Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 1 - Jan/Mar - 2017

Original Article Imprimir 

Páginas 22 a 28

Cardiorespiratory fitness and physical activity level in adolescents enrolled in full-time schools in the state of Paraná

Aptitud cardiorrespiratoria y nivel de actividad física en adolescentes de escuelas en tiempo integral en el estado de Paraná

Aptidão cardiorrespiratória e nível de atividade física em adolescentes de escolas em tempo integral no estado do Paraná

Autores: Lilian Messias Sampaio Brito1; Ana Caroline Paranhos Miksza2; Daniele Sari3; Margaret Cristina da Silva Boguszewski4

1. Doctoral student in Child and Adolescent Health. Master's Degree in Physical Activity and Health, Paraná Federal University (UFPR). Curitiba, Paraná State, Brazil
2. Bachelor's Degree in Medicine, Paraná Federal University (UFPR). Curitiba, Paraná State, Brazil
3. Bachelor's Degree in Medicine, Paraná Federal University (UFPR). Curitiba, Paraná State, Brazil
4. PhD and MD in Pediatric Endocrinology, Gothenburg University (GU), Gothenburg, Sweden. Master`s Degree in Child and Adolescent Health. Professor, Paraná Federal University (UFPR). Curitiba, Paraná State, Brazil

Lilian Messias Sampaio Brito
Pós-Graduação em Saúde da Criança e do Adolescente (Pediatria)
Rua General Carneiro, 181, 14º andar
Curitiba, PR, Brasil. CEP: 80060-900

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How to cite this article

Keywords: Physical fitness, physical activity, cardiorespiratory, students.
Palabra Clave: Aptitud física, actividad física, cardiorrespiratorio, estudiantes.
Descritores: Aptidão física, atividade física, cardiorrespiratório, estudantes.

OBJECTIVE: Evaluate the impact of physical activity on cardiorespiratory fitness through the test of cardiorespiratory aptitude.
METHODS: We evaluated 294 students, between 12 to 16 years old, from 3 full-time public schools of Paraná State. The schools were classified as rural, large urban center and mixed zone. 277 students responded to the 3 days questionary of physical activity, categorized as 300 minutes/week. All students underwent weight, height and waist circumference assessment. Body mass index (BMI) and Z score body mass index were calculated and used to group students into underweight, normal weight and overweight / obesity classes. The evaluation of cardiorespiratory fitness was performed by determining the maximum volume of oxygen during the Test Come and Go 20 meters by Léger, and categorized as very weak / weak, regular and good / excellent.
RESULTS: Large urban center students presented higher prevalence overweight, and increased abdominal circumference. 35.5% of the students had physical activity ≥ 300 minutes / week. Girls were the majority among students with good cardiorespiratory fitness / excellent (65.6%), while 66.7% of boys were considered very weak / weak. 92.1% of the students from rural area had good / excellent cardiorespiratory fitness, and 68.4% had some physical activity.
CONCLUSION: When students were analyzed as a group, no relationship was found between physical activity and cardiorespiratory fitness. However, analyzing the schools separately, cardiorespiratory fitness in students from rural areas was higher mainly because walking and cycling are the most used means of transport and leisure.

OBJETIVO: Evaluar el impacto del nivel de actividad física sobre el acondicionamiento cardiorrespiratorio, a través del nivel de aptitud cardiorrespiratoria.
MÉTODOS: Fueron evaluados 294 estudiantes, entre 12 y 16 años, de tres escuelas públicas de enseñanza integral del Estado de Paraná, clasificadas como: zona rural, gran centro urbano y zona mixta. Un total de 277 estudiantes contestaron al cuestionario recordatorio de 3 días de actividad física, categorizado en 300 minutos/semana. Todos pasaron por evaluación de peso, estatura y circunferencia abdominal, cálculo de índice de masa corporal (IMC), score-z de IMC y fueron clasificados bajo peso, peso adecuado y sobrepeso/obesidad. La evaluación de la aptitud cardiorrespiratoria fue realizada por la determinación del volumen de oxígeno máximo durante el Test de Va y Viene de 20 metros de Léger y categorizado en muy débil/débil, regular y buena/excelente.
RESULTADOS: Alumnos de grandes centros urbanos presentaron mayor prevalencia de exceso de peso, circunferencia abdominal elevada y 35,5% de ellos tenían nivel de actividad física ≥300 minutos/semana. Las niñas fueron mayoría entre los alumnos con aptitud cardiorrespiratoria buena/excelente (65,6%), mientras la mayoría de los niños presentaron aptitud cardiorrespiratoria muy débil/débil (66,7%). El 92,1% de los alumnos de zona rural obtuvieron aptitud cardiorrespiratoria buena/excelente, y el 68,4% tenían algún nivel de actividad física.
CONCLUSIÓN: Cuando se analizan todos los adolescentes como un grupo, no observamos relación entre nivel de actividad física y la aptitud cardiorrespiratoria. Sin embargo, analizando las escuelas por separado, la aptitud cardiorrespiratoria en los estudiantes de la zona rural es mayor porque caminan a pie y usan bicicleta como medio de transporte u ocio.

