Geographical Variation in Health-Related Physical Fitness and Body Composition among Chilean 8th Graders: A Nationally Representative Cross-Sectional Study

<div><p>Purpose</p><p>In addition to excess adiposity, low cardiorespiratory fitness (CRF) and low musculoskeletal fitness (MSF) are important independent risk factors for future cardio-metabolic disease in adolescents, yet global fitness surveillance in adolescents is poor. The objective of this study was to describe and investigate geographical variation in levels of health-related physical fitness, including CRF, MSF, body mass index (BMI), and waist circumference (WC) in Chilean 8th graders.</p><p>Methods</p><p>This cross-sectional study was based on a population-based, representative sample of 19,929 8th graders (median age = 14 years) in the 2011 National Physical Education Survey from Chile. CRF was assessed with the 20-meter shuttle run test, MSF with standing broad jump, and body composition with BMI and WC. Data were classified according to health-related standards. Prevalence of levels of health-related physical fitness was mapped for each of the four variables, and geographical variation was explored at the country level by region and in the Santiago Metropolitan Area by municipality.</p><p>Results</p><p>Girls had significantly higher prevalence of unhealthy CRF, MSF, and BMI than boys (p<0.05). Overall, 26% of boys and 55% of girls had unhealthy CRF, 29% of boys and 35% of girls had unhealthy MSF, 29% of boys and 44% of girls had unhealthy BMI, and 31% of adolescents had unhealthy WC. High prevalence of unhealthy fitness levels concentrates in the northern and middle regions of the country and in the North and Southwest sectors for the Santiago Metropolitan Area.</p><p>Conclusion</p><p>Prevalence of unhealthy CRF, MSF, and BMI is relatively high among Chilean 8th graders, especially in girls, when compared with global estimates. Identification of geographical regions and municipalities with high prevalence of unhealthy physical fitness presents opportunity for targeted intervention.</p></div

Health-related physical fitness in a representative sample (N = 19,904) of Chilean 8th-grade students: The 2011 National Physical Education Survey.

<p>Data are mean (standard error) or percent (standard error) and n of category within sex. NI, needs improvement; CRF, cardiorespiratory fitness; MSF, musculoskeletal fitness; BMI, body mass index; WC, waist circumference. ^†P-values reflect sex differences within strata. Cardiorespiratory fitness is classified according to FITNESGRAM 2011 maximal aerobic capacity cut-points <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Welk1" target="_blank">[39]</a>. ^bUnhealthy musculoskeletal fitness is standing broad jump below the 20th percentile of European adolescents <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Ortega3" target="_blank">[14]</a>. ^cBody mass index is classified according to the FITNESSGRAM 2011 health-related standards <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Laurson1" target="_blank">[42]</a>. ^dWaist circumference is classified according to health-related cut-points <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Messiah1" target="_blank">[46]</a>.</p><p>Health-related physical fitness in a representative sample (N = 19,904) of Chilean 8th-grade students: The 2011 National Physical Education Survey.</p

High prevalence of unhealthy physical fitness among Chilean 8th-grade students (N = 19,904)^a concentrates in the northern and middle regions of the country.

<p>Δ Prevalence of unhealthy physical fitness is significantly higher than in the Santiago Metropolitan Region (p<0.05). ▽ Prevalence of unhealthy physical fitness is significantly lower than in the Santiago Metropolitan Region (p<0.05). ^aSample size varies for each fitness variable: n, cardiorespiratory fitness = 17,928; n, musculoskeletal fitness = 19,777; n, body mass index = 19,904; n, waist circumference = 19,895. ^bUnhealthy cardiorespiratory fitness is combined needs improvement and needs improvement – health risk FITNESGRAM 2011 maximal aerobic capacity groups <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Welk1" target="_blank">[39]</a>. ^cUnhealthy musculoskeletal fitness is defined as standing broad jump below the 20^th percentile of European adolescents <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Ortega3" target="_blank">[14]</a>. ^dUnhealthy body mass index is combined needs improvement and needs improvement – health risk FITNESGRAM 2011 BMI groups <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Laurson1" target="_blank">[42]</a>. ^eWaist circumference is classified according to health-related cut-points <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Messiah1" target="_blank">[46]</a>.</p

Demographic characteristics, including body mass index, of a representative sample (N = 19,904) of Chilean 8th-grade students: The 2011 National Physical Education Survey.

<p>Data are mean (standard error) or percent (standard error) and n of category within sex. ^†P-values reflect sex differences within strata. ^aGroups defined by Chilean Ministry of Education <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-XX11" target="_blank">[101]</a>. ^bBerdegue et al <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Berdegu1" target="_blank">[47]</a>; n, urbanicity = 17,269. ^cWHO BMI-for-age cut-points <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-deOnis1" target="_blank">[43]</a>. ^dInternational Obesity Task Force BMI cut-points <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Cole1" target="_blank">[44]</a>.</p><p>Demographic characteristics, including body mass index, of a representative sample (N = 19,904) of Chilean 8th-grade students: The 2011 National Physical Education Survey.</p

Geographical variation in health-related physical fitness of Chilean 8th-grade students: The 2011 National Physical Education Survey.

