Greater weekly exercise volume is associated with lower prevalence of metabolic comorbidities, psychiatric conditions, and exertional symptoms in youth athletes undergoing pre-participation screening: an observational study

Introduction: Physical activity has been associated with improved cardiovascular health outcomes in adults. However, the specific associations between physical activity volume and cardiovascular outcomes in youth athletes are less defined. Methods: This study analyzed data from the HeartBytes National Youth Database, compiled from Simon's Heart. Simon's Heart is a nonprofit organization that includes information from sports pre-participation examinations for adolescents. The dataset encompasses demographics, electrocardiogram (ECG) findings, and exercise-related symptoms. Youth athletes' self-reported weekly physical activity volume was classified into four levels: <2 h, 2-5 h, 5-10 h, and >10 h, with less than 2 h taken as the reference group. Given the physical diMerences among athletes aged 12 to 20, the sample was stratified into middle and high school athlete groups. Logistic regression analysis was performed to evaluate the association between weekly exercise volume and cardiovascular risk factors, controlling for the confounding eMects of age, race, sex, body mass index, and area-level socioeconomic status. Results: Among 7,048 youth athletes (median age 15.1 years; interquartile range: 13.6-16.5), most were male (60.7%) and White (85.5%). Increased weekly exercise volume was associated with lower odds of attention deficit hyperactivity disorder (ADHD), anxiety or depression, and obesity in both middle and high school athletes. Greater exercise volume high school athletes, though these did not reach statistical significance. Greater weekly physical activity volume was associated with lower prevalence of cardiovascular disease risk factors, psychiatric comorbidities, and exertional symptoms in youth athletes. Given the cross-sectional design, causal relationships cannot be established and further studies are needed to clarify the clinical significance of these findings.