OBJETIVO: Avaliar o impacto do nível de atividade física sobre o condicionamento cardiorrespiratório, através do nível de aptidão cardiorrespiratória.
MÉTODOS: Foram avaliados 294 estudantes, entre 12 e 16 anos, de três escolas públicas de ensino integral do Estado do Paraná, classificadas como: zona rural, grande centro urbano e zona mista. 277 estudantes responderam ao questionário recordatório de 3 dias de atividade física, categorizado em 300 minutos/semana. Todos passaram por avaliação de peso, estatura e circunferência abdominal, cálculo de índice de massa corporal (IMC), escore-z do IMC e foram classificados em baixo peso, peso adequado e sobrepeso/obesidade. A avaliação da aptidão cardiorrespiratória foi realizada pela determinação do volume de oxigênio máximo durante o Teste de Vai e Vem de 20 metros de Léger e categorizada em muito fraca/fraca, regular e boa/excelente.
RESULTADOS: Alunos de grandes centros urbanos apresentaram maior prevalência de excesso de peso, circunferência abdominal aumentada e 35,5% deles tinham nível de atividade física ≥300 minutos/semana. As meninas foram maioria entre os alunos com aptidão cardiorrespiratória boa/excelente (65,6%), enquanto a maioria dos meninos apresentaram aptidão cardiorrespiratória muito fraca/fraca (66,7%). 92,1% dos alunos de zona rural obtiveram aptidão cardiorrespiratória boa/excelente, e 68,4% tinham algum nível de atividade física.
CONCLUSÃO: Quanto analisados todos os adolescentes como um grupo, não observamos relação entre nível de atividade física e a aptidão cardiorrespiratória. Porém, analisando as escolas separadamente a aptidão cardiorrespiratória nos estudantes da zona rural é maior porque caminham a pé e usam bicicleta como meio de transporte ou lazer.


Cardiorespiratory fitness (CRF) is an indicator of a person´s cardiorespiratory status, subject to significant genetic influence and tending to be impacted positively through regular physical activity 1. Measured by the maximum oxygen (O2) consumption value and defined as the highest rate at which O2 may be taken up and used by the body during vigorous exercise, 1 it is directly associated with cardiovascular and metabolic risks2.

Changing habits among adolescents are well known in terms of declining physical activities3, with studies conducted in several Brazilian cities showing sedentary lifestyle rates varying from 39% to 93.5%3,4,5. Insufficient physical activity is rated as one of the factors pumping up obesity during childhood and youth, through declining cardiorespiratory fitness, in addition to being a risk factor for the appearance of cardiovascular, metabolic and bone-related diseases, as well as psychiatric disorders (anxiety and depression)2,6. As childhood and adolescence are phases during which eating patterns and lifestyles are being shaped, healthy habits during this period foster healthier futures7.

This study assesses cardiorespiratory fitness, physical activity levels and the prevalence of obesity (Z Score on the BMI and waist circumference) among adolescents attending school full-time, meaning they spend at least seven hours a day at school during the academic year. The schools participating in this study follow the Single Class Full-Time Education Model, with 45 hours a week of classes and at least three hours a week of physical education8,9. According to the 2013 School Census, there are 68 single class full-time schools in Paraná State, with 8,206 pupils enrolled.


