Physical activity, cardiorespiratory fitness, and cardiovascular health in children

What is it about?

Cardiovascular disease (CVD) remains one of the greatest causes of adult mortality worldwide. It is now recognized that CVD is partly a paediatric problem given that its onset extends back to childhood, even though clinical symptoms may not become apparent until much later in life. Therefore, from a primary prevention point of view, the extent to which physical activity orcardiorespiratory fitness (CRF) may deter this process starting already from a young age is of utmost importance. However, in contrast to the large amount of evidence linking adults’ physical activity and CRF to incident CVD and all-cause mortality, there is not much evidence linking levels of physical activity or CRF in young age to CVD or mortality later in life. Indeed, thus far, no studies have been able to follow children and adolescents to old age to enable the examination of such association prospectively. Because CVD is rare among the young, studies investigating the relationship between physical activity, CRF and cardiovascular health have therefore focused their attention on intermediary pathways linked to traditional cardiometabolic risk factors, as illustrated in Figure. This chapter discusses the evidence across these pathways. In addition, it also covers the associations between physical activity and CRF with more direct markers or early vascular ageing, enabled by the development, over the last two decades, of technology that enables its non-invasive assessment.

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Why is it important?

The favourable impact that physical activity and/or CRF during youth have on other cardiometabolic risk factors (mainly obesity, blood pressure, and possibly insulin resistance) seem to constitute the preferential pathways through which beneficial effects on cardiovascular health later in life can be expected. This holds also true for the associations between physical activity or CRF with markers of arterial aging in children and adolescents, as well as between the cumulative or lifelong exposure levels to lower physical activity and physical fitness levels with those markers in adulthood. According to the evidence available, it is seems more important to be active and fit throughout the life-course than to be active or fit only as a child. This sustainability dimension thus needs to be incorporated in preventive measures aiming at the promotion of physical activity among the young as a means to prevent metabolic and cardiovascular diseases later in life.