-BR).Thismaybeattributedtothechangesanddifferences inlifestylesofeachregionorcountry.13

In relation to other national studies, such as Hobold and Hübner14_with_students_of_10–14_years_old,_the_BMI_behaved_as

‘below’,forbothfemaleandmalefromthecityofMarechalCândido Rondon(Paraná,Brazil).Ronqueetal.15_in_adolescents_aged_10–15

yearsoldfromthecityofLondrina(Paraná,Brazil),obtainedhigher BMIvaluesthanthepresentstudy,inindividualswithlowandhigh cardiorespiratoryﬁtnessbasedonthecriteriaoftheFitnessgram®. However,thesampleherestudiedremainedabovethe schoolchil-dren from the Vale do Cotinguiba (Sergipe, Brazil) studied by Petroskietal.16_Although_with_respect_to_Spanish_7–12_years_old

schoolchildrenfromAragón,haveshowntobeequivalent.17

Theinvestigationofmorphologicalparametersbecomesmore relevantwhendetectspossibilitiesofbodyfataccumulation,the emergenceofchronicdiseasesandcardiovasculardiseases.Malina andBouchard18_emphasized_that_the_female_acquires_greater_gains

offatmassthanboysfromlatechildhoodtolateadolescence. Inthissense,theBF%(Table1)ofbothgroupswerehigherthan thoseobtainedbyDellagranaetal.19_and_Hobold_and_Hübner.14

In this perspective,Lloyd etal.20 _in _students _aged_10–12 _years

oldfromTexas–USA,foundaBF%of14.3inmales,atthesame levelofthisstudy,althoughthefemaleshowed8.5%,avaluevery belowtheresultsofthisstudy.Despitevariations,theseresultsput thesampleofthisstudyfarfromriskofoverweightandobesity accordingFitnessgram®criteria.21_This_evidence_was_corroborated

bytheparametersoftheBMI(Fig.1),whichalsoreportlevelsbelow normal.

Severalstudies22–25 _over _the _past_decade _have _reported_the

trendtowardsaminorcardiorespiratoryﬁtnessonfemaleschool studentscomparedtotheirmalecounterparts.Thisphenomenon canbeexplained by suddenchanges inbody composition dur-ingpuberty,particularlyfat massforgirls.18_In_addition_to_this,

LaMonteetal.26_obtained_that_the_maximal_oxygen_consumption

isinverselyproportionaltoBMI,inadditiontootherserumlipid parameters.

ItwasevidencedthattheCRFofmaleswashigherthanfemales, whilefortheBMI,therewerenodifferencesbetweenthegroups. WhilemostofthegroupremainedinthenormalrangeforBMI (79.9%),itdrewattentiontothehighprevalenceoftheentire sam-ple(50.8%)withpoorperformanceforVO2max,particularlywith

respecttothefemalegroup,which57.1%ofthemdidnotﬁtthe healthcriteriaadoptedbyFitnessgram®.Furthermore,weproved thehypothesisof aninverserelationshipbetweenVO2maxand

BMI,inchildrenandadolescents,acrucialperiodoflifetodevelop thesephysicalqualities.27

Becauseitisanimportantfunctionalaspect,whichifneglected inchildhoodandadolescenceleadstoextremedamagetohealthin adulthood,theresultofthisstudyonCRFrequiresspeciﬁcattention bythegovernmentandeducationalauthorities.Itiswellknown theseculartrendinthedeclineofthisphysicalqualitybyseveral factors,includingincreasedtimespentinsedentarybehaviors,like ahighrateofexposuretotelevision.28

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Thistransitiontosedentarylifestyleanditseffectsare strength-enedbythephenomenonofurbanizationofthesociety,asreported Chillónetal.,29_who_studied_spanish_{schoolchildren}_from

antag-onisticgeographicareas,ruraland urban,wherelowerlevelsof VO2maxwerefoundintheurbanschoolchildrencomparedtotheir

ruralpeers.Datafromtwocross-sectionalstudiesinadolescents of12.5-17.5yearsoldfromZaragoza(Spain)revealedanincrease inCRFover5years.30_According_to_the_authors,_these_data_follow

theopposite totheconsistentdecrease incardiorespiratory fit-nessidentifiedbystudiesaround27countriesandfivegeographic regionsaroundtheworld.