An analytical, prospective and observational cross-sectional study was conducted between June 2013 and October 2014 that encompassed 294 adolescents (158 girls and 136 boys), between 12 and 16 years old, enrolled in the 7th to 9th grades of full-time classes at three government schools in Paraná State, classified as: rural zone (located in a green and lightly-populated area of a town with 3,800 inhabitants, with a farm-based economy); major urban hub (with 1,864,416 inhabitants and an essentially industrial economy); and mixed rural/urban zone (with 129.265 inhabitants and a school located in an urban area where economic activities are split between agriculture and industry, depending on their location in the town and the economic characteristics of each region).10

All the pupils received a letter of invitation listing the goals and procedures of the study, together with Deeds of Informed Consent. After these documents were returned, completed and signed by parents or guardians, data collection activities began. Their weight, height and waist circumference were measured, the latter halfway between the bottom rib and the upper edge of the iliac crest, classifying them as normal with WC <75 percentile based on age and gender11. The Body Mass Index (BMI) and the BMI Z Score were calculated through the AnthroPlus program released by the World Health Organization (WHO). The BMI Z Score was used to rate these youngsters as underweight (Z Score -2), adequate weight (≥ Z Score -2 and <Z Score +1) and overweight/obese (≥ Z Score +1).

Physical activity Levels (PAL) were obtained through the Three-Day Physical Activity Recall (3DPAR) technique that originated in studies by Trost et al.12, Weston et al.13 and Pate et al.14, validated by Pires et al.15. The pupils completed the questionnaire on a Friday, recalling their activities on Wednesday and Thursday, and one day on the weekend (Sunday), at 30-minute from 7 a.m. to midnight. The questionnaire contained a numbered list with 55 activities where these youngsters entered the type of activity performed on the respective day, together with its duration and intensity (light, moderate, intense or very intense). On this basis, the estimated PAL for each pupil was calculated for the three days under examination, with the cut-off point for analyzing vigorous activity being PAL ≥ 300 minutes of intense/very intense physical activity a week16.

The CRF was measured by the maximum VO2 value obtained through the 20 meters Shuttle Run test proposed by Léger et al.17 and validated by Duarte and Duarte18. This test consists of shuttle runs over a 20-meter distance at time intervals controlled by sound signals, with speed during the first stage of the run being 8.5 km/h, with the signal frequency increasing by 0.5 km/h each minute. The test ended when each participant was unable to keep pace and twice failed to reach the finish lines within the set time. Polar heart rate monitors ( were used to monitor heartbeats at the start and end of the assessment. The maximum VO2 was calculated through the shuttle run test, based on the equation for the 6 - 18 year-old age bracket: y=31.025 + 3.238(1) - 3.248(2) + <0.1536(1)(2) where: y=ml/kg/min; 1=km/h (maximum speeds reached during the test) and 2=age (in years). With the maximum VO2 calculated, the CRF was grouped into three fitness categories: poor/ very poor, fair and good/excellent, based on the study by Rodrigues et al.19. Pupils were excluded with orthopedic or neurological alterations that prevented them from understanding the assessment and / or engaging in the physical activities planned for the study.

The Statistica 10.0 (Statsoft) statistical package was used, running frequency tests for different categories and using the chi-squared test for linear trends. The CRF was positioned as a dependent variable, with the PAL as an independent variable.

This study was approved by the Ethics Committee for Research with Human Beings at Paraná Federal University, registered as follows: CEP: 148.438/2012-11 and CAAE: 08389212.6.0000.009, compliant with Resolution 466/12 issued by the National Health Council.


Table 1 presents the general characteristics of the group of 294 adolescents by school of origin, of whom 41 (14.3%) youngsters were classified as low weight under the BMI Z Score, 178 (62.2%) as adequate weight and 67 (23.4%) as overweight/obese (excess weight). Of the 292 whose waist circumferences were measured, 44 (15.1%) presented abdominal obesity. When assessing the students grouped by schools, those enrolled at the school in the major urban hub were more likely to be overweight, with higher BMI Z Scores and waist circumferences, with only 2 (4.4%) of them rated as underweight, 24 (53.3%) as adequate weight and 19 (42.2%) as overweight/obese. At the rural school, 7 (6.2%) were rated as underweight, 84 (75%) as adequate weight and 21 (18.7%) as overweight/obese. The equivalent figures for the mixed zone school were 32 (24.8%), 70 (54.3%) and 27 (20.9%).

Among the 277 youngsters completing the 3DPAR questionnaire, only 89 (32.1%) presented a PAL ≥300 minutes per week. The highest frequency of teens with PAL≥ 300 minutes per week was noted in the school located in the major urban hub (35.5%), followed by 31.8 % in the mixed zone school and 31.6 % in the rural zone.

Of the 126 pupils completing the Léger test, 42 (33.3%) presented very poor/poor CRF, 20 (15.9%) presented fair CRF and 64 (50.8%) were good/excellent. Among the 64 pupils with good/excellent CRF, 42 (65.6%) were girls. While among the 42 with very poor/poor CRF, 28 (66.7%) were boys. There was no significant correlation between gender and CRF (p=<0.08).

