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OXYGEN UPTAKE AND INDICATORS OF OBESITY: META-ANALYSIS INCLUDING 17,604 ADOLESCENTS

CONSUMO DE OXÍGENO E INDICADORES DE OBESIDAD: METANÁLISIS INCLUINDO 17.604 ADOLESCENTES

ABSTRACT

Introduction:

Low aerobic fitness levels are associated with excess body adiposity in adolescents. However, studies that have analyzed this association in adolescents have used different methods and measures to evaluate aerobic fitness, making it difficult to compare the results.

Objective:

To conduct a systematic review with meta-analysis of studies that have analyzed the association between aerobic fitness and anthropometric body adiposity indicators in adolescents aged 10-19 years.

Methods:

A systematic search was performed in May 2016, updated in March 2017, in the following electronic databases: LILACS (BIREME), Embase, MEDLINE (PubMed), Web of Science (Web of Knowledge), Scopus, and SPORTDiscus.

Results:

Twenty-three studies were selected. The meta-analysis indicated that as the aerobic fitness levels increased, the BMI, waist circumference and body fat percentage values of the adolescents decreased.

Conclusion:

There is a negative association between aerobic fitness (evaluated by measuring maximum oxygen uptake in the 20-meter Shuttle Run test) and the body fat percentage, BMI and waist circumference of adolescents and a negative association between aerobic fitness (assessed by measuring the number of laps in the 20-meter Shuttle Run test) and body fat percentage. However, caution is required in the interpretation of data due to the heterogeneity of the studies analyzed. Level of Evidence II; Systematic review of studies with level II of evidence.

Keywords:
Anthropometry; Aptitude; Health; Physical fitness

RESUMEN

Introducción:

La evidencia sugiere que los niveles bajos de aptitud aeróbica están asociados a un exceso de adiposidad corporal en los adolescentes. Sin embargo, los estudios que analizaron esta asociación en adolescentes utilizaron diferentes métodos y medidas para evaluar la aptitud aeróbica, lo que dificulta la comparación de los resultados encontrados.

Objetivo:

Realizar una revisión sistemática con metanálisis de estudios que evaluaron la asociación entre aptitud aeróbica e indicadores antropométricos de adiposidad corporal en adolescentes de 10 a 19 años.

Método:

Se realizó una búsqueda sistemática en mayo de 2016, actualizada em marzo de 2017, en las bases de datos electrónicas: LILACS (BIREME), Embase, MEDLINE (PubMed), Web of Science (Web of Knowledge), Scopus y SPORTDiscus. Esta revisión incluyó estudios transversales con adolescentes de 10 a 19 años que analizaron la asociación entre la aptitud aeróbica (con diferentes métodos de evaluación) y los indicadores antropométricos de la adiposidad corporal (utilizando la antropometría como método).

Resultados:

Se seleccionaron 23 estudios. El metanálisis indicó que a medida que aumentaban los niveles de aptitud aeróbica, el IMC, la circunferencia de la cintura y el porcentaje de grasa corporal de los adolescentes disminuían.

Conclusión:

Existe una asociación negativa entre la aptitud aeróbica (evaluada por el test Shuttle Run 20 metros mediante el consumo máximo de oxígeno) y el porcentaje de grasa, IMC y circunferencia de cintura de los adolescentes y una asociación negativa entre la aptitud aeróbica evaluada por el test Shuttle Run 20 metros según el número de vueltas y el porcentaje de grasa corporal. Sin embargo, se requiere precaución al interpretar los datos debido a la heterogeneidad de los estudios analizados. Nivel de evidencia II; Revisión sistemática de estudios de nivel II

Descriptores:
Antropometría; Aptitud; Salud; Aptitud física

RESUMO

Introdução:

Os baixos níveis de aptidão aeróbica estão associados ao excesso de adiposidade corporal em adolescentes. Porém, os estudos que analisaram essa associação em adolescentes, utilizaram diferentes métodos e medidas para avaliar a aptidão aeróbica, o que dificulta a comparação dos resultados.

Objetivos:

Realizar uma revisão sistemática com metanálise de estudos que analisaram a associação entre aptidão aeróbica e indicadores antropométricos de adiposidade corporal em adolescentes de 10 a 19 anos.

Métodos:

Realizou-se busca sistemática em maio de 2016, atualizada em março de 2017, nas seguintes bases de dados eletrônicas: LILACS (BIREME), Embase, MEDLINE (PubMed), Web of Science (Web of Knowledge), Scopus e SPORTDiscus.

Resultados:

Foram selecionados 23 estudos. A metanálise indicou que à medida que aumentavam os níveis de aptidão aeróbica, diminuíam os valores de IMC, do perímetro da cintura e do percentual de gordura corporal dos adolescentes.

Conclusões:

Existe uma associação negativa entre aptidão aeróbica (avaliada pela medida da captação de oxigênio no teste de corrida de vaivém de 20 metros [20m Shuttle Run]) e percentual de gordura, IMC e perímetro da cintura dos adolescentes e associação negativa entre aptidão aeróbica (avaliada pela contagem de voltas no teste de vai e vem de 20 metros) e percentual de gordura corporal. Contudo, é necessária cautela na interpretação dos dados devido à heterogeneidade dos estudos analisados. Nível de evidência II; Revisão sistemática de Estudos de Nível II

Descritores:
Antropometria; Aptidão; Saúde; Aptidão física

INTRODUCTION

Adequate aerobic fitness levels are important health marker in children and adolescents and are strongly associated with the prevention of diseases.11 Moreira C, Santos R, de Farias Júnior JC, Vale S, Santos PC, Soares-Miranda L, et al. Metabolic risk factors, physical activity and physical fitness in azorean adolescents: a cross-sectional study. BMC Public Health. 2011;11:214.,22 American College of Sports Medicine. In ACSM’s Guidelines for Exercise Testing and Prescription. 9nd ed. Philadelphia: Lippincott Williams & Wilkins; 2014. On the other hand, the low aerobic fitness levels are associated with metabolic syndrome and increase of cardiovascular risk factors that can manifest even in adolescence.11 Moreira C, Santos R, de Farias Júnior JC, Vale S, Santos PC, Soares-Miranda L, et al. Metabolic risk factors, physical activity and physical fitness in azorean adolescents: a cross-sectional study. BMC Public Health. 2011;11:214.

Recent estimates indicate that more than three million Brazilian students aged 13-17 years are overweight.33 Pesquisa Nacional de Saúde do Escolar: 2015/IBGE, Coordenação de População e Indicadores Sociais. Rio de Janeiro: IBGE; 2016. The world projection for 2025 is that approximately 75 million children and adolescents are overweight and obese.44 Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica (ABESO). Mapa da Obesidade [Accessed in: 20 may 2017]. Available in: http://www.abeso.org.br/atitude-saudavel/mapa-obesidade.
http://www.abeso.org.br/atitude-saudavel...
In Latin America, approximately 21 million adolescents (between 2008 and 2013) and one-third of adolescents in the United States (in 2003 and 2004) presented body fat above normal levels.55 Rivera JA, de Cossío TG, Pedraza LS, Aburto TC, Sánchez TG, Martorell R. Childhood and adolescent overweight and obesity in Latin America: a systematic review. Lancet Diabetes Endocrinol. 2014;2(4):321-32. These data are worrisome because excess weight is a risk factor for cardiovascular and pulmonary diseases, diabetes mellitus, biliary disorders and some cancers,66 World Health Organization. Global Status Report on noncommunicable diseases. 2014 [Accessed in: 20 may 2017]. Available in: http://www.who.int/nmh/publications/ncd-status-report-2014/en/.
http://www.who.int/nmh/publications/ncd-...
increasing the chances of premature mortality.11 Moreira C, Santos R, de Farias Júnior JC, Vale S, Santos PC, Soares-Miranda L, et al. Metabolic risk factors, physical activity and physical fitness in azorean adolescents: a cross-sectional study. BMC Public Health. 2011;11:214.

One of the ways to identify excess weight is through anthropometry.77 American College of Sports Medicine. In ACSM’s Health-Related Physical Fitness Assessment Manual. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2008. Widely used in epidemiological research, anthropometry is considered easy to apply, to have low cost and good validity indexes when compared to more precise methods.77 American College of Sports Medicine. In ACSM’s Health-Related Physical Fitness Assessment Manual. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2008. For being non-invasive methods that systematically measure body size and dimensions, anthropometric indicators are well accepted and widely used in population research, helping to detect changes in body pattern, health conditions, performance and functional capacity.88 Barbosa L, Chaves OC, Ribeiro RCL. Anthropometric and body composition parameters to predict body fat percentage and lipid profile in schoolchildren. Rev Paul Pediatr. 2012;30(4):520-8.

The fact that aerobic fitness levels in adolescents are gradually decreasing99 Silva DAS, Petroski EL, Gaya ACA. Secular changes in aerobic fitness levels in Brazilian children. Rev Bras Med Esporte. 2017;23(6):450-4. is even more worrying when associated with excess body adiposity. Studies have identified that one of the possible explanations for the various cardiovascular changes and the onset of chronic diseases in overweight individuals may be related to low aerobic fitness levels.11 Moreira C, Santos R, de Farias Júnior JC, Vale S, Santos PC, Soares-Miranda L, et al. Metabolic risk factors, physical activity and physical fitness in azorean adolescents: a cross-sectional study. BMC Public Health. 2011;11:214.,22 American College of Sports Medicine. In ACSM’s Guidelines for Exercise Testing and Prescription. 9nd ed. Philadelphia: Lippincott Williams & Wilkins; 2014. These data seem to be independent of the anthropometric index used,1010 Ronque ERV, Cyrino ES, Mortatti AL, Moreira A, Avelar A, Carvalho FO, et al. Relationship between cardiorespiratory fitness and indicators of body adiposity in adolescents. Rev Paul Pediatr. 2010;28(3):296-302. since adequate aerobic fitness levels are associated with greater amount of fat-free mass. Thus, early body fat discrimination is an alternative to identify high fat concentration and to identify groups considered to be at health risk.1111 Ruiz JR, Rizzo NS, Hurtig-Wennlöf A, Ortega FB, Wärnberg J, Sjöström M. Relations of total physical activity and intensity to fitness and fatness in children: The European Youth Heart Study. Am J Clin Nutr. 2006;84(2):299-303.

