Revista Adolescência e Saúde

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

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 15 nº 2 - Apr/Jun - 2018

Original Article Imprimir 

Páginas 19 a 28


Influence of anthropometric parameters in the functional capacity of adolescents

Influencia de Parámetros Antropométricos en la capacidad funcional de adolescentes

Influência de parâmetros antropométricos na capacidade funcional de adolescentes

Autores: Rubia Diniz de Andrade1; Martina Estevam Brom Vieira1; Tânia Cristina Dias da Silva Hamu3,5; Thaís Inácio Rolim Póvoa4,5; Cibelle Kayenne Martins Roberto Formiga2

1. Graduation in Physical Therapy by the Physical Education and Physiotherapy School of Goiás State (ESEFFEGO), Goiás State University (UEG). Goiânia, GO, Brazil
2. Doctor in Medical Sciences from the Medical College of Ribeirão Preto (FMRP), São Paulo University (USP). Ribeirão Preto, SP, Brazil. Assistant Teacher of Physical Education and Physiotherapy School of Goiás State (ESEFFEGO), Goiás State University (UEG). Goiânia, GO, Brazil
3. Doctor in Health Sciences from the University of Brasilia (UnB). Brasília, DF, Brazil. Assistante Teacher of the Physical Education and Physiotherapy School of the Goiás State (ESEFFEGO), Goiás State University (UEG). Goiânia, GO, Brazil
4. Doctor in Health Sciences from the Goiás Federal University (UFG). AssistantTeache os the Physical Education and Physiotherapy School of Goiás State (ESEFFEGO), Goiás State University (UEG). Goiânia, GO, Brazil
5. Incentive Scholarship Program (ISP) of the UEG

Cibelle Kayenne Martins Roberto Formiga
Universidade Estadual de Goiás, Campus Escola de Educação Física e Fisioterapia do Estado de Goiás
Av. Anhanguera, 3228, Setor Leste Universitário
Goiânia, GO, Brasil. CEP: 74643-010
(cibellekayenne@gmail.com)

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Keywords: Physical fitness, obesity, adolescent, anthropometry.
Palabra Clave: Aptitud física, obesidad, adolescente, antropometría.
Descritores: Aptidão física, obesidade, adolescente, antropometria.

Abstract:
OBJECTIVE: Evaluate the influence of anthropometric parameters on the functional capacity of adolescents.
METHODS: Cross-sectional study with sample of 85 students of a public school in the city of Goiânia (Goiás), 55 of which were female with ages between 11 to 14 years. The adolescents were classified into two groups (eutrophic and overweight) according to the physical evaluation of BMI. The parameters analyzed were: body mass index (BMI), abdominal circumference (AC), neck circumference (NC) and skinfolds of the calf (CSF), tricipital (TSF) and subscapular (SSF). Functional capacity assessment was performed by the six-minute walk test (TC6').
RESULTS: In the total sample, 72% were classified as eutrophic and 28% were overweight/obese. Individuals with overweight/obesity had higher values of AC, NC, BMI and skinfolds, which were significantly associated with cardiorespiratory fitness. There was association of TSF with heart rate and peripheral Oxygen Saturation post-test. In general, the eutrophic presented better cardiorespiratory fitness. There was no significant difference between the groups in the mean WD regardless of the values presented. The adolescents were walking within the mean predicted for the test.
CONCLUSION: Anthropometric parameters influenced functional capacity. High anthropometric parameters of BMI, AC, NC and TSF were related to cardiorespiratory parameters and, consequently, to poor functional capacity, with low reference values in the 6MWD.

Resumen:
OBJETIVO: Evaluar la influencia de parámetros antropométricos en la capacidad funcional de adolescentes.
MÉTODOS: Estudio transversal con muestra de 85 estudiantes de una escuela pública de la ciudad de Goiás (Goiás), siendo 55 del sexo femenino con edades entre 11 y 14 años. Los adolescentes fueron clasificados en dos grupos (eutróficos y exceso de peso) de acuerdo con la evaluación física del IMC. Los parámetros analizados fueron: índice de masa corporal (IMC), medida de la circunferencia abdominal (CA), circunferencia de cuello (CP) y pliegues cutáneos de la pantorrilla (DCP), tricipital (DCT) y subescapular (DCS). La evaluación de la capacidad funcional fue realizada por la prueba de caminata de seis minutos (TC6 ').
RESULTADOS: En la muestra total, 72% fueron clasificados como eutróficos y 28% con sobrepeso. Los individuos con sobrepeso / obesidad presentaron mayores valores de CA, CP, IMC y dobleces cutáneos, asociados significativamente con aptitud cardiorrespiratoria. Hubo asociación de la DCT con frecuencia cardíaca y SpO2 post-test. En general, los eutróficos presentan un mejor acondicionamiento cardiorrespiratorio. No hubo diferencia significativa entre los grupos en los promedios de la distancia recorrida (DP), independientemente de los valores presentados. Los adolescentes caminaron dentro del promedio previsto para la prueba.
CONCLUSIÓN: Los parámetros antropométricos influyeron en la capacidad funcional. Los parámetros antropométricos elevados de IMC, CA, CP y DCT, se relacionan con parámetros cardiorrespiratorios y, consecuentemente, en la capacidad funcional insatisfactoria, con bajos valores de referencia en la DP en el TC6'.

