Exploring the Multivariate Association Between Physical Fitness and Cardiometabolic Risk in Children and Adolescents

To explore the multivariate pattern associations between physical fitness and adiposity with cardiometabolic risk among children and adolescents.

Cross-sectional study including 6405 participants (6-18 y; 3567 females). Waist circumference, sum of 3 skinfolds, and physical fitness measures (abdominal endurance, agility, cardiorespiratory fitness, flexibility, speed, and lower/upper limb power) were assessed. A continuous risk score (cMetS) was calculated as the mean of the z-scores for glucose, systolic blood pressure, total cholesterol and high-density lipoprotein cholesterol ratio, and triglycerides. Three models were tested using multivariate patterns analysis, of which the following explanatory variables were included: (1) both physical fitness and adiposity measures, (2) only physical fitness, and (3) physical fitness adjusted for adiposity measures. In the latter model, cMetS was also adjusted for adiposity.

Inverse associations with cMetS were found for abdominal endurance, agility, cardiorespiratory fitness, lower limb power, and speed among males; and agility and cardiorespiratory fitness among females; without adjustment for adiposity. When cMetS and physical fitness were adjusted for adiposity, agility (only among males) and cardiorespiratory fitness remained associated with cMetS.

The findings highlight the consistent adiposity-independent role of cardiorespiratory fitness as the primary fitness marker associated with cardiometabolic health during childhood and adolescence, alongside evidence linking agility to risk.