Many studies have analyzed the relationship between aerobic fitness and anthropometric indicators in the young population and in general found a negative association among variables.1010 Ronque ERV, Cyrino ES, Mortatti AL, Moreira A, Avelar A, Carvalho FO, et al. Relationship between cardiorespiratory fitness and indicators of body adiposity in adolescents. Rev Paul Pediatr. 2010;28(3):296-302.,1212 Arango CM, Parra DC, Gómez LF, Lema L, Lobelo F, Ekelund U. Screen time, cardiorespiratory fitness and adiposity among school-age children from Monteria, Colombia. J Sci Med Sport. 2014;17(5):491-5.2323 Lang JJ, Belanger K, Poitras V, Janssenc I, Tomkinson GR, Tremblay MS. Systematic review of the relationship between 20 m shuttle runperformance and health indicators among children and youth. J Sci Med Sport. 2017;S1440-2440(17):30990-8. However, studies have used different methods and measures to evaluate aerobic fitness, such as direct and indirect tests and presented the results as absolute VO2max, relative VO2max and VO2peak.2020 Minasian V, Marandi SM, Kelishadi R, Abolhassani H. Correlation between Aerobic Fitness and Body Composition in Middle School Students. Int J Prev Med. 2014;5(Suppl 2):102-7.2222 Silva DAS, Teixeira DM, de Oliveira G, Petroski EL, de Farias JM. Aerobic fitness in adolescents in southern Brazil: Association with sociodemographic aspects, lifestyle and nutritional status. Rev Andal Med Deporte. 2016;9(1):17–22. This fact implies in the comparison of the results found by studies, because in indirect methods, for example, mathematical formulas are used to predict VO2max22 American College of Sports Medicine. In ACSM’s Guidelines for Exercise Testing and Prescription. 9nd ed. Philadelphia: Lippincott Williams & Wilkins; 2014.. In addition, studies that investigated the relationship between aerobic fitness and anthropometric indicators in the same sample have made use of four1313 Awotidebe A, Monyeki MA, Moss SJ, Strydom GL, Amstrong M, Kemper HCG. Relationship of adiposity and cardiorespiratory fitness with resting blood pressure of South African adolescents: the PAHL Study. J Hum Hypertens. 2015;30(4):245-51., or at most three indicators,1010 Ronque ERV, Cyrino ES, Mortatti AL, Moreira A, Avelar A, Carvalho FO, et al. Relationship between cardiorespiratory fitness and indicators of body adiposity in adolescents. Rev Paul Pediatr. 2010;28(3):296-302.,1515 Coelho-e-Silva MJ, Vaz Ronque ER, Cyrino ES, Fernandes RA, Valente-dos-Santos J, Machado-Rodrigues A, et al. Nutritional status, biological maturation and cardiorespiratory fitness in Azorean youth aged 11–15 years. BMC Public Health. 2013;22(13):495.1818 Jiménez-Pavón D, Castillo MJ, Moreno LA, Kafatos A, Manios Y, Kondaki K, et al. Fitness and fatness are independently associated with markers of insulin resistance in European adolescents; The HELENA Study. Int J Pediatr Obes. 2011;6(3-4):253-60.,2424 Andreasi V, Michelin E, Rinaldi AE, Burini RC. Physical fitness and associations with anthropometric measurements in 7 to 15-year-old school children. J Pediatr (Rio J). 2010;86(6):497-502.2727 Sveinsson T, Arngrimsson AS, Johannsson E. Association between aerobic fitness, body composition, and physical activity in 9- and 15-year-olds. Eur J Sport Sci. 2009;9(3):141-50. which limits the identification of magnitude of association between body fat distributed in different body parts and aerobic fitness. Thus, investigating the degree of association between fat distributed in different body regions and aerobic fitness may help in identifying fat sites that are more sensitive to modifications with improved aerobic fitness.

This study aimed to perform a systematic review with meta-analysis including studies that have analyzed the association between aerobic fitness and anthropometric body adiposity indicators in adolescents aged 10-19 years.

METODOD

The method used in the systematic review and meta-analysis were consistent with the norms of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).2828 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10)1006-12.

In this systematic review with meta-analysis, there was no physical test restriction to measure aerobic fitness, since the use of a specific test may exclude important results of this outcome. In addition, the applicability of different tests is very common in aerobic fitness studies. It is understood that this fact allows obtaining mixed results; therefore, it was tested whether the different measures of aerobic fitness would result in different findings on the association between aerobic fitness and anthropometric body adiposity indicators. The aerobic fitness indicators included in this systematic review were: maximal oxygen uptake (VO2max), absolute VO2max (l.min−1), relative VO2max (ml.kg−1.min−1), peak oxygen uptake (VO2peak), number of laps in the 20-m Shuttle Run test, aerobic fitness score and aerobic power (W.kg−1 or Kg.m.min).

The systematic search was performed in the following electronic databases: LILACS (BIREME), Embase, MEDLINE (PubMed), Web of Science (Web of Knowledge), Scopus and SPORTDiscus. The search was initially performed in May 2016 and updated in March 2017. Studies that analyzed the association between aerobic fitness and anthropometric body adiposity indicators until the date of the search were included. The year of publication of articles was disregarded in order to cover as many studies as possible. Boolean operators AND and OR, parentheses, quotation marks and asterisks were used in each database. Parentheses were used to combine search terms by outcome, exposure and population categories. Quotation marks were used to search for exact terms or expressions. Asterisk was used to search for all words derived from the same prefix. Descriptors came from DEC’s (Health Sciences Descriptors), MESH (Medical Subject Headings) and words related to the subject.

The research groups were: Outcome (aerobic fitness) (“Aptitude” OR “Aptitude Tests” OR “Physical Fitness” OR “Physical fitness” OR “aerobic capacity” OR “aerobic fitness” OR “cardiorespiratory capacity” OR “Cardiovascular fitness” OR “cardiorespiratory fitness” OR “aerobic power” OR “aerobic endurance” OR “cardiorespiratory endurance” OR “oxygen consumption” OR “maximum oxygen consumption” OR “maximal oxygen uptake” OR “VO2 maximal” AND Exposure (anthropometric indicators) “fats” OR “fat body” OR “body mass index” OR “BMI” OR “obesity” OR “adiposity” OR “body size” OR “excess weight” OR “overweight” OR “body composition” OR “Body fat distribution” OR “Anthropometry” OR “Anthropometric indicators” OR “skinfolds” OR “waist” OR “central obesity” OR “abdominal obesity” OR “waist to height ratio” OR “Conicity index” OR “circumference” OR “Body Weight” OR” “Body Height” AND Population (adolescents) “adolescent” OR “adolescence” OR “student” OR “youth” OR “teen” OR “teenager”.

We used only one descriptor for skinfold and circumference in order to broaden the search, considering that all titles indexed with these keywords would be identified, regardless of the type of skinfold or circumference used in the survey.

Searches were conducted in the online databases with descriptors in English language and the results were exported to EndNote® reference manager software version X7 (Thomson Reuters, New York, USA).

The entire process of selection and evaluation of articles was analyzed by two reviewers using a systematic method. First, the titles of articles were read. The abstracts were then analyzed according to the inclusion criteria. After reviewing abstracts, the full text of articles was obtained, read and included if they met the inclusion criteria. In case of disagreement among reviewers about the inclusion and exclusion criteria, a third reviewer was asked to evaluate the article, reaching final consensus.

The selection criteria of studies were: (a) being original research article; (b) including adolescents aged 10-19 years;2929 WHO. World Health Organization. The challenge of obesity in the WHO European Region and the strategies for response: summary. Denmark, 2007. (c) having cross-sectional design; (d) having sample of 50 or more adolescents, in order to guarantee statistical power;3030 Vagetti GC, Barbosa Filho VC, Moreira NB, Oliveira VD, Mazzardo O, Campos WD. Association between physical activity and quality of life in the elderly: a systematic review, 2000-2012. Rev Bras Psiquiatr. 2014;36(1):76-88. (e) including at least two anthropometric body adiposity indicators in order to compare which anthropometric indicator had greater magnitude of association with aerobic fitness; (f) studies that used only anthropometry to measure anthropometric indicators.

Monographs, dissertations, theses, abstracts, chapters or books and point of view / opinion of experts were not included in the review, as well as studies including adolescents with some type of disease and / or mental and / or physical problem (anemia, cognitive problems, diabetes, depression, asthma, bronchitis, metabolic syndrome, physical disability), or adolescents from specific groups (athletes and obese individuals); articles without full access (after searching databases and contacting authors by e-mail); articles published in a language other than English, Spanish or Portuguese (no articles were found in Spanish, Portuguese and English only); studies that presented only descriptive statistics of data to identify differences between aerobic fitness and anthropometric body adiposity indicators; studies that have analyzed body composition using techniques other than anthropometric indicators (X-ray absorptiometry (DXA), Plestimography or Bioimpedance).

Two reviewers independently assessed the methodological quality of studies using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.3131 National Heart Lung and Blood Institute. Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies - NHLBI, NIH. National Institutes of Health. 2014 [Accessed in: 15 nov 2015]. Available in: https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort.
https://www.nhlbi.nih.gov/health-pro/gui...
This instrument of methodological analysis is indicated to help the internal validity (potential risk of selection, information or confusion) of cross-sectional studies and cohorts. In the case of disagreements between the two reviewers, a third reviewer analyzed the criteria in question for consensus between them. Score from 13 to 14 was considered good, from nine to 12 moderate and below nine poor.3131 National Heart Lung and Blood Institute. Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies - NHLBI, NIH. National Institutes of Health. 2014 [Accessed in: 15 nov 2015]. Available in: https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort.
https://www.nhlbi.nih.gov/health-pro/gui...
,3232 Xia Q, Fan D, Yang X, Li X, Zhang X, Wang M, et al. Progression rate of ankylosing spondylitis in patients with undifferentiated spondyloarthritis: A systematic review and meta-analysis. Medicine (Baltimore). 2017;96(4): e5960.