Thefactthatthedatafromthisstudyarealignedwiththeglobal trendisworrying,becauselowlevelsofthisvariablearerelated toriskofcardiovasculardiseases,whichbegininchildhoodand progresssilentlyuntiladulthood,andareassociatedwithahigh numberofdeathsinsomepopulations.22,31,32_The_low_performance

ofstudentsfromAracaju(presentstudy)on20mshuttle-runtest– onlyoneboyforeveryten(13.7%andonegirlforeveryﬁve(23.2%) metthecutoffpointsproposedbyFitnessgram®–contrastswith theresultsobtainedbyGuedesetal.,33_who_found_that_about_50%

onbothboysandgirls,reachedhealthcriteria.Accordingtothe authors,theseresultsarenotoptimistic,especiallybecausethey observedadeclineinproportionwhenincreasingage,especiallyin physicalteststhatinvolvelargemusclegroups.

Usually,girls tendto bemore affected bythe advancement ofpuberty,aswasalsoseeninRodriguesetal.,34_who_found_an

increase inaerobic powerin men,from 43.5to49.5mlkg/min. However,similartothepresentstudy,itwasobservedadecreasein valuesfrom38.3to36.8mlkg/minonfemale,withintheagerange studied.Inturn,46.0%ofstudentsinCanoas(RioGrandedoSul, Brazil)12_reached_the_zone_of_normality._Both_studies_corroborate

theperformancereachedbythestudentsfromthepresentsample. ThedevelopmentofestimativeequationsofCRFwithout exer-cisemightbealow-costalternativetoapplicateinthestudiesthat involvelargequantitiesofsubjects,furthermore,itmightprovidea rapiddiagnosticofthecurrentstatus,mainlyinphysicaleducation classesorbeforetrainingprogram.However,thesetoolsmustbe usedcarefullyifthepurposeistopredictmoreaccuratelyVO2max

inpatientsorathletes.35

InthepresentstudyitwasalsopossibletoidentifyhowBMI exerted inﬂuence on VO2max values in males (R2=0.850) and

females(R2₌_0.907)._This_evidence_was_also_observed_in

Marques-VidalandDias36_,_who_studied_children_in_the_same_age_than_the

presentstudy,Monyekietal.,37_in_14-year-old_adolescents,

Castro-Pi ˜neiro et al.,38 _in _6- _to _17-year-old _children _and _adolescents,

Arrudaetal.39_,_in_children_and_adolescents_{participating}_in_a_sports

project,andBotelhoetal.,40_in_which_the_higher_the_BMI,_the_lower

thecardiorespiratoryﬁtnessandphysicalﬁtnessingeneral. ItshouldbeemphasizedthestudyofAiresetal.,41_who

evalu-ated11-to18-year-oldboysandgirlsfromPortugal.Theauthors obtainedthatthestudentsintherangeofoverweightandobesity hadlower levelsofCRF, therebyconﬁrminga negative correla-tionbetweenhighfatandVO2max,furthermorereafﬁrmingthat

asedentarylifestyleisastrongpredictorofheartdisease. Althoughcross-sectionalstudiesand thescoresof ﬁeldtests showrelative limitationastoitsreproducibility,ashighlighted intheliterature,42_they_have_been_widely_adopted_as_benchmarks

forhealth-relatedphysicalﬁtness.JustastheFitnessgram®tests battery,benchmarkssuchasColeetal.43_and_World_Health

Orga-nization(WHO)44_play_a_key_role,_though_Khadilkar_et_al.13_have

emphasizedthepossibleconstraintsintheadoptionoftheir cut-offpointsduetotheanthropometricchangesinpopulationover timeandthehinderingofthecategorizationofchildrenand ado-lescents.

