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Results from cross-sectional and longitudinal studies such as Alimentacion y Valoracion del Estado Nutricional en Adolescentes: Food and Assessment of the Nutritional Status of Spanish Adolescents (AVENA) and the European Youth Heart Study (EYHS) respectively, highlight physical fitness as a key health marker in childhood and adolescence. Moderate and vigourous levels of physical activity stimulate functional adaptation of all tissues and organs in the body (i.e. improve fitness), thereby also making them less vulnerable to lifestyle-related degenerative and chronic diseases. To identify children and adolescents at risk for these major public health diseases and to be able to evaluate the effects of alternative intervention strategies in European countries and internationally, comparable testing methodology across Europe has to be developed, tested, agreed upon and included in the health monitoring systems currently under development by the European Commission (EC): the Directorate General for Health and Consumer Affairs (DG SANCO); the Statistical Office of the European Communities (EUROSTAT), etc. The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study group plans, among other things, to describe the health-related fitness of adolescents in a number of European countries. Experiences from AVENA and EYHS will be taken advantage of. This review summarises results and experiences from the developmental work so far and suggests a set of health-related fitness tests for possible use in future health information systems.

The European Youth Heart Study (EYHS) addresses cardiovascular disease risk factors and their determinants in European children and adolescents. The Swedish part of the study began with cross-sectional data collection in 9- and 15-year-old schoolchildren in 1998–1999 (EYHS-I). Repeated observations of the key indicators were performed in 2004–2005 (EYHS-II). The purpose of this study was to assess potential dropout effects in EYHS-II. Participants in both EYHS-I and EYHS-II (n=459) were compared with dropouts who participated only in the EYHS-I (n=678) in relation to baseline physical activity, cardiorespiratory fitness and socioeconomic and anthropometric characteristics. Bivariate comparisons were performed using chi-square tests and gamma tests for nominal and ordinal data, respectively. Continuous data were compared by t tests and Mann−Whitney tests depending on the distribution. The Bonferroni correction was used to control for multiple hypothesis testing. Multiple logistic regression with backward elimination of variables was applied to study independent effects of variables on the probability of becoming a dropout. Analyses were performed separately for the younger and older age groups. The dropout proportion in EYHS-II was 60%. Subjects from the older age group were less likely to participate in the follow-up study (32% vs. 50%, p

The question as to whether fitness should be assessed in a European health monitoring system, perhaps from the early stages of life onwards, remains to be answered. We aimed to examine the associations between cardiorespiratory fitness and metabolic risk factors in children. A total of 873 healthy children from Sweden and Estonia aged 9–10 years (444 girls and 429 boys) were randomly selected. A maximal ergometer bike test was used to estimate cardiorespiratory fitness. Additional cardiovascular risk factors were assessed. Significant differences among cardiorespiratory fitness quartiles for the sum of five skinfolds, insulin resistance, triglycerides, and total cholesterol (TC) and high-density lipoprotein cholesterol (HDLc) ratio were shown in girls whereas in boys, the sum of five skinfolds and insulin resistance were significantly different. The lowest sum of five skinfolds and insulin resistance was shown in the highest cardiorespiratory fitness quartile in girls and boys, and the lowest values of triglyceride and TC/HDLc values in the highest cardiorespiratory fitness quartile was observed only in girls. Cardiorespiratory fitness was negatively associated with a clustering of metabolic risk factors in girls and boys. The results add supportive evidence to the body of knowledge suggesting that cardiorespiratory fitness in children is an important health marker and thus should be considered to be included in a pan-European health monitoring system.

The purpose of this study was to improve the understanding of the relationship between cardiorespiratory fitness (CRF) and the early aetiology of cardiovascular disease. We examined if the levels of traditional and novel cardiovascular disease risk factors were influenced by the levels of CRF in children. A total of 339 randomly selected children aged 9–10 years participated in the Swedish part of the European Youth Heart Study (EYHS). CRF was estimated by a maximal ergometer bike test and dichotomized into low and high categories. Additional measured outcomes included fasting triglycerides, high density lipoprotein cholesterol (HDLc), C-reactive protein, homocysteine, blood pressure, body mass index, sum of five skinfolds and waist circumference. Homeostasis model assessment (HOMA) was computed from insulin and glucose measurements. Body mass index, skinfold thickness, waist circumference and insulin resistance (HOMA) levels were lower both in girls and boys with high CRF compared to those with low CRF. In girls, the levels of C-reactive protein were significantly lower in those with high CRF compared with those with low CRF, while HDLc levels showed the opposite pattern. The levels of triglycerides and homocysteine showed a tendency to be lower in girls having low CRF compared to those with high CRF. The results indicate that the levels of several traditional and novel cardiovascular disease risk factors are positively influenced by the levels of CRF in school-aged children. The data call for the development, testing and implementation of preventive strategies with stronger emphasis on CRF, especially for those children with low CRF. They also reinforce the need to include CRF testing in pan-European Health Monitoring Systems, also among younger individuals.