All statistical analyses were performed with the use of Data Analysis and Statistical Software – STATA®, version 13.0 (StataCorp, Texas, USA). The combined correlation coefficients between anthropometric parameters and aerobic fitness were calculated according to the correlation coefficient values r provided in each article. To reduce the possibility of bias due to different tests and measurements used to assess aerobic fitness, we conducted separate meta-analyzes for each type of test and measurement used. Correlation coefficients were converted by the Fisher’s r-to-z transformation to obtain approximately normally distributed z-values to further calculate the 95% CI. Then, combined correlation coefficients and respective 95% CI were converted back to correlation units using the method described by Borenstein et al..3333 Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to Meta-Analysis. 1ed. United Kingdom: John Wiley & Sons; 2009. Heterogeneity was considered significant when p < 0.1 on the chi-square test or I² > 50%. Sensitivity analysis was performed to assess the influence of each study on the pooled correlation coefficient by omitting each study individually. Publication bias analysis and meta-regression models were not assessed because the minimum number of studies for the implementation of this test in each analysis (≥10) was not achieved.3434 Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. 5.1.0 In: The Cochrane Collaboration; 2011 [Accessed in 15 may 2016]. Available in: http://handbook.cochrane.org.
http://handbook.cochrane.org...

We adopted the p value < 0.05 for statistical significance and the respective cut-off points of the combined correlation coefficients to indicate the strength of association: r ≤ 0.20 - poor correlation; 0.20≤ r ≤0.40 - average correlation; 0.40≤ r ≤0.60 moderate correlation; 0.60≤ r ≤0.80 - substantial correlation; and r ≥ 0.81 - strong correlation.3535 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.

RESULTS

The initial literature search carried out on May 2016 identified a total of 32,159 publications in databases. In the search update on March 2017, 4,075 other articles were found. After the removal of duplicate studies and the reading of titles and abstracts, 178 studies were read in their entirety. At the end of the search, 23 articles were included in the systematic review (all articles belonging to the search of year 2016)1010 Ronque ERV, Cyrino ES, Mortatti AL, Moreira A, Avelar A, Carvalho FO, et al. Relationship between cardiorespiratory fitness and indicators of body adiposity in adolescents. Rev Paul Pediatr. 2010;28(3):296-302.,1212 Arango CM, Parra DC, Gómez LF, Lema L, Lobelo F, Ekelund U. Screen time, cardiorespiratory fitness and adiposity among school-age children from Monteria, Colombia. J Sci Med Sport. 2014;17(5):491-5.2222 Silva DAS, Teixeira DM, de Oliveira G, Petroski EL, de Farias JM. Aerobic fitness in adolescents in southern Brazil: Association with sociodemographic aspects, lifestyle and nutritional status. Rev Andal Med Deporte. 2016;9(1):17–22.,2424 Andreasi V, Michelin E, Rinaldi AE, Burini RC. Physical fitness and associations with anthropometric measurements in 7 to 15-year-old school children. J Pediatr (Rio J). 2010;86(6):497-502.2727 Sveinsson T, Arngrimsson AS, Johannsson E. Association between aerobic fitness, body composition, and physical activity in 9- and 15-year-olds. Eur J Sport Sci. 2009;9(3):141-50.,3636 Bim RH, Nardo Junior N. Aptidão física relacionada à saúde de adolescentes estagiários da Universidade Estadual de Maringá. Acta Sci Health Sci. 2005;27(1):77-85.4242 Cureton KJ, Boileau RA, Lohman TG, Kiisner JE. Determinants of Distance Running Performance in Children: Analysis of a Path Model. Res Q. 1977;48(2):270-9.,. No search article of year 2017 was included. Of the 23 studies included in the systematic review,4343 Gonçalves ECA, Fernandes R, Alves Júnior CAS, Silva DAS, Trindade, EBSM. Tables/Figures of the article “Oxygen uptake and obesity indicators: meta-analysis including 17.604 adolescents”. 15 june 2021.OSFHOME. https://osf.io/wp5xc/
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only 10 had sufficient data for the meta-analysis. The selection process of studies is presented in Figure 1.

Figure 1
Flowchart of selection of the association studies between aerobic fitness and anthropometric indicators of body adiposity in adolescentes.

Data availability

Every data set that supports the results of this study was provided to the OSFHOME repository and can be accessed at https://osf.io/wp5xc/4343 Gonçalves ECA, Fernandes R, Alves Júnior CAS, Silva DAS, Trindade, EBSM. Tables/Figures of the article “Oxygen uptake and obesity indicators: meta-analysis including 17.604 adolescents”. 15 june 2021.OSFHOME. https://osf.io/wp5xc/
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The methodological quality of most studies (n = 14), was evaluated as poor.1010 Ronque ERV, Cyrino ES, Mortatti AL, Moreira A, Avelar A, Carvalho FO, et al. Relationship between cardiorespiratory fitness and indicators of body adiposity in adolescents. Rev Paul Pediatr. 2010;28(3):296-302.,1212 Arango CM, Parra DC, Gómez LF, Lema L, Lobelo F, Ekelund U. Screen time, cardiorespiratory fitness and adiposity among school-age children from Monteria, Colombia. J Sci Med Sport. 2014;17(5):491-5.1414 Buchan DS, Young JD, Boddy LM, Baker JS. Independent Associations Between Cardiorespiratory Fitness, Waist Circumference, BMI, and Clustered Cardiometabolic Risk in Adolescents. Am J Hum Biol. 2014;26(1):29–35.,1616 de Arruda GA, Fernandes RA, Christófaro DGD, de Oliveira AR. Relationship between chronological age, adiposity and health-related physical fitness on boys and girls. Rev Andal Med Deporte. 2013;6(1):24-9.,1717 Galavíz KI, Tremblay MS, Colley R, Jáuregui E, López y Taylor J, Janssen I. Associations between physical activity, cardiorespiratory fitness, and obesity in Mexican children. Salud Publica de Mex. 2012;54(5):463-9.,2020 Minasian V, Marandi SM, Kelishadi R, Abolhassani H. Correlation between Aerobic Fitness and Body Composition in Middle School Students. Int J Prev Med. 2014;5(Suppl 2):102-7.,2424 Andreasi V, Michelin E, Rinaldi AE, Burini RC. Physical fitness and associations with anthropometric measurements in 7 to 15-year-old school children. J Pediatr (Rio J). 2010;86(6):497-502.,2525 Lloyd LK, Bishop PA, Walker JL, Sharp KR, Richardson MT. The Influence of Body Size and Composition on FITNESSGRAM(r) Test Performance and the Adjustment of FITNESSGRAM(r) Test Scores for Skinfold Thickness in Youth. Meas in Phys Educ and Exerc Sci. 2003;7(4):205-26.,3636 Bim RH, Nardo Junior N. Aptidão física relacionada à saúde de adolescentes estagiários da Universidade Estadual de Maringá. Acta Sci Health Sci. 2005;27(1):77-85.,3939 Klasson-Heggebø L, Andersen LB, Wennlof AH, Sardinha LB, Harro M, Froberg K, et al. Graded associations between cardiorespiratory fitness, fatness, and blood pressure in children and adolescents. Br J Sports Med. 2006;40(1):25–9.4242 Cureton KJ, Boileau RA, Lohman TG, Kiisner JE. Determinants of Distance Running Performance in Children: Analysis of a Path Model. Res Q. 1977;48(2):270-9. All other studies (n = 9)1515 Coelho-e-Silva MJ, Vaz Ronque ER, Cyrino ES, Fernandes RA, Valente-dos-Santos J, Machado-Rodrigues A, et al. Nutritional status, biological maturation and cardiorespiratory fitness in Azorean youth aged 11–15 years. BMC Public Health. 2013;22(13):495.,1818 Jiménez-Pavón D, Castillo MJ, Moreno LA, Kafatos A, Manios Y, Kondaki K, et al. Fitness and fatness are independently associated with markers of insulin resistance in European adolescents; The HELENA Study. Int J Pediatr Obes. 2011;6(3-4):253-60.,1919 Ribeiro RR, Santos KD, Carvalho WRG, Gonçalves EM, Roman EP, Minatto G. Aerobic fitness and biological and sociodemographic indicators in female school children. Rev Bras Cineantropom Desempenho Hum. 2013;15(4):448-57.,2121 Silva DAS, Tremblay MS, Pelegrini A, de Lima Silva JMF, Petroski EL. Low aerobic fitness in Brazilian adolescents. Rev Bras Med Esporte. 2015;21(2):94-8., 2222 Silva DAS, Teixeira DM, de Oliveira G, Petroski EL, de Farias JM. Aerobic fitness in adolescents in southern Brazil: Association with sociodemographic aspects, lifestyle and nutritional status. Rev Andal Med Deporte. 2016;9(1):17–22., 2626 Martins CL, Andersen LB, Aires LM, Ribeiro JC, Mota JA. Association between Fitness, Different Indicators of Fatness, and Clustered Cardiovascular Diseases Risk Factors in Portuguese Children and Adolescents. Open Sports Sci. 2010;3:149-54., 2727 Sveinsson T, Arngrimsson AS, Johannsson E. Association between aerobic fitness, body composition, and physical activity in 9- and 15-year-olds. Eur J Sport Sci. 2009;9(3):141-50., 3737 España-Romero V, Ortega FB, Ruiz JR, Artero EG, Martínez-Gómez D, Vicente-Rodriguez G, et al. Role of Cardiorespiratory Fitness on the Association Between Physical Activity and Abdominal Fat Content in Adolescents: The HELENA Study. Int J Sports Med. 2010;31(10):679– 82., 3838 Lohman TG, Ring K, Pfeiffer K, Camhi S, Arredondo E, Pratt C, et al. Relationships among Fitness, Body Composition, and Physical Activity. Med Sci Sports Exerc. 2008;40(6):1163–70. obtained moderate methodological quality. No study presented high methodological quality.