<p>PR, unadjusted prevalence ratio; CI, confidence interval. ^aUnhealthy cardiorespiratory fitness is combined needs improvement and needs improvement – health risk FITNESGRAM 2011 maximal aerobic capacity groups <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Welk1" target="_blank">[39]</a>. ^bUnhealthy musculoskeletal fitness is defined as standing broad jump below the 20th percentile of European adolescents <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Ortega3" target="_blank">[14]</a>. ^cUnhealthy body mass index is combined needs improvement and needs improvement – health risk FITNESGRAM 2011 BMI groups <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Laurson1" target="_blank">[42]</a>. ^dWaist circumference is classified according to health-related cut-points <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Messiah1" target="_blank">[46]</a>. ^eBerdegue et al <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Berdegu1" target="_blank">[47]</a>; n, urbanicity = 17,269. ^f90.5% urban, per present definition. ^gComunas were grouped into 7 sectors based on geographical location. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone-0108053-g002" target="_blank">Figure 2</a> presents a map of the 7 sectors. Sample size in Santiago Metropolitan Region varies for each fitness variable: n, cardiorespiratory fitness = 6,082; n, musculoskeletal fitness = 6,894; n, body mass index and waist circumference = 6,957. ‡Effect of urban versus rural is different within Santiago Metropolitan Region than in all other regions (p<0.05). *p<0.05.</p><p>Geographical variation in health-related physical fitness of Chilean 8th-grade students: The 2011 National Physical Education Survey.</p

High prevalence of unhealthy physical fitness among Chilean 8th-grade students levels concentrates in the north and southwest sectors of the Santiago Metropolitan Area (n, Santiago Region = 6,957).

<p>^aC, Central. Comunas (municipalities) were grouped into 7 sectors based on geographical location. ^aSample size varies for each fitness variable: n, cardiorespiratory fitness = 6,082; n, musculoskeletal fitness = 6,894; n, body mass index and waist circumference = 6,957. ^bCombined needs improvement and needs improvement – health risk FITNESGRAM 2011 maximal aerobic capacity groups. ^cUnhealthy musculoskeletal fitness is defined as standing broad jump below the 20^th percentile of European adolescents <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Ortega3" target="_blank">[14]</a>. ^dUnhealthy body mass index is combined needs improvement and needs improvement – health risk FITNESGRAM 2011 BMI groups <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Laurson1" target="_blank">[42]</a>. ^eWaist circumference is classified according to health-related cut-points <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108053#pone.0108053-Messiah1" target="_blank">[46]</a>.</p

Reliability of “Fuprecol study” of morphologic, musculoskeletal, motor and cardiorespiratory component (mean±SD) in boys (n = 124) and girls (n = 105) from Bogota, Colombia.

<p>^a The average of right and left side scores is shown in the table and was used for the analyses. BIA: bioelectrical impedance analysis</p><p>Reliability of “Fuprecol study” of morphologic, musculoskeletal, motor and cardiorespiratory component (mean±SD) in boys (n = 124) and girls (n = 105) from Bogota, Colombia.</p

Inter-observer TEM, relative TEM and intra-observer morphologic component assessments of children and adolescents from Bogota, Colombia.

<p>TEM: technical error of measurement; BIA: bioelectrical impedance analysis</p><p>Inter-observer TEM, relative TEM and intra-observer morphologic component assessments of children and adolescents from Bogota, Colombia.</p

Bland–Altman plot of the handgrip, standing broad jump, vertical jump, sit and reach, 4x10m shuttle run, 20-m shuttle run of children and adolescents from Bogota, Colombia. The central dotted line represents the mean differences between the second trial (T2) and the first trial (T1); the upper and lower dotted lines represent the upper and lower 95% limits of agreement (mean differences ± 1.96 SD of the differences), respectively.

<p>Bland–Altman plot of the handgrip, standing broad jump, vertical jump, sit and reach, 4x10m shuttle run, 20-m shuttle run of children and adolescents from Bogota, Colombia. The central dotted line represents the mean differences between the second trial (T2) and the first trial (T1); the upper and lower dotted lines represent the upper and lower 95% limits of agreement (mean differences ± 1.96 SD of the differences), respectively.</p

Additional file 1: Table S1. of One-day workshop-based training improves physical activity prescription knowledge in Latin American physicians: a pre-test post-test study

Relative gain by country where the EIM workshop was offered. (DOCX 79 kb