Although agreement is needed on optimal field-based tests across the lifespan, cardiorespiratory fitness tests provide suitable objective measures that could complement existing evaluation processes for physical activity interventions, programmes and strategies.Ī large body of evidence supports cardiorespiratory fitness as a strong and independent predictor of cardiovascular disease and all-cause mortality. Due to of the low cost of equipment, no need for specialized human resources, the ability to assess multiple participants simultaneously and easily interpretable results, field-based cardiorespiratory fitness assessments are promising. 5 These types of field-based tests have been incorporated into surveillance systems in some high- and middle-income countries, although further evidence describing implementation and feasibility in countries across income categories is needed. 7 Furthermore, the 20 m shuttle run test has been proposed as a suitable and feasible health indicator for international surveillance in children and adolescents. 6 Among children and adolescents, the 20 m shuttle run test is a widely used field-based assessment, with a recent study reporting results from 50 countries, including 16 low-income countries. For at-risk populations, the 6-minute walk test (that is, distance covered in 6 minutes) is commonly used. For instance, the time-to-complete 800 to 1500 m runs are popular in Asia, whereas the 12-minute distance walk and/or run and the 2 km walk tests are popular in Europe and North America. Among adults, several field-based measures have been used to estimate cardiorespiratory fitness. 5, 6 However, laboratory-based testing is costly and impractical for population-based assessments with large samples. Cardiorespiratory fitness is often reported as maximal oxygen uptake ( VO 2max) in adults, peak oxygen uptake ( VO 2peak) in children and adolescents or is standardized as metabolic equivalents. The gold standard measure of cardiorespiratory fitness remains laboratory-based assessments with gas analysis. Cardiorespiratory fitness may provide a stable reflection of recent physical activity levels, similar to glycosylated haemoglobin, reflecting glucose control over a period of several months. 5 From a public health perspective, cardiorespiratory fitness provides a robust measure, because of its low month-to-month variability within individuals. 5 Although 30–50% of cardiorespiratory fitness is determined by genetics, habitual physical activity remains the primary means of improving fitness which is therefore a proximal outcome of physical activity levels. Here we provide our perspective on using cardiorespiratory fitness as an objective measure that could complement the evaluation process of the global plan by providing a proximal outcome of physical activity levels in individuals of all ages and for countries across income categories.Ĭardiorespiratory fitness represents an intermediate variable between physical activity behaviours and health outcomes that reflects the capacity of numerous bodily organs, such as the heart, lungs and muscles, to support energy production during physical activity and exercise. 4 As an alternative, cardiorespiratory fitness is a physical trait that is primarily determined by physical activity behaviours. Under ideal conditions, objective measures can provide more accurate estimates of overall physical activity levels, although they are not always feasible and pose challenges related to increased cost and time required for data collection and analysis. 3 Some researchers and surveillance systems are moving towards more objective measures, such as pedometers or accelerometers. 2 Although self-reported physical activity has several benefits related to feasibility and obtaining an understanding of the context in which individuals are active, self-reporting could be susceptible to response biases, hindering its validity. For surveillance, WHO has previously used self-reported physical activity measures, such as the Global Physical Activity Questionnaire. 1 An important component of this plan is the evaluation process for monitoring global changes in the prevalence of insufficient physical activity and for assessing the global plan’s impact and related efforts. 1 The plan involves a multifaceted approach to create a society that intrinsically values and prioritizes policy investments in physical activity as a regular part of everyday life. The World Health Organization (WHO) recently developed a Global action plan on physical activity aimed at attaining a 15% relative reduction in the global prevalence of insufficient physical activity in adolescents and adults by 2030.
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