A total of 13 studies opted for the 20-meter Shuttle Run test to measure aerobic fitness.1010 Ronque ERV, Cyrino ES, Mortatti AL, Moreira A, Avelar A, Carvalho FO, et al. Relationship between cardiorespiratory fitness and indicators of body adiposity in adolescents. Rev Paul Pediatr. 2010;28(3):296-302.,1212 Arango CM, Parra DC, Gómez LF, Lema L, Lobelo F, Ekelund U. Screen time, cardiorespiratory fitness and adiposity among school-age children from Monteria, Colombia. J Sci Med Sport. 2014;17(5):491-5.1515 Coelho-e-Silva MJ, Vaz Ronque ER, Cyrino ES, Fernandes RA, Valente-dos-Santos J, Machado-Rodrigues A, et al. Nutritional status, biological maturation and cardiorespiratory fitness in Azorean youth aged 11–15 years. BMC Public Health. 2013;22(13):495.,1717 Galavíz KI, Tremblay MS, Colley R, Jáuregui E, López y Taylor J, Janssen I. Associations between physical activity, cardiorespiratory fitness, and obesity in Mexican children. Salud Publica de Mex. 2012;54(5):463-9.2020 Minasian V, Marandi SM, Kelishadi R, Abolhassani H. Correlation between Aerobic Fitness and Body Composition in Middle School Students. Int J Prev Med. 2014;5(Suppl 2):102-7.,2525 Lloyd LK, Bishop PA, Walker JL, Sharp KR, Richardson MT. The Influence of Body Size and Composition on FITNESSGRAM(r) Test Performance and the Adjustment of FITNESSGRAM(r) Test Scores for Skinfold Thickness in Youth. Meas in Phys Educ and Exerc Sci. 2003;7(4):205-26.,2626 Martins CL, Andersen LB, Aires LM, Ribeiro JC, Mota JA. Association between Fitness, Different Indicators of Fatness, and Clustered Cardiovascular Diseases Risk Factors in Portuguese Children and Adolescents. Open Sports Sci. 2010;3:149-54.,3636 Bim RH, Nardo Junior N. Aptidão física relacionada à saúde de adolescentes estagiários da Universidade Estadual de Maringá. Acta Sci Health Sci. 2005;27(1):77-85.,3737 España-Romero V, Ortega FB, Ruiz JR, Artero EG, Martínez-Gómez D, Vicente-Rodriguez G, et al. Role of Cardiorespiratory Fitness on the Association Between Physical Activity and Abdominal Fat Content in Adolescents: The HELENA Study. Int J Sports Med. 2010;31(10):679– 82. Maximal and submaximal exertion tests in cycle ergometer,2727 Sveinsson T, Arngrimsson AS, Johannsson E. Association between aerobic fitness, body composition, and physical activity in 9- and 15-year-olds. Eur J Sport Sci. 2009;9(3):141-50.,3838 Lohman TG, Ring K, Pfeiffer K, Camhi S, Arredondo E, Pratt C, et al. Relationships among Fitness, Body Composition, and Physical Activity. Med Sci Sports Exerc. 2008;40(6):1163–70.,3939 Klasson-Heggebø L, Andersen LB, Wennlof AH, Sardinha LB, Harro M, Froberg K, et al. Graded associations between cardiorespiratory fitness, fatness, and blood pressure in children and adolescents. Br J Sports Med. 2006;40(1):25–9.,4141 Docherty D, Gaul CA. Relationship of Body Size, Physique, and Composition to Physical Performance in Young Boys and Girls. Int J Sports Med. 1991;12(6):525-32. treadmill progressive test,4040 Leite N, Milano GE, Cieslak F, Stefanello JMF, Radominski RB. Aptidão cardiorrespiratória, perfil lipídico e metabólico em adolescentes obesos e não-obesos. Rev Bras Educ Fis Esporte. 2009;23(3):275-82.,4242 Cureton KJ, Boileau RA, Lohman TG, Kiisner JE. Determinants of Distance Running Performance in Children: Analysis of a Path Model. Res Q. 1977;48(2):270-9. 9 minute walk / run test,1616 de Arruda GA, Fernandes RA, Christófaro DGD, de Oliveira AR. Relationship between chronological age, adiposity and health-related physical fitness on boys and girls. Rev Andal Med Deporte. 2013;6(1):24-9.,2222 Silva DAS, Teixeira DM, de Oliveira G, Petroski EL, de Farias JM. Aerobic fitness in adolescents in southern Brazil: Association with sociodemographic aspects, lifestyle and nutritional status. Rev Andal Med Deporte. 2016;9(1):17–22.,2424 Andreasi V, Michelin E, Rinaldi AE, Burini RC. Physical fitness and associations with anthropometric measurements in 7 to 15-year-old school children. J Pediatr (Rio J). 2010;86(6):497-502. 12-minute walk / run1616 de Arruda GA, Fernandes RA, Christófaro DGD, de Oliveira AR. Relationship between chronological age, adiposity and health-related physical fitness on boys and girls. Rev Andal Med Deporte. 2013;6(1):24-9. and the step-mCAFT test2121 Silva DAS, Tremblay MS, Pelegrini A, de Lima Silva JMF, Petroski EL. Low aerobic fitness in Brazilian adolescents. Rev Bras Med Esporte. 2015;21(2):94-8. were also used.

The most used outcome indicator was the relative VO2max (ml.kg−1.min−1).1010 Ronque ERV, Cyrino ES, Mortatti AL, Moreira A, Avelar A, Carvalho FO, et al. Relationship between cardiorespiratory fitness and indicators of body adiposity in adolescents. Rev Paul Pediatr. 2010;28(3):296-302.,1212 Arango CM, Parra DC, Gómez LF, Lema L, Lobelo F, Ekelund U. Screen time, cardiorespiratory fitness and adiposity among school-age children from Monteria, Colombia. J Sci Med Sport. 2014;17(5):491-5.,1313 Awotidebe A, Monyeki MA, Moss SJ, Strydom GL, Amstrong M, Kemper HCG. Relationship of adiposity and cardiorespiratory fitness with resting blood pressure of South African adolescents: the PAHL Study. J Hum Hypertens. 2015;30(4):245-51.,1717 Galavíz KI, Tremblay MS, Colley R, Jáuregui E, López y Taylor J, Janssen I. Associations between physical activity, cardiorespiratory fitness, and obesity in Mexican children. Salud Publica de Mex. 2012;54(5):463-9.,1818 Jiménez-Pavón D, Castillo MJ, Moreno LA, Kafatos A, Manios Y, Kondaki K, et al. Fitness and fatness are independently associated with markers of insulin resistance in European adolescents; The HELENA Study. Int J Pediatr Obes. 2011;6(3-4):253-60.,2020 Minasian V, Marandi SM, Kelishadi R, Abolhassani H. Correlation between Aerobic Fitness and Body Composition in Middle School Students. Int J Prev Med. 2014;5(Suppl 2):102-7.,2121 Silva DAS, Tremblay MS, Pelegrini A, de Lima Silva JMF, Petroski EL. Low aerobic fitness in Brazilian adolescents. Rev Bras Med Esporte. 2015;21(2):94-8.,3636 Bim RH, Nardo Junior N. Aptidão física relacionada à saúde de adolescentes estagiários da Universidade Estadual de Maringá. Acta Sci Health Sci. 2005;27(1):77-85.,3737 España-Romero V, Ortega FB, Ruiz JR, Artero EG, Martínez-Gómez D, Vicente-Rodriguez G, et al. Role of Cardiorespiratory Fitness on the Association Between Physical Activity and Abdominal Fat Content in Adolescents: The HELENA Study. Int J Sports Med. 2010;31(10):679– 82.,4040 Leite N, Milano GE, Cieslak F, Stefanello JMF, Radominski RB. Aptidão cardiorrespiratória, perfil lipídico e metabólico em adolescentes obesos e não-obesos. Rev Bras Educ Fis Esporte. 2009;23(3):275-82.,4242 Cureton KJ, Boileau RA, Lohman TG, Kiisner JE. Determinants of Distance Running Performance in Children: Analysis of a Path Model. Res Q. 1977;48(2):270-9. The absolute VO2max (l.kg−1.min-1) was estimated in two studies4141 Docherty D, Gaul CA. Relationship of Body Size, Physique, and Composition to Physical Performance in Young Boys and Girls. Int J Sports Med. 1991;12(6):525-32.,4242 Cureton KJ, Boileau RA, Lohman TG, Kiisner JE. Determinants of Distance Running Performance in Children: Analysis of a Path Model. Res Q. 1977;48(2):270-9. and the VO2peak (relative and absolute) in one study.1919 Ribeiro RR, Santos KD, Carvalho WRG, Gonçalves EM, Roman EP, Minatto G. Aerobic fitness and biological and sociodemographic indicators in female school children. Rev Bras Cineantropom Desempenho Hum. 2013;15(4):448-57. The distance in meters was evaluated in three studies.1616 de Arruda GA, Fernandes RA, Christófaro DGD, de Oliveira AR. Relationship between chronological age, adiposity and health-related physical fitness on boys and girls. Rev Andal Med Deporte. 2013;6(1):24-9.,2222 Silva DAS, Teixeira DM, de Oliveira G, Petroski EL, de Farias JM. Aerobic fitness in adolescents in southern Brazil: Association with sociodemographic aspects, lifestyle and nutritional status. Rev Andal Med Deporte. 2016;9(1):17–22.,2424 Andreasi V, Michelin E, Rinaldi AE, Burini RC. Physical fitness and associations with anthropometric measurements in 7 to 15-year-old school children. J Pediatr (Rio J). 2010;86(6):497-502. A total of five studies used the number of laps in a given test1010 Ronque ERV, Cyrino ES, Mortatti AL, Moreira A, Avelar A, Carvalho FO, et al. Relationship between cardiorespiratory fitness and indicators of body adiposity in adolescents. Rev Paul Pediatr. 2010;28(3):296-302.,1414 Buchan DS, Young JD, Boddy LM, Baker JS. Independent Associations Between Cardiorespiratory Fitness, Waist Circumference, BMI, and Clustered Cardiometabolic Risk in Adolescents. Am J Hum Biol. 2014;26(1):29–35.,1515 Coelho-e-Silva MJ, Vaz Ronque ER, Cyrino ES, Fernandes RA, Valente-dos-Santos J, Machado-Rodrigues A, et al. Nutritional status, biological maturation and cardiorespiratory fitness in Azorean youth aged 11–15 years. BMC Public Health. 2013;22(13):495.,2525 Lloyd LK, Bishop PA, Walker JL, Sharp KR, Richardson MT. The Influence of Body Size and Composition on FITNESSGRAM(r) Test Performance and the Adjustment of FITNESSGRAM(r) Test Scores for Skinfold Thickness in Youth. Meas in Phys Educ and Exerc Sci. 2003;7(4):205-26.,2626 Martins CL, Andersen LB, Aires LM, Ribeiro JC, Mota JA. Association between Fitness, Different Indicators of Fatness, and Clustered Cardiovascular Diseases Risk Factors in Portuguese Children and Adolescents. Open Sports Sci. 2010;3:149-54. and three studies used power as indicator.2727 Sveinsson T, Arngrimsson AS, Johannsson E. Association between aerobic fitness, body composition, and physical activity in 9- and 15-year-olds. Eur J Sport Sci. 2009;9(3):141-50.,3838 Lohman TG, Ring K, Pfeiffer K, Camhi S, Arredondo E, Pratt C, et al. Relationships among Fitness, Body Composition, and Physical Activity. Med Sci Sports Exerc. 2008;40(6):1163–70.,3939 Klasson-Heggebø L, Andersen LB, Wennlof AH, Sardinha LB, Harro M, Froberg K, et al. Graded associations between cardiorespiratory fitness, fatness, and blood pressure in children and adolescents. Br J Sports Med. 2006;40(1):25–9.