Resumo:
OBJETIVO: Avaliar a influência de parâmetros antropométricos na capacidade funcional de adolescentes.
MÉTODOS: Estudo transversal com amostra de 85 estudantes de uma escola pública da cidade de Goiânia (Goiás), sendo 55 do sexo feminino com idades entre 11 e 14 anos. Os adolescentes foram classificados em dois grupos (eutróficos e excesso de peso) de acordo com a avaliação física do IMC. Os parâmetros analisados foram: índice de massa corporal (IMC), medida da circunferência abdominal (CA), circunferência de pescoço (CP) e dobras cutâneas da panturrilha (DCP), tricipital (DCT) e subescapular (DCS). A avaliação da capacidade funcional foi realizada pelo teste de caminhada de seis minutos (TC6').
RESULTADOS: Na amostra total, 72% classificados como eutróficos e 28% com excesso de peso. Indivíduos com sobrepeso/ obesidade apresentaram maiores valores de CA, CP, IMC e dobras cutâneas, associados significativamente com aptidão cardiorrespiratória. Houve associação da DCT com frequência cardíaca e SpO2 pós-teste. De forma geral, os eutróficos apresentam ter melhor condicionamento cardiorrespiratório. Não houve diferença significativa entre os grupos nas médias da distância percorrida (DP), independente dos valores apresentados. Os adolescentes caminharam dentro da média prevista para o teste.
CONCLUSÃO: Parâmetros antropométricos influenciaram na capacidade funcional. Parâmetros antropométricos elevados de IMC, CA, CP e DCT se relacionam com parâmetros cardiorrespiratórios e, consequentemente, na capacidade funcional insatisfatória, com baixos valores de referência na DP no TC6'.

INTRODUCTION

Functional capacity (FC) is the ability of the individual to perform, in an autonomous way, the activities of daily living (ADLs)1. It has the following components: absolute cardiorespiratory fitness (VO2 max) (L.min-1) and fitness relative to body mass (mL kg - 1.min-1).

The sedentary lifestyle associated with low levels of cardiorespiratory fitness explains the increase in juvenile obesity2. In addition, there is an association between cardiorespiratory disability and cardiovascular risk factors, and it can be used to compare the physical conditioning of adolescents from different nutritional states2,3.

For this reason, the appropriate use of the components of cardiorespiratory fitness, endurance and body composition, with the practice of physical activity in childhood and adolescence, bring several health benefits3,4. On the other hand, the low level of regular cardiorespiratory activity favors the development of numerous chronic-degenerative disorders, such as obesity, cardiovascular diseases and arterial hypertension, at an earlier age4,5.

Recently, the Ministry of Health published data showing the increase in obesity in Brazil6. According to the survey, the prevalence of the disease increased from 11.8% in 2006 to 18.9% in 2016, where 53.2 thousand people are overweight. Estimates for Latin America are that 3.8 million children and 21.1 million adolescents are overweight or obese7. Through this framework, the World Health Organization (WHO) included physical activity in the World Public Health Agenda by launching the Global Strategy on Diet, Physical Activity and Health, with the aim of reducing physical inactivity by 10% by 20257.

The evaluation of CF or cardiorespiratory fitness can be simulated by means of physical tests, as they allow to diagnose possible alterations, as well as to evaluate the effect of interventions based on exercise programs2. The six-minute walk test (TC6') evaluates CF during physical exercise, besides being highly applicable, low cost and easy to administer8,9. The test can further evaluate the responses of the systems involved during exercise, including the cardiorespiratory and musculoskeletal systems9. In this context, the objective of the present study was to analyze the influence of anthropometric parameters on the functional capacity of adolescents walking in a public school in Goiânia, Goiás.


MATERIALS AND METHODS

A cross-sectional study was carried out with 93 students, however, at the end of the study only 85 adolescents participated in all stages of the study. Of the 85 participants, 55 were female and 30 were male, aged 11 to 14, and were regularly enrolled in the Goiás Institute of Education (IEG), a public school in the city of Goiânia, State of Goiás. Data collection was performed between August 2015 and March 2016. The G Power software 3.1.9.2 (effect size of 0.60, power of 0.80 and error of 5% ) with the result of 85 participants. Participants were divided into two groups (eutrophic and overweight/obese) according to the physical evaluation after admission in the survey.