Theﬁndingsofthisstudywereexplainedtothemanagersofthe MunicipalEducationfromthecityofAracaju,inordertoalertthem

oftheneedofthedevelopmentofpublicpolicytowardsthe adop-tionofregularphysicalactivitieswithintheschoolcommunity.

Inconclusion,thedataofthepresentstudyshowedthatCRF ofboyswashigherthanthegirlsandtherewerenodifferences withrespecttoBMI.Ontheotherhand,theBF%ofthegirlsshowed higherlevels.Onbothsexestherewereaminimalprevalenceof schoolchildrenatriskofoverweightandobesity,accordingtothe criteriaproposedbyFitnessgram®.RelativetoCRF,ahigh preva-lenceonbothsexesbehavedbelowthearearelatedtohealth.The linearregressiontoestimateVO2maxfromBMImetexpectations

forstudiesonapopulationscaleandconﬁrmedaninverse relation-shipbetweenbothvariables,whichhighlightstheneedofassociate theparametersofphysicalﬁtnessandhealthforanearlydiagnostic ofexposuretophysicalinactivity,obesityandothercardiovascular riskfactors.

Conﬂictofinterest

Theauthordeclarenothaveconﬂictofinterest.

References

1.SilvaDAS,PetroskiEL,GayaACA.Anthropometricandphysicalﬁtness differ-encesamongBrazilianadolescentswhopracticedifferentteamcourtsports.J HumKinet.2013;36:77–86.

2.ErlandsonMC,SherarLB,MosewichAD,KowalskiKC,BaileyDA,Baxter-Jones ADG.Doesthecontrolforbiologicalmaturityimprovephysicalactivitytracking? MedSciSportsExerc.2011;43:800–7.

3.BelliKC,CalegaroC,RichterCM,KlafkeJZ,SteinR,VieciliPRN.Aptidão car-diorrespiratóriadeumaamostraregionalbrasileiradistribuídaemdiferentes tabelas.ArqBrasCardiol.2012;99:811–7.

4.MaranhãoNetoGA,DeLeonAP,LiraVA,FarinattiPTV.Assessmentof cardio-respiratoryﬁtnesswithoutexerciseinelderlymenwithchroniccardiovascular andmetabolicdiseases.JAgingRes.2012;2012:1–6.

5.RossWD,Marfell-JonesMJ.Cineantropometria.In:MacDougallJD,WengerHA, GreenHJ,editors.Evaluaciónﬁsiologicadeldeportista.3aed.Barcelona: Edito-rialPaidotribo;2005.p.277–377.

6.LohmanTG.Theuseofskinfoldtoestimatebodyfatnessonchildrenandyouth. JPhysEducRecreatDance.1987;58:98–102.

7.CyrinoES,OkanoAH,GlanerMF,RomanziniM,GobboLA,MakoskiA,etal. Impactoftheuseofdifferentskinfoldcalipersfortheanalysisofthebody composition.RevBrasMedEsporte.2003;9:150–3.

8.LégerLA,MercierD,GadouryC,LambertJ.Themultistage20-mshuttleruntest foraerobicﬁtness.JSportSci.1988;6:93–101.

9.CooperInstitute forAerobics Research. Theprudential FITNESSGRAMtest administrationmanual.Champaign:HumanKineticsBooks;1999.

10.LiuN,PlowmanS,LooneyM.Thereliabilityandvalidityofthe20mshuttletest inAmericanstudents12–15yearsold.ResQExercSport.1992;63:360–5.

11.DuarteMFS,DuarteCR.Validadedotesteaeróbiodecorridadevai-e-vemde 20metros.RevBrasCiêneMov.2001;9:07–14.

12.BergmannMLA,HalpernR,BergmannGG.Perﬁllipídico,deaptidão cardiorres-piratóriaedecomposic¸ãocorporaldeumaamostradeescolaresda8a_série_de Canoas/RS.RevBrasMedEsporte.2008;14:22–7.