A total of 18 studies investigated BMI as one of the anthropometric body adiposity indicators possibly associated with aerobic fitness.1010 Ronque ERV, Cyrino ES, Mortatti AL, Moreira A, Avelar A, Carvalho FO, et al. Relationship between cardiorespiratory fitness and indicators of body adiposity in adolescents. Rev Paul Pediatr. 2010;28(3):296-302.,1212 Arango CM, Parra DC, Gómez LF, Lema L, Lobelo F, Ekelund U. Screen time, cardiorespiratory fitness and adiposity among school-age children from Monteria, Colombia. J Sci Med Sport. 2014;17(5):491-5.1818 Jiménez-Pavón D, Castillo MJ, Moreno LA, Kafatos A, Manios Y, Kondaki K, et al. Fitness and fatness are independently associated with markers of insulin resistance in European adolescents; The HELENA Study. Int J Pediatr Obes. 2011;6(3-4):253-60.,2020 Minasian V, Marandi SM, Kelishadi R, Abolhassani H. Correlation between Aerobic Fitness and Body Composition in Middle School Students. Int J Prev Med. 2014;5(Suppl 2):102-7.2222 Silva DAS, Teixeira DM, de Oliveira G, Petroski EL, de Farias JM. Aerobic fitness in adolescents in southern Brazil: Association with sociodemographic aspects, lifestyle and nutritional status. Rev Andal Med Deporte. 2016;9(1):17–22.,2424 Andreasi V, Michelin E, Rinaldi AE, Burini RC. Physical fitness and associations with anthropometric measurements in 7 to 15-year-old school children. J Pediatr (Rio J). 2010;86(6):497-502.2727 Sveinsson T, Arngrimsson AS, Johannsson E. Association between aerobic fitness, body composition, and physical activity in 9- and 15-year-olds. Eur J Sport Sci. 2009;9(3):141-50.,3636 Bim RH, Nardo Junior N. Aptidão física relacionada à saúde de adolescentes estagiários da Universidade Estadual de Maringá. Acta Sci Health Sci. 2005;27(1):77-85.,3838 Lohman TG, Ring K, Pfeiffer K, Camhi S, Arredondo E, Pratt C, et al. Relationships among Fitness, Body Composition, and Physical Activity. Med Sci Sports Exerc. 2008;40(6):1163–70.,4040 Leite N, Milano GE, Cieslak F, Stefanello JMF, Radominski RB. Aptidão cardiorrespiratória, perfil lipídico e metabólico em adolescentes obesos e não-obesos. Rev Bras Educ Fis Esporte. 2009;23(3):275-82. Skinfolds were analyzed in 16 studies,1313 Awotidebe A, Monyeki MA, Moss SJ, Strydom GL, Amstrong M, Kemper HCG. Relationship of adiposity and cardiorespiratory fitness with resting blood pressure of South African adolescents: the PAHL Study. J Hum Hypertens. 2015;30(4):245-51.,1515 Coelho-e-Silva MJ, Vaz Ronque ER, Cyrino ES, Fernandes RA, Valente-dos-Santos J, Machado-Rodrigues A, et al. Nutritional status, biological maturation and cardiorespiratory fitness in Azorean youth aged 11–15 years. BMC Public Health. 2013;22(13):495.2222 Silva DAS, Teixeira DM, de Oliveira G, Petroski EL, de Farias JM. Aerobic fitness in adolescents in southern Brazil: Association with sociodemographic aspects, lifestyle and nutritional status. Rev Andal Med Deporte. 2016;9(1):17–22.,2424 Andreasi V, Michelin E, Rinaldi AE, Burini RC. Physical fitness and associations with anthropometric measurements in 7 to 15-year-old school children. J Pediatr (Rio J). 2010;86(6):497-502.2727 Sveinsson T, Arngrimsson AS, Johannsson E. Association between aerobic fitness, body composition, and physical activity in 9- and 15-year-olds. Eur J Sport Sci. 2009;9(3):141-50.,3636 Bim RH, Nardo Junior N. Aptidão física relacionada à saúde de adolescentes estagiários da Universidade Estadual de Maringá. Acta Sci Health Sci. 2005;27(1):77-85.,3939 Klasson-Heggebø L, Andersen LB, Wennlof AH, Sardinha LB, Harro M, Froberg K, et al. Graded associations between cardiorespiratory fitness, fatness, and blood pressure in children and adolescents. Br J Sports Med. 2006;40(1):25–9.,4141 Docherty D, Gaul CA. Relationship of Body Size, Physique, and Composition to Physical Performance in Young Boys and Girls. Int J Sports Med. 1991;12(6):525-32. and three of them1313 Awotidebe A, Monyeki MA, Moss SJ, Strydom GL, Amstrong M, Kemper HCG. Relationship of adiposity and cardiorespiratory fitness with resting blood pressure of South African adolescents: the PAHL Study. J Hum Hypertens. 2015;30(4):245-51.,1515 Coelho-e-Silva MJ, Vaz Ronque ER, Cyrino ES, Fernandes RA, Valente-dos-Santos J, Machado-Rodrigues A, et al. Nutritional status, biological maturation and cardiorespiratory fitness in Azorean youth aged 11–15 years. BMC Public Health. 2013;22(13):495.,2626 Martins CL, Andersen LB, Aires LM, Ribeiro JC, Mota JA. Association between Fitness, Different Indicators of Fatness, and Clustered Cardiovascular Diseases Risk Factors in Portuguese Children and Adolescents. Open Sports Sci. 2010;3:149-54. used the sum of the triceps and subscapular skinfolds to analyze body fat percentage by the equation of Slaughter et al.,4444 Slaughter MH, Lohman TG, Boileau RA, Horswill CA, Stillman RJ, Van Loan MD, et al. Skinfold equations for estimation of body fatness in children and youth. Hum Biol. 1988;60(5):709-23. two1010 Ronque ERV, Cyrino ES, Mortatti AL, Moreira A, Avelar A, Carvalho FO, et al. Relationship between cardiorespiratory fitness and indicators of body adiposity in adolescents. Rev Paul Pediatr. 2010;28(3):296-302., 3636 Bim RH, Nardo Junior N. Aptidão física relacionada à saúde de adolescentes estagiários da Universidade Estadual de Maringá. Acta Sci Health Sci. 2005;27(1):77-85. used the sum of the triceps and subscapular skinfolds to analyze body fat percentage using the equation of Boileau et al.;4545 Boileau RA, Lohman TG, Slaughter MH. Exercise and body composition in children and youth. Scand J Med Sci Sports. 1985;7(1):17-27. one study2424 Andreasi V, Michelin E, Rinaldi AE, Burini RC. Physical fitness and associations with anthropometric measurements in 7 to 15-year-old school children. J Pediatr (Rio J). 2010;86(6):497-502. used the sum of the triceps and subscapular skinfolds to analyze body fat percentage using the equation of Lohman;4646 Lohman TG. Applicability of body composition techniques and constants for children and youth. In: Pandolf KB. Exercise and sport sciences reviews. New York: Macmillan, 1986.,4747 Lohman TG. The use of skinfold to estimate body fatness on children and youth. Journal of Physical Education, Recreation & Dance. 1987;58(9):98-102. one study1919 Ribeiro RR, Santos KD, Carvalho WRG, Gonçalves EM, Roman EP, Minatto G. Aerobic fitness and biological and sociodemographic indicators in female school children. Rev Bras Cineantropom Desempenho Hum. 2013;15(4):448-57. used the sum of triceps and medial calf skinfolds to identify body fat percentage by means of the equation of Slaughter et al.;4444 Slaughter MH, Lohman TG, Boileau RA, Horswill CA, Stillman RJ, Van Loan MD, et al. Skinfold equations for estimation of body fatness in children and youth. Hum Biol. 1988;60(5):709-23. one study1616 de Arruda GA, Fernandes RA, Christófaro DGD, de Oliveira AR. Relationship between chronological age, adiposity and health-related physical fitness on boys and girls. Rev Andal Med Deporte. 2013;6(1):24-9. evaluated body fat percentage by the sum of triceps, subscapular and medial calf skinfolds using the equation of Slaughter et al.4444 Slaughter MH, Lohman TG, Boileau RA, Horswill CA, Stillman RJ, Van Loan MD, et al. Skinfold equations for estimation of body fatness in children and youth. Hum Biol. 1988;60(5):709-23. one study2020 Minasian V, Marandi SM, Kelishadi R, Abolhassani H. Correlation between Aerobic Fitness and Body Composition in Middle School Students. Int J Prev Med. 2014;5(Suppl 2):102-7. used these same skinfolds to include the values in the equation of Eston et al.4848 Eston R, Thomas R. Kinanthropometery and exercise phyisiology laboratory manual: TL, tests, procedures and data. 3rd ed. Abingdon, Oxon, UK: Routledge; 2009. and one study4242 Cureton KJ, Boileau RA, Lohman TG, Kiisner JE. Determinants of Distance Running Performance in Children: Analysis of a Path Model. Res Q. 1977;48(2):270-9. did not report the skinfolds used.

