Physical Activity Guidelines and Cardiovascular Risk in Children

A Cross Sectional Analysis to Determine Whether 60 Minutes Is Enough

L. M. Füssenich; L. M. Boddy; D. J. Green; L. E. F. Graves; L. Foweather; R. M. Dagger; N. McWhannell; J. Henaghan; N. D. Ridgers; G. Stratton; N. D. Hopkins


BMC Public Health. 2016;16(67) 

In This Article


Physical activity (PA) predicts cardiovascular disease (CVD) morbidity and mortality[1] and prevents and/or reduces traditional and emerging cardiovascular (CV) risk factors in healthy and high risk children.[2,3] The American College of Sports Medicine originally published PA recommendations for young people in 1988, albeit based on their adult recommendations.[4] These guidelines and the supporting evidence base have been re-evaluated numerous times in an attempt to account for advances in PA and CVD risk factor measurement techniques.[5,6] Most recently, The World Health Organization (WHO) updated their paediatric PA recommendations[7] to reflect findings from a review by Janssen and LeBlanc[2] and the European Youth Heart Study,[8] which suggested that previous guidelines underestimated the activity necessary to reduce CVD risk in young people. The WHO guidelines now suggest children aged 5–17 years accumulate 60 min of moderate-to-vigorous physical activity (MVPA) daily, in addition to everyday physical activities, and that vigorous intensity physical activity (VPA) should be incorporated at least three times per week.

Whilst the updated guidelines address some of the limitations of previous versions[3] and advocate more PA than previously, numerous limitations remain. No study has empirically tested guidelines by comparing CVD risk in children who do achieve them to those who do not, whilst both Andersen et al. and Strong et al.[3,9] provide comprehensive reviews on the dose response relationship, and make important recommendations for childhood PA, they do not test the validity of current recommendations using empirical data. Secondly, current guidelines are based on self-report PA, which has numerous limitations, and do not include novel CVD risk markers as outcome measures. Andersen et al.[3] addressed these limitations via inclusion of objective PA data, and novel inflammatory markers. However, endothelial and diastolic dysfunction are yet to be included in such analyses despite the crucial role each plays in the development of CVDs,[10] their strong prognostic capacity in predicting CV events,[11,12] and clear associations with PA.[13–15] Finally, evidence suggests VPA may have potent effects on CVD risk,[16] yet, WHO recommendations on VPA specifically, remain vague. With these limitations in mind, we sought to evaluate whether adherence to current WHO recommendations equates to a reduction in CVD risk in children. Secondly, we aimed to examine if, and in what quantity, VPA provides additional CVD risk benefits beyond moderate PA (MPA).