13.KhadilkarVV,KhadilkarAV,ColeTJ,ChiplonkarSA,PanditD.Overweightand obesityprevalenceandbodymassindextrendsinIndianchildren.IntJPediatr Obes.2011;6:216–24.

14.HoboldE,HübnerWT.Análisedeaspectosmorfológicosefuncionais relaciona-dosàsaúdedosalunosdoprojeto“Futurodojudô:iniciac¸ãoealtonívelatravés doesportesocial”.RevistaVariaScientia.2009;09:11–25.

15.RonqueERV,CyrinoES,MortattiAL,MoreiraA,AvelarA,CarvalhoFO,etal. Relac¸ãoentreaptidãocardiorrespiratóriaeindicadoresdeadiposidadecorporal emadolescentes.RevPaulPediatr.2010;28:296–302.

16.PetroskiEL,SilvaRJS,PelegriniA.Crescimentofísicoeestadonutricionalde crianc¸aseadolescentesdaregiãodeCotinguiba,Sergipe.RevPaulPediatr. 2008;26:206–11.

17.AraI,MorenoLA,LeivaMT,GutinB,CasajusJA.Adiposity,physicalactivity,and physicalﬁtnessamongchildrenfromAragón,Spain.Obesity.2007;15:1918–24.

18.MalinaRM,BouchardC.Atividadefísicadoatletajovem:docrescimentoà maturac¸ão.SãoPaulo:Roca;2002.

19.DellagranaRA,SmolarekAC,LaatEF,CamposW.Estadonutricionale desem-penhomotordecrianc¸aspraticantesdehandebol.FitPerfJ.2010;9:72–7.

20.LloydLK,BishopPA,WalkerJL,SharpKR,RichardsonMT.Theinﬂuenceofbody sizeandcompositiononFITNESSGRAM®_test_performance_and_the_adjustment ofFITNESSGRAM®_test_scores_for_skinfold_thickness_in_youth._Meas_Phys_Educ ExercSci.2003;7:205–26.

21.ShortFX,WinnickJP.Testitemsandstandardsrelatedtobodycompositionon theBrocicportPhysicalFitnessTest.AdaptPhysActQ.2005;22:356–70.

(6)

22.PaludoAC,FernandesRA,BlasquezG,ZambrinLF,SerassueloJuniorH. Con-cordânciaentre duas classificações para a aptidãocardiorrespiratória em crianças.RevPaulPediatr.2012;30:404–8.

23.BergmannGG,AraújoMLB,GarlippDC,LorenziTDC,GayaA.Alterac¸ãoanual nocrescimentoenaaptidãofísicarelacionadaàsaúdedeescolares.RevBras CineantropomDesempenhoHum.2005;7:55–61.

24.WinsleyRJ,FulfordJ,RobertsAC,WelsmanJR,ArmstrongN.Sexdifferencein peakoxygenuptakeinprepubertalchildren.JSciMedSport.2009;12:647–51.

25.ChillónP,OrtegaFB,RuizJR,DeBourdeaudhuijI,Martínez-GómezD, Vicente-RodriguezG,etal.Activecommutingandphysicalactivityinadolescentsfrom Europe:resultsfromtheHELENAstudy.PediatrExercSci.2011;23:207–17.

26.LaMonteMJ,BarlowCE,JurcaR,KampertJB,ChurchTS,BlairSN. Cardiorespira-toryﬁtnessisinverselyassociatedwiththeincidenceofmetabolicsyndrome: aprospectivestudyofmenandwomen.Circulation.2005;112:505–12.

27.OrtegaFB,RuizaJR,CastilloMJ,MorenoLA,González-GrossaM,WärnbergJ, etal.Bajoniveldeformafísicaenlosadolescentesespa ˜noles.Importanciaparala saludcardiovascularfutura(EstudioAVENA).RevEspCardiol.2005;58:898–909.

28.AggioD,OgunleyeAA,VossC,SandercockGR.Temporalrelationshipsbetween screen-timeandphysicalactivity withcardiorespiratory ﬁtnessinEnglish schoolchildren:a2-yearlongitudinalstudy.PrevMed.2012;55:37–9.