Another anthropometric indicator used was the sum of the skinfolds evaluated by 10 different studies. The sum of triceps and subscapular skinfold thickness was analyzed by three studies.1010 Ronque ERV, Cyrino ES, Mortatti AL, Moreira A, Avelar A, Carvalho FO, et al. Relationship between cardiorespiratory fitness and indicators of body adiposity in adolescents. Rev Paul Pediatr. 2010;28(3):296-302.,2121 Silva DAS, Tremblay MS, Pelegrini A, de Lima Silva JMF, Petroski EL. Low aerobic fitness in Brazilian adolescents. Rev Bras Med Esporte. 2015;21(2):94-8.,2222 Silva DAS, Teixeira DM, de Oliveira G, Petroski EL, de Farias JM. Aerobic fitness in adolescents in southern Brazil: Association with sociodemographic aspects, lifestyle and nutritional status. Rev Andal Med Deporte. 2016;9(1):17–22. Two studies analyzed the sum of triceps, biceps, subscapular and suprailiac skinfolds.2727 Sveinsson T, Arngrimsson AS, Johannsson E. Association between aerobic fitness, body composition, and physical activity in 9- and 15-year-olds. Eur J Sport Sci. 2009;9(3):141-50.,3939 Klasson-Heggebø L, Andersen LB, Wennlof AH, Sardinha LB, Harro M, Froberg K, et al. Graded associations between cardiorespiratory fitness, fatness, and blood pressure in children and adolescents. Br J Sports Med. 2006;40(1):25–9. One study analyzed the sum of triceps and medial calf skinfolds,2525 Lloyd LK, Bishop PA, Walker JL, Sharp KR, Richardson MT. The Influence of Body Size and Composition on FITNESSGRAM(r) Test Performance and the Adjustment of FITNESSGRAM(r) Test Scores for Skinfold Thickness in Youth. Meas in Phys Educ and Exerc Sci. 2003;7(4):205-26. one study analyzed the sum of the triceps, biceps and medial calf skinfolds,1717 Galavíz KI, Tremblay MS, Colley R, Jáuregui E, López y Taylor J, Janssen I. Associations between physical activity, cardiorespiratory fitness, and obesity in Mexican children. Salud Publica de Mex. 2012;54(5):463-9. one study analyzed the sum of the triceps, subscapular and medial calf skinfolds,1616 de Arruda GA, Fernandes RA, Christófaro DGD, de Oliveira AR. Relationship between chronological age, adiposity and health-related physical fitness on boys and girls. Rev Andal Med Deporte. 2013;6(1):24-9. one study analyzed the sum of the triceps, biceps, subscapular, suprailiac, supraspinatus, abdominal, thigh and medial calf skinfolds4141 Docherty D, Gaul CA. Relationship of Body Size, Physique, and Composition to Physical Performance in Young Boys and Girls. Int J Sports Med. 1991;12(6):525-32. and one study analyzed the sum of triceps, biceps, subscapular, suprailiac, thigh and medial calf skinfolds.1818 Jiménez-Pavón D, Castillo MJ, Moreno LA, Kafatos A, Manios Y, Kondaki K, et al. Fitness and fatness are independently associated with markers of insulin resistance in European adolescents; The HELENA Study. Int J Pediatr Obes. 2011;6(3-4):253-60.

Waist circumference was investigated by 11 studies.1212 Arango CM, Parra DC, Gómez LF, Lema L, Lobelo F, Ekelund U. Screen time, cardiorespiratory fitness and adiposity among school-age children from Monteria, Colombia. J Sci Med Sport. 2014;17(5):491-5.1414 Buchan DS, Young JD, Boddy LM, Baker JS. Independent Associations Between Cardiorespiratory Fitness, Waist Circumference, BMI, and Clustered Cardiometabolic Risk in Adolescents. Am J Hum Biol. 2014;26(1):29–35.,1717 Galavíz KI, Tremblay MS, Colley R, Jáuregui E, López y Taylor J, Janssen I. Associations between physical activity, cardiorespiratory fitness, and obesity in Mexican children. Salud Publica de Mex. 2012;54(5):463-9.,1818 Jiménez-Pavón D, Castillo MJ, Moreno LA, Kafatos A, Manios Y, Kondaki K, et al. Fitness and fatness are independently associated with markers of insulin resistance in European adolescents; The HELENA Study. Int J Pediatr Obes. 2011;6(3-4):253-60.,2424 Andreasi V, Michelin E, Rinaldi AE, Burini RC. Physical fitness and associations with anthropometric measurements in 7 to 15-year-old school children. J Pediatr (Rio J). 2010;86(6):497-502.,2626 Martins CL, Andersen LB, Aires LM, Ribeiro JC, Mota JA. Association between Fitness, Different Indicators of Fatness, and Clustered Cardiovascular Diseases Risk Factors in Portuguese Children and Adolescents. Open Sports Sci. 2010;3:149-54.,2727 Sveinsson T, Arngrimsson AS, Johannsson E. Association between aerobic fitness, body composition, and physical activity in 9- and 15-year-olds. Eur J Sport Sci. 2009;9(3):141-50.,3737 España-Romero V, Ortega FB, Ruiz JR, Artero EG, Martínez-Gómez D, Vicente-Rodriguez G, et al. Role of Cardiorespiratory Fitness on the Association Between Physical Activity and Abdominal Fat Content in Adolescents: The HELENA Study. Int J Sports Med. 2010;31(10):679– 82.,3939 Klasson-Heggebø L, Andersen LB, Wennlof AH, Sardinha LB, Harro M, Froberg K, et al. Graded associations between cardiorespiratory fitness, fatness, and blood pressure in children and adolescents. Br J Sports Med. 2006;40(1):25–9.,4040 Leite N, Milano GE, Cieslak F, Stefanello JMF, Radominski RB. Aptidão cardiorrespiratória, perfil lipídico e metabólico em adolescentes obesos e não-obesos. Rev Bras Educ Fis Esporte. 2009;23(3):275-82. Body mass was used as an anthropometric indicator in six of the 23 studies included in the systematic review.1515 Coelho-e-Silva MJ, Vaz Ronque ER, Cyrino ES, Fernandes RA, Valente-dos-Santos J, Machado-Rodrigues A, et al. Nutritional status, biological maturation and cardiorespiratory fitness in Azorean youth aged 11–15 years. BMC Public Health. 2013;22(13):495.,1919 Ribeiro RR, Santos KD, Carvalho WRG, Gonçalves EM, Roman EP, Minatto G. Aerobic fitness and biological and sociodemographic indicators in female school children. Rev Bras Cineantropom Desempenho Hum. 2013;15(4):448-57.,2525 Lloyd LK, Bishop PA, Walker JL, Sharp KR, Richardson MT. The Influence of Body Size and Composition on FITNESSGRAM(r) Test Performance and the Adjustment of FITNESSGRAM(r) Test Scores for Skinfold Thickness in Youth. Meas in Phys Educ and Exerc Sci. 2003;7(4):205-26.,3838 Lohman TG, Ring K, Pfeiffer K, Camhi S, Arredondo E, Pratt C, et al. Relationships among Fitness, Body Composition, and Physical Activity. Med Sci Sports Exerc. 2008;40(6):1163–70.,4141 Docherty D, Gaul CA. Relationship of Body Size, Physique, and Composition to Physical Performance in Young Boys and Girls. Int J Sports Med. 1991;12(6):525-32.,4242 Cureton KJ, Boileau RA, Lohman TG, Kiisner JE. Determinants of Distance Running Performance in Children: Analysis of a Path Model. Res Q. 1977;48(2):270-9. Only two studies used the waist-to-height ratio.2727 Sveinsson T, Arngrimsson AS, Johannsson E. Association between aerobic fitness, body composition, and physical activity in 9- and 15-year-olds. Eur J Sport Sci. 2009;9(3):141-50., 3737 España-Romero V, Ortega FB, Ruiz JR, Artero EG, Martínez-Gómez D, Vicente-Rodriguez G, et al. Role of Cardiorespiratory Fitness on the Association Between Physical Activity and Abdominal Fat Content in Adolescents: The HELENA Study. Int J Sports Med. 2010;31(10):679– 82.

The studies included in the meta-analysis used one method (20-m Shuttle Run Test) and two different measures (VO2max and number of laps performed) to evaluate aerobic fitness. We performed pooled analyzes of studies that used the same test and the same measure to avoid possible biases.

