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

Purpose : To explore the multivariate pattern associations between physical fitness and adiposity with cardiometabolic risk among children and adolescents. Method : 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. Results : 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. Conclusion : 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.