29.ChillónP,OrtegaFB,FerrandoJA,CasajusJA.Physicalﬁtnessinruralandurban childrenandadolescentsfromSpain.JSciMedSport.2011;14:417–23.

30.Moliner-UrdialesD,RuizJR,OrtegaFB,Jiménez-PavónD,Vicente-RodriguezG, Rey-LópezJP,etal.Seculartrendsinhealth-relatedphysicalﬁtnessinSpanish adolescents:theAVENAandHELENAStudies.JSciMedSport.2010;13:584–8.

31.FranchiKMB,MontenegroRMJr.Atividadefísica:umanecessidadeparaaboa saúdenaterceiraidade.RevBrasPromoc¸Saúde.2005;18:152–6.

32.LeeDC,SuiX,ArteroEG,LeeIM,ChurchTS,McAuleyPA,etal.Long-termeffects ofchangesincardiorespiratoryﬁtnessandbodymassindexonall-causeand cardiovasculardiseasemortalityinmen.Circulation.2011;124:2483–90.

33.GuedesDP,MirandaNetoJT,GermanoJM,LopesV,SilvaAJRM.Health-related physicalﬁtnessofschoolchildren:theFitnessgramprogram.RevBrasMed Esporte.2012;18:72–6.

34.RodriguesAN,PerezAJP,CarlettiL,BissoliNS,AbreuGR.Valoresdeconsumo máximodeoxigêniodeterminadospelotestecardiopulmonaremadolescentes: umapropostadeclassiﬁcac¸ão.JPediatr.2006;82:426–30.

35.CáceresJMS,UlbrichAZ,PanigasTF,BenettiM.Anon-exercisepredictionmodel forestimationofcardiorespiratoryﬁtnessinadults.RevBrasCineantropom DesempenhoHum.2012;14:287–95.

36.Marques-VidalP,DiasCM.TrendsinoverweightandobesityinPortugal:the NationalHealthSurveys1995–96and1998–99.ObesRes.2005;13:1141–5.

37.MonyekiMA,NeetensR,MossSJ,TwiskJ.Therelationshipbetweenbody com-positionandphysicalﬁtnessin14yearoldadolescentsresidingwithinthe Tlokwelocalmunicipality,SouthAfrica.ThePAHLstudy.BMCPublicHealth. 2012;12:374–81.

38.Castro-Pi ñeiroJ,OrtegaFB,KeatingXD,González-MontesinosJL,SjöstromM, RuizJR.Percentilevaluesforaerobicperformancerunning/walkingfieldtests inchildrenaged6–17years:influenceofweightstatus.NutrHosp.2011;26: 572–8.

39.ArrudaGA,FernandesRA,ChristófaroDGD,OliveiraAR.Relac¸ãoentreidade cronológica,indicadoresdeadiposidadecorporaleaptidãofísicarelacionadaà saúdeemmeninosemeninas.RevAndalMedDeporte.2013;6:24–9.

40.BotelhoG,AguiarM,AbrantesC.Howcriticalistheeffectofbodymassindex inphysicalﬁtnessandphysicalactivityperformanceinadolescents.JPhysEduc Sport.2013;13:19–26.

41.AiresL,SilvaP,SilvaG,SantosMP,RibeiroJC,MotaJ.Intensityofphysical activ-ity,cardiorespiratoryﬁtness,andbodymassindexinyouth.JPhysActHealth. 2010;7:54–9.

42.GuedesDP,GuedesJERP.Manualpráticoparaavaliac¸ãoemeducac¸ãofísica.São Paulo:Manole;2006.

43.ColeTJ,BellizziMC,FlegalKM,DietzWH.Establishingastandarddeﬁnition forchildoverweightandobesityworldwide:internationalsurvey.BrMedJ. 2000;320:1–6.

44.WorldHealthOrganization (WHO).Obesity: preventingandmanagingthe globalepidemic.ReportofaWHOconsultation.WHOtechnicalreportseries 894.Geneva:WorldHealthOrganization;2000.