Meta-analysis revealed that BMI for boys or girls was negatively and moderately associated with aerobic fitness when assessed by the 20-m Shuttle Run Test and measured by VO2max4343 Gonçalves ECA, Fernandes R, Alves Júnior CAS, Silva DAS, Trindade, EBSM. Tables/Figures of the article “Oxygen uptake and obesity indicators: meta-analysis including 17.604 adolescents”. 15 june 2021.OSFHOME. https://osf.io/wp5xc/
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Meta-analysis of studies that assessed BMI and included adolescents of both sexes showed no significant association.4343 Gonçalves ECA, Fernandes R, Alves Júnior CAS, Silva DAS, Trindade, EBSM. Tables/Figures of the article “Oxygen uptake and obesity indicators: meta-analysis including 17.604 adolescents”. 15 june 2021.OSFHOME. https://osf.io/wp5xc/
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For body fat percentage in both sexes and for boys, the meta-analysis showed a negative and moderate association between this outcome and aerobic fitness when assessed by the 20-m Shuttle Run Test and measured by VO2max4343 Gonçalves ECA, Fernandes R, Alves Júnior CAS, Silva DAS, Trindade, EBSM. Tables/Figures of the article “Oxygen uptake and obesity indicators: meta-analysis including 17.604 adolescents”. 15 june 2021.OSFHOME. https://osf.io/wp5xc/
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while this relationship was weaker when assessed by the 20-m Shuttle Run Test and measured by the number of laps performed.4343 Gonçalves ECA, Fernandes R, Alves Júnior CAS, Silva DAS, Trindade, EBSM. Tables/Figures of the article “Oxygen uptake and obesity indicators: meta-analysis including 17.604 adolescents”. 15 june 2021.OSFHOME. https://osf.io/wp5xc/
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Meta-analysis of studies that included only girls showed no significant association.4343 Gonçalves ECA, Fernandes R, Alves Júnior CAS, Silva DAS, Trindade, EBSM. Tables/Figures of the article “Oxygen uptake and obesity indicators: meta-analysis including 17.604 adolescents”. 15 june 2021.OSFHOME. https://osf.io/wp5xc/
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The combined correlation between waist circumference and aerobic fitness when assessed by the 20-m Shuttle Run Test and measured by VO2max was −0.50 (95% CI: −0.65 to −0.31, p<0.001) for boys and −0.45 (95% CI: −0.66 to −0.16, p=0.003) for girls, characterizing a negative and moderate relationship.4343 Gonçalves ECA, Fernandes R, Alves Júnior CAS, Silva DAS, Trindade, EBSM. Tables/Figures of the article “Oxygen uptake and obesity indicators: meta-analysis including 17.604 adolescents”. 15 june 2021.OSFHOME. https://osf.io/wp5xc/
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Meta-analysis of studies that assessed waist circumference and included adolescents of both sexes showed no significant association.4343 Gonçalves ECA, Fernandes R, Alves Júnior CAS, Silva DAS, Trindade, EBSM. Tables/Figures of the article “Oxygen uptake and obesity indicators: meta-analysis including 17.604 adolescents”. 15 june 2021.OSFHOME. https://osf.io/wp5xc/
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For body weight in both sexes, the meta-analysis showed no significant association.4343 Gonçalves ECA, Fernandes R, Alves Júnior CAS, Silva DAS, Trindade, EBSM. Tables/Figures of the article “Oxygen uptake and obesity indicators: meta-analysis including 17.604 adolescents”. 15 june 2021.OSFHOME. https://osf.io/wp5xc/
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No study included in this meta-analysis that correlated body weight and aerobic fitness performed stratified analyzes by sex or included only boys or girls in their studies.

Heterogeneity (I22 American College of Sports Medicine. In ACSM’s Guidelines for Exercise Testing and Prescription. 9nd ed. Philadelphia: Lippincott Williams & Wilkins; 2014. > 50% or chi² test < 0.1) was observed in all analyses performed.4343 Gonçalves ECA, Fernandes R, Alves Júnior CAS, Silva DAS, Trindade, EBSM. Tables/Figures of the article “Oxygen uptake and obesity indicators: meta-analysis including 17.604 adolescents”. 15 june 2021.OSFHOME. https://osf.io/wp5xc/
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It is not possible to conduct a sensitivity analysis in majority of the analyses performed due to the small number of studies (n=2). Sensitivity analysis that could be performed showed that the removal of a single study resulted in significant changes in combined correlation coefficients for two outcomes analyzed.4343 Gonçalves ECA, Fernandes R, Alves Júnior CAS, Silva DAS, Trindade, EBSM. Tables/Figures of the article “Oxygen uptake and obesity indicators: meta-analysis including 17.604 adolescents”. 15 june 2021.OSFHOME. https://osf.io/wp5xc/
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When the studies of Awotidebe et al.1313 Awotidebe A, Monyeki MA, Moss SJ, Strydom GL, Amstrong M, Kemper HCG. Relationship of adiposity and cardiorespiratory fitness with resting blood pressure of South African adolescents: the PAHL Study. J Hum Hypertens. 2015;30(4):245-51. or Coelho and Silva et al.1515 Coelho-e-Silva MJ, Vaz Ronque ER, Cyrino ES, Fernandes RA, Valente-dos-Santos J, Machado-Rodrigues A, et al. Nutritional status, biological maturation and cardiorespiratory fitness in Azorean youth aged 11–15 years. BMC Public Health. 2013;22(13):495. are removed, statistical significance is lost for the relationship between body fat percentage and aerobic fitness for both sexes when assessed by the 20-m Shuttle Run Test and measured by the number of laps performed. When the studies of Bim & Nardo Jr.3636 Bim RH, Nardo Junior N. Aptidão física relacionada à saúde de adolescentes estagiários da Universidade Estadual de Maringá. Acta Sci Health Sci. 2005;27(1):77-85. or Minasian et al.2020 Minasian V, Marandi SM, Kelishadi R, Abolhassani H. Correlation between Aerobic Fitness and Body Composition in Middle School Students. Int J Prev Med. 2014;5(Suppl 2):102-7. are removed, statistical significance is reached for the relationship between body fat percentage and aerobic fitness for girls when assessed by the 20-m Shuttle Run Test and measured by VO2max. For other sensitivity analyses, the removal of a single study did not result in significant differences. 4343 Gonçalves ECA, Fernandes R, Alves Júnior CAS, Silva DAS, Trindade, EBSM. Tables/Figures of the article “Oxygen uptake and obesity indicators: meta-analysis including 17.604 adolescents”. 15 june 2021.OSFHOME. https://osf.io/wp5xc/
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DISCUSSION

The present systematic review identified 23 studies (considering the inclusion and exclusion criteria) that analyzed the association between aerobic fitness and anthropometric body adiposity indicators in adolescents aged 10-19 years. The results of the meta-analysis showed that as the aerobic fitness levels increased (20-meter Shuttle Run test measured by VO2max), BMI and waist circumference values decreased. The body fat percentage presented a negative association regardless of the type of measurement used in the 20-m Shuttle Run Test (VO2max or number of laps).

Excess body fat is important inducer of systemic inflammation and this fact contributes to cardiovascular diseases linked to obesity.1111 Ruiz JR, Rizzo NS, Hurtig-Wennlöf A, Ortega FB, Wärnberg J, Sjöström M. Relations of total physical activity and intensity to fitness and fatness in children: The European Youth Heart Study. Am J Clin Nutr. 2006;84(2):299-303. Increased serum C-reactive protein (CRP) levels have been reported in obese individuals4949 Gowri V, Rizvi SG, Squib S, Al Futaisi A. High-sensitivity Creactive protein is a marker of obesity and not of polycystic ovary syndrome. Fertil Steril. 2010;94(7):2832-4. and have been reported as associated with anthropometric indicators such as BMI.5050 Hickling S, Hung J, Knuiman M, Divitini M, Beilby J. Are the associations between diet and C-reactive protein independent of obesity? Prev Med. 2008;47(1):71–6. One of the most important and strong contributors to increased serum CRP levels is visceral adiposity,5151 Oliveira A, Lopes C, Severo M, Rodriguez-Artalejo F, Barros H. Body fat distribution and C-reactive protein— a principal component analysis. Nutr Metab Cardiovasc Dis. 2011;21(5):347-54. since adipokines stimulate the hepatic synthesis of CRP.1111 Ruiz JR, Rizzo NS, Hurtig-Wennlöf A, Ortega FB, Wärnberg J, Sjöström M. Relations of total physical activity and intensity to fitness and fatness in children: The European Youth Heart Study. Am J Clin Nutr. 2006;84(2):299-303. Studies have shown that CRP is positively associated with trunk adiposity measures such as waist circumference5252 Chou HH, Hsu LA, Liu CJ, Teng MS, Wu S, Ko YL. Insulin resistance is associated with C-reactive protein independent of abdominal obesity in nondiabetic Taiwanese. Metabolism. 2010;59(6):824–30. and body fat percentage,5353 Lemieux I, Pascot A, Prud’homme D, Alméras N, Bogaty P, Nadeau A, et al. Elevated C-reactive protein another component of the atherothrombotic profile of abdominal obesity. Arterioscler Thromb Vasc Biol. 2001;21(6):961-7. which were associated in this study.

As a consequence, CRP levels are closely linked to aerobic fitness levels.5454 Church TS, Barlow CE, Earnest CP, Kampert JB, Priest EL, Blair SN. Associations between cardiorespiratory fitness and C-reactive protein in men. Arterioscler Thromb Vasc Biol. 2002;22(11):1869-76. A study has shown that the higher the aerobic fitness level, the lower the CRP level. The relationship between aerobic fitness and CRP is explained by the action that physical exercise exerts on adipose tissue, that is, the practice of physical exercise leads to improvement in aerobic fitness and reduction in the inflammatory process caused by body adiposity.5555 Silverman MN, Deuster PA. Biological mechanisms underlying the role of physical fitness in health and resilience. Interface Focus. 2014;4(5):20140040. This enhancement in aerobic fitness reduces inflammation of visceral adipose tissue because it causes reduction in adipocyte size, reduction in macrophage infiltration, increased peripheral blood flow, increased mitochondrial function, facilitated oxidation of fatty acids, decreased oxidative stress, and improved resistance to cell stress.1111 Ruiz JR, Rizzo NS, Hurtig-Wennlöf A, Ortega FB, Wärnberg J, Sjöström M. Relations of total physical activity and intensity to fitness and fatness in children: The European Youth Heart Study. Am J Clin Nutr. 2006;84(2):299-303.