Table 2 shows the CRF for each school group: 51% of the mixed zone school pupils presented CRF rated as very poor/poor at higher levels than the other two groups, while 92.1% of the rural zone pupils presented good/excellent CRF.

Table 3 presents the CRF by PAL for each pupil, separated by school. There was no significant link between CRF and PAL when analyzing all three schools together (p=<0.8). When analyzed by school, we noted a direct link between PAL <300 min/week and Very poor/poor CRF (p=<0.04) at the school in the major urban hub, while in the rural zone school, 68.4% of pupils with good/excellent CRF reported PAL <300 min/week.

This leads to the inference that there is a significant link (p<0.05) between waist circumference and BMI Z Score with CRF, as at places with more visceral obesity and overweight/obesity, there was also a higher frequency of very poor/poor CRF.


Using questionnaires to assess physical activity levels, we noted that only 32% of these youngsters were involved in physical activity for more than 300 minutes/week, which is the figure recommenced by the World Health Organization (OMS)16.

We also noted that around 23% of them were either overweight or obese, with many also presenting abdominal obesity, which is a risk factor for metabolic and cardiovascular diseases3,5. At the three locations assessed in this study (major urban hub, rural zone and mixed zone), 42% of the schoolchildren in the major urban hub were overweight, which is higher than the figures found by other similar studies, reflecting an uptrend towards overweight among children and teens4,7, while a greater percentage of the rural zone pupils posted adequate weights. This difference contradicts the survey, which showed there was no difference in BMI and fat mass among youngsters living in rural and urban areas17.

These findings are worrying, as the youngsters assessed are enrolled in full-time schools, with meals scheduled throughout the day, in addition to physical activity programs, which should ensure they meet the recommended weekly duration14. One explanation may be the influence of cultural factors that boost consumption of high-fat processed foods that are more easily available in major cities, in addition to fewer after-school activities3,4,7.

It is interesting to note that among the youngsters completing the 3DPAR questionnaire, a higher frequency of PAL ≥300 minutes/week was noted among pupils living in the major urban hub, although this difference was minor compared to the other schools. When assessed through the Léger test, only half posted good/excellent CRF figures, most of them girls. The opposite was found for boys, who were generally among those with very poor/poor CRF. An explanation may be the fact that more girls are going through puberty, associated with better physical performance 4,5.

Still with regard to CRF, most of the rural youngsters presented good/excellent CRF, while most of the mixed zone school pupils presented CRF rated as very poor/poor. However, the rural zone pupils did not mention PAL ≥ 300 minutes/week. Only at the school in the major urban hub did pupils with lower PAL also post very poor/poor CRF figures. This finding may be due to the PAL assessment method through the 3DPAR questionnaire, completed by groups with different lifestyles. This method is subjective, and each child self-assesses his or her own activities, ranking them as intense /very intense. Although this is a simple, low-cost PAL assessment method, it depends on the memory and interpretation of the respondents, who may find it hard to understand questions or report the intensity and duration of their ativities16.

Better CRF among rural adolescents has already been reported and explained through greater aerobic resistance among these youngsters, compared to their urban peers20. The large number of youngsters at the rural zone school who were self-rated as having low PAL, may be due to the fact that they often walk or cycle to school, with these activities rated as intense /very intense, demonstrating the positive influence of rural activities, habits and customs on the CRF of these youngsters20. Different lifestyles among rural and urban youngsters, in terms of eating habits and PAL, may be explained by the determining factor of their environments on their behaviors, while rural activities burn more calories than urban contexts where sedentary lifestyles predominate among work-related activities20.


Finally, we found no link between PAL and CRF when comparing youngsters within the same group. However, when the schools were analyzed separately, we noted a direct correlation between PAL and CRF in the major urban hub, while at the rural zone school, this was not noted, with high CRF levels occurring independently of the PAL. A possible explanation for this is that the CRF of rural adolescents is naturally good, due to their lifestyles, as most of them get around by walking or cycling, which result in higher and more intense PAL, with a direct influence on CRF. Assessing pupils through their CRF levels seems to be a better health indicator than merely the number of hours spent each week on physical activities.

Note of thanks

To the University Level Staff Higher Education Coordination Office (CAPES), Paraná Federal University, and the Paraná State Education Bureau.


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