Establishing modified Canadian Aerobic Fitness Test (mCAFT) cut-points to detect clustered cardiometabolic risk among Canadian children and youth aged 9 to 17 years

Abstract

The objective of this study was to establish cut-points to identify potential clustered cardiometabolic risk among children (aged 9–13 years) and youth (aged 14–17 years) using the modified Canadian Aerobic Fitness Test (mCAFT). Nationally representative cross-sectional data were obtained from cycles 1 and 2 (2007–2011) of the Canadian Health Measures Survey. Cardiorespiratory fitness was measured using the mCAFT, which was used to estimate peak oxygen consumption. Clustered cardiometabolic health was identified as the mean of 4 standardized variables: sum of 4 skinfolds; total cholesterol–to–high-density lipoprotein ratio; and systolic and diastolic blood pressure. In total, 2106 (49% female) participants were retained for this analysis. The optimal mCAFT cut-point for males was 49 and 46 mL·kg–1·min–1 among children and youth, respectively. Among females, the mCAFT cut-point was 46 and 37 mL·kg–1·min–1 among children and youth, respectively. In 2016–2017, 83% of females and 71% of males met the new mCAFT cut-points. The mCAFT cut-points can help identify children and youth at potential risk of poor cardiometabolic health in public health surveillance, clinical, and school-based settings. Novelty We developed new mCAFT cut-points to identify potential clustered cardiometabolic risk among Canadian children and youth. These mCAFT cut-points can be used to inform national health surveillance efforts.

Discussion of “Establishing modified Canadian Aerobic Fitness Test (mCAFT) cut-points to detect clustered cardiometabolic risk among Canadian children and youth aged 9 to 17 years” – The need for foundational fitness research in Canada: is there room for innovation?

“…Fourth, the exclusion rate for cardiorespiratory fitness testing in children in the CHMS was very high resulting in a bias towards those who are healthy and fit having a valid measure. Indeed the values reported by Lang et al (2020) of optimal mCAFT cut-points for cardiometabolic risk for males of 49 and 46 mL•kg −1 •min −1 and females of 46 and 37 mL•kg −1 •min −1 among children and youth, respectively, are very high compared with global comparisons (Ruiz et al 2016;Silva et al 2016) and 83% of females and 71% of males met the new mCAFT cut-points. This bias likely inflated the results reported by Lang et al (2020), resulting in a perception that Canadian children are very fit and healthy when this may not be the case.…”

“…In this issue, Lang et al (2020) aimed to establish cardiorespiratory fitness (peak oxygen consumption (V O 2peak )) cut-points to help identify clustered cardiometabolic risk among Canadian children and youth using data derived from the modified Canadian Aerobic Fitness Test (mCAFT; Canadian Society for Exercise Physiology (CSEP) 2003, 2013) administered in the Statistics Canada Canadian Health Measures Survey (CHMS;Tremblay et al 2007). The authors suggest that these mCAFT cut-points can be used to inform national surveillance and identify children and youth at risk.…”

“…While the mCAFT has a robust history of development as summarized by Lang et al (2020), there are notable limitations. First, the research informing the validity and reliability of the mCAFT for predicting maximal oxygen consumption (V O 2max ) was completed in the late 1980s (Weller 1989) with the prediction equation published a few years later (Weller et al 1993).…”

Reply to Discussion of “Establishing modified Canadian Aerobic Fitness Test (mCAFT) cut-points to detect clustered cardiometabolic risk among Canadian children and youth aged 9 to 17 years” – The need for foundational fitness research in Canada: is there room for innovation?

“…They highlighted that (i) the validity and reliability evidence for the test is outdated in adults and nonexistent in children and youth aged <15 years; (ii) the background validation evidence for the test and prediction equation to estimate peak oxygen consumption (V O 2peak ) is often cited incorrectly in the literature; (iii) the Canadian Health Measures Survey (CHMS) exclusion criteria for the mCAFT were very strict and may bias the results; (iv) the mCAFT may not properly control for body weight when estimating V O 2peak ; and (v) using the mCAFT in research on temporal trends and international comparisons in cardiorespiratory fitness is difficult (Tremblay and Tomkinson 2020). While many of the issues raised have merit, we hope to clarify our position for publishing our mCAFT cut-points in Canadian children and youth (Lang et al 2020). We also want to take this opportunity to highlight the expanding debate in the cardiorespiratory fitness literature which points toward a clear need for innovation and change.…”

“…In our paper published in this issue (Lang et al 2020) we established mCAFT cut-points to identify Canadian children and youth at increased risk of poor cardiometabolic health. We used established statistical methods in a large nationally representative sample of Canadians and obtained cut-point values that are considered high (males: 49-46 mL·kg −1 ·min −1 ; females 46-37 mL·kg −1 ·min −1 ) in comparison with previously identified international cut-points obtained using different field-based tests of cardiorespiratory fitness (males: ϳ42 mL·kg −1 ·min −1 ; females: ϳ35 mL·kg −1 ·min −1 ; Ruiz et al 2016).…”