Of the different tests to measure aerobic fitness, the 20-meter Shuttle Run test was the field test used by all studies included in the meta-analysis.1010 Ronque ERV, Cyrino ES, Mortatti AL, Moreira A, Avelar A, Carvalho FO, et al. Relationship between cardiorespiratory fitness and indicators of body adiposity in adolescents. Rev Paul Pediatr. 2010;28(3):296-302.,1313 Awotidebe A, Monyeki MA, Moss SJ, Strydom GL, Amstrong M, Kemper HCG. Relationship of adiposity and cardiorespiratory fitness with resting blood pressure of South African adolescents: the PAHL Study. J Hum Hypertens. 2015;30(4):245-51.1515 Coelho-e-Silva MJ, Vaz Ronque ER, Cyrino ES, Fernandes RA, Valente-dos-Santos J, Machado-Rodrigues A, et al. Nutritional status, biological maturation and cardiorespiratory fitness in Azorean youth aged 11–15 years. BMC Public Health. 2013;22(13):495.,1717 Galavíz KI, Tremblay MS, Colley R, Jáuregui E, López y Taylor J, Janssen I. Associations between physical activity, cardiorespiratory fitness, and obesity in Mexican children. Salud Publica de Mex. 2012;54(5):463-9.2020 Minasian V, Marandi SM, Kelishadi R, Abolhassani H. Correlation between Aerobic Fitness and Body Composition in Middle School Students. Int J Prev Med. 2014;5(Suppl 2):102-7.,2525 Lloyd LK, Bishop PA, Walker JL, Sharp KR, Richardson MT. The Influence of Body Size and Composition on FITNESSGRAM(r) Test Performance and the Adjustment of FITNESSGRAM(r) Test Scores for Skinfold Thickness in Youth. Meas in Phys Educ and Exerc Sci. 2003;7(4):205-26.,3636 Bim RH, Nardo Junior N. Aptidão física relacionada à saúde de adolescentes estagiários da Universidade Estadual de Maringá. Acta Sci Health Sci. 2005;27(1):77-85. This test is one of the most suitable to measure aerobic fitness indirectly1111 Ruiz JR, Rizzo NS, Hurtig-Wennlöf A, Ortega FB, Wärnberg J, Sjöström M. Relations of total physical activity and intensity to fitness and fatness in children: The European Youth Heart Study. Am J Clin Nutr. 2006;84(2):299-303. and allows analyzing performance by different parameters (number of laps, predicted VO2max, stages) of aerobic fitness. The doubt about which estimate (VO2max or number of laps) should be used is frequent among researchers5656 Minatto G, Barbosa Filho VC, Berria J, Petroski EL. School-Based Interventions to Improve Cardiorespiratory Fitness in Adolescents: Systematic Review with Meta-analysis. Sports Med. 2016;46(9):1273-92. and was observed in this review.

The sensitivity analysis altered the statistical significance of the meta-analysis regarding the association between body fat percentage and aerobic fitness assessed by the 20-meter Shuttle Run test by the number of laps in both sexes and VO2max for females. That is, when the study of Awotidebe et al. 1313 Awotidebe A, Monyeki MA, Moss SJ, Strydom GL, Amstrong M, Kemper HCG. Relationship of adiposity and cardiorespiratory fitness with resting blood pressure of South African adolescents: the PAHL Study. J Hum Hypertens. 2015;30(4):245-51. or Coelho and Silva et al.1515 Coelho-e-Silva MJ, Vaz Ronque ER, Cyrino ES, Fernandes RA, Valente-dos-Santos J, Machado-Rodrigues A, et al. Nutritional status, biological maturation and cardiorespiratory fitness in Azorean youth aged 11–15 years. BMC Public Health. 2013;22(13):495. is excluded, the significance of aerobic fitness assessed by the 20-meter Shuttle Run test by the number of laps and body fat percentage is lost. In addition, when the study from Bim & Nardo Jr.3636 Bim RH, Nardo Junior N. Aptidão física relacionada à saúde de adolescentes estagiários da Universidade Estadual de Maringá. Acta Sci Health Sci. 2005;27(1):77-85. or Minasian et al.2020 Minasian V, Marandi SM, Kelishadi R, Abolhassani H. Correlation between Aerobic Fitness and Body Composition in Middle School Students. Int J Prev Med. 2014;5(Suppl 2):102-7. is removed, the significance of aerobic fitness assessed by the 20-meter Shuttle Run test by means of VO2max is reached. A possible justification is that the four studies1313 Awotidebe A, Monyeki MA, Moss SJ, Strydom GL, Amstrong M, Kemper HCG. Relationship of adiposity and cardiorespiratory fitness with resting blood pressure of South African adolescents: the PAHL Study. J Hum Hypertens. 2015;30(4):245-51.,1515 Coelho-e-Silva MJ, Vaz Ronque ER, Cyrino ES, Fernandes RA, Valente-dos-Santos J, Machado-Rodrigues A, et al. Nutritional status, biological maturation and cardiorespiratory fitness in Azorean youth aged 11–15 years. BMC Public Health. 2013;22(13):495.,2020 Minasian V, Marandi SM, Kelishadi R, Abolhassani H. Correlation between Aerobic Fitness and Body Composition in Middle School Students. Int J Prev Med. 2014;5(Suppl 2):102-7.,3636 Bim RH, Nardo Junior N. Aptidão física relacionada à saúde de adolescentes estagiários da Universidade Estadual de Maringá. Acta Sci Health Sci. 2005;27(1):77-85. also estimated body fat percentage in adolescents (sum of triceps and subscapular skinfolds), different from the other studies included in this meta-analysis that evaluated body fat percentage by the sum of biceps, triceps, subscapular, suprailiac, medial calf and thigh skinfolds1818 Jiménez-Pavón D, Castillo MJ, Moreno LA, Kafatos A, Manios Y, Kondaki K, et al. Fitness and fatness are independently associated with markers of insulin resistance in European adolescents; The HELENA Study. Int J Pediatr Obes. 2011;6(3-4):253-60. and by the sum of triceps and medial calf skinfolds.2525 Lloyd LK, Bishop PA, Walker JL, Sharp KR, Richardson MT. The Influence of Body Size and Composition on FITNESSGRAM(r) Test Performance and the Adjustment of FITNESSGRAM(r) Test Scores for Skinfold Thickness in Youth. Meas in Phys Educ and Exerc Sci. 2003;7(4):205-26. This shows that a discussion about possible homogeneity for skinfolds to be used in adolescents becomes necessary.

To our knowledge, the present meta-analysis was the first to analyze aerobic fitness and different anthropometric body adiposity indicators in adolescents (10-19 years). A systematic review was conducted with a similar theme, but examined the association between aerobic performance (exclusively through the 20-m Shuttle Run Test) and health indicators in children and adolescents of school age (5-17 years) in North America.2323 Lang JJ, Belanger K, Poitras V, Janssenc I, Tomkinson GR, Tremblay MS. Systematic review of the relationship between 20 m shuttle runperformance and health indicators among children and youth. J Sci Med Sport. 2017;S1440-2440(17):30990-8. The correlation coefficients of studies included in the study by Lang et al.2323 Lang JJ, Belanger K, Poitras V, Janssenc I, Tomkinson GR, Tremblay MS. Systematic review of the relationship between 20 m shuttle runperformance and health indicators among children and youth. J Sci Med Sport. 2017;S1440-2440(17):30990-8. had wide variation (r = −0.70 to r = −0.10), demonstrating that adiposity alone did not explain performance in the 20-m Shuttle Run Test.2323 Lang JJ, Belanger K, Poitras V, Janssenc I, Tomkinson GR, Tremblay MS. Systematic review of the relationship between 20 m shuttle runperformance and health indicators among children and youth. J Sci Med Sport. 2017;S1440-2440(17):30990-8. It is important to emphasize that this study analyzed researches that used a specific type of field test to evaluate aerobic fitness (Shuttle Run 20 meters) and the present study made a systematic search for different methods of assessing aerobic fitness and presented the results separately. In addition, the study by Lang et al. 2323 Lang JJ, Belanger K, Poitras V, Janssenc I, Tomkinson GR, Tremblay MS. Systematic review of the relationship between 20 m shuttle runperformance and health indicators among children and youth. J Sci Med Sport. 2017;S1440-2440(17):30990-8. included researches of different designs (longitudinal and cross-sectional) and worked with children and adolescents (5-17 years). This review evaluated only cross-sectional surveys with adolescents aged 10-19 years. All these differences between the two studies hinder the comparison and justify the different results found.

This meta-analysis has some limitations that must be considered. First, few studies have evaluated the same anthropometric or body composition parameters using the same test and the same measurement for aerobic fitness assessment. Therefore, a cautious interpretation of results is necessary since the meta-analysis may have been underestimated or overestimated. Second, studies had a cross-sectional design, which does not allow temporal or causal relationships. Third, the studies included are heterogeneous in terms of age, sample size and cutoff points for assessing aerobic fitness and anthropometric indicators. This heterogeneity, together with potential confounding factors such as maturational stage and level of physical activity of adolescents may have partially affected the results. To compensate for these factors, the random effects analysis model was used. Due to the small number of studies, it was not possible to perform sensitivity tests in all analyses, nor meta-regression to explore the sources of heterogeneity.

Perspective

This meta-analysis presents strengths. To our knowledge, this meta-analysis is the first that gathered all the available evidence that evaluated the association between anthropometric indicators with aerobic fitness only in adolescents. Samples of studies included in the meta-analysis ranged from 78 to 12,946 individuals, while pooled analysis (systematic review) of studies included a total of 17,604 participants. Our meta-analysis therefore increased statistical power and found significant associations not observed in part of included studies. We also separated analyses according to the method and measurement used to evaluate aerobic fitness, and also stratified by sex, which demonstrates more reliable estimates.

CONCLUSION

It could be concluded that this meta-analysis showed that there is a negative association between aerobic fitness (as measured by the 20-meter Shuttle Run test through VO2max) and body fat percentage, BMI and waist circumference of adolescents and negative association between aerobic fitness assessed by the 20-meter Shuttle Run test by means of the number of laps and body fat percentage. However, caution is required in the interpretation of data due to the heterogeneity of studies analyzed.

ACKNOWLEDGMENTS

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) [Coordination for the Improvement of Higher Education Personnel] – Finance Code 001.

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Publication Dates

  • Publication in this collection
    15 Nov 2021
  • Date of issue
    2021

History

  • Received
    08 Jan 2021
  • Accepted
    12 Apr 2021
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