This study was elaborated in accordance with the Directives and Norms Regulating Research Involving Human Beings (Resolution 466/2012 of the National Health Council), and approved by the Research Ethics Committee of the Pontifical Catholic University of Goiás - PUC/GOIÁS (CAAE 14954913.6.0000.0037). All participants received an invitation containing the study procedures and the Informed Consent Form (Appendix 1). When they returned with the completed ICF and signed by the parents or guardians, data collection began. The inclusion criteria in the research were: age group of 11 to 14 years old, of both sexes, whose parents and/or guardians authorized the legal participation through the TCLE, to be regularly enrolled in the educational network. Exclusion criteria were: adolescents with orthopedic deficits installed, unstable angina and myocardial infarction during the months prior to the test and who were not adequately medicated, resting heart rate (HR) greater than 120 beats per minute, systolic pressure greater than 180 mmHg and diastolic pressure greater than 100 mmHg, pulmonary embolism, need for walking aid, important visual, auditory or cognitive alterations that made it impossible to participate in the test, adolescents classified as underweight, and adolescents who refused to participate in the study or whose parents didn´t provide legal consent through the ICF.

Body weight (kg) was measured using a digital scale (Filizola®, series 3134 nº 86713 with divisions of 100 g and maximum load of 150 kg), where the adolescents were barefoot, in light clothes, and in orthostatic position, with distance side of the feet and stare at one point ahead. The height (cm) was measured using the stadiometer with fixed base and mobile cursor, with the adolescent in the orthostatic position and with the feet united. To ensure the accuracy of height measurement, a square was used, supported on the vertex of the head.

The body mass index (BMI) (kg/m2) was calculated according to the World Health Organization (WHO) reference data10. For the nutritional classification of the percentiles the technical norm of the MedCalc system was used, where the adolescents were classified as: Eutrophic when the BMI/Age was between 10th and 85th percentile; Overweight when percentile was above or equal to 85; Obesity with a percentile above 97. Adolescents classified as low weight were excluded from the survey because of the small number in the sample (n = 2). Those classified as overweight and obese were allocated to the group referred to in this study as Excess weight.

Sexual maturation was measured by self-evaluation through figures proposed by Tanner (1981). Figures in different levels of development of pubic hair and development of breasts for girls and boys; figures about the genitalia. The adolescents marked the figures corresponding to their pubertal stages and from this the classification was made in prepubescent (stage 1 in the breasts and in the pubic hair in the girls, stage 1 in the genitalia and in the pubic hair in the boys) and pubertal (stage ≥ 2), and the prepubescent was not included in the study.

Abdominal circumference (AC) was determined during normal expiration with an inextensible tape with resolution in millimeters (mm) and length of 2 meters. This was obtained at the time of the umbilical scar, with the teenager upright and the abdomen relaxed. Measurements of neck circumference (CP) were performed with the adolescent standing and the head positioned in the horizontal plane. The neck was palpated to locate the cricoid cartilage, where it placed the measuring tape exerting minimum pressure. The triceps, calf and subscapular skinfolds thickness was performed with the aid of a scientific adipometer (Cescorf®) with resolution of 0.1 mm, according to the procedures (ISAK) 11.

The socioeconomic level was evaluated by a questionnaire developed by the Brazilian Association of Research Companies (ABEP). The calculation was made by a points system adopted as Brazil's Standard Classification of Economic Classification. The total score ranged from 0 to 46 and was classified as: class A=35-46; B=23-34; C=14-22, D=8-13 and E=≤7. Adolescents answered about transportation to school, practiced activities, TV time, quality and quantity of sleep, health and diet perception, and physical activity practice12. The sedentary behavior was verified through the Socioeconomic Questionnaire of Physical Activity, validated in the Brazilian population.

Functional capacity was assessed by means of the TC6' '. The individuals were previously evaluated and in this evaluation the physical examination was performed. The participants were submitted to the TC6', following the general criteria standardized by the American Thoracic Society (ATS)13, that is, a previous 10-minute rest in the pre-test period with initial and final measurements of blood pressure and the subjective sensation of exertion through of the Borg Scale (Appendix 5), heart rate (HR), respiratory frequency (RF) and peripheral oxygen saturation (SpO2). The reference values used were according to the reference equations for distance prediction in the TC6' 'according to classification for Brazilians14.

Statistical analysis was performed with the statistical program Statistical Package for Social Sciences (SPSS), version 23.0. The normality of the data was verified using the Kolmogorov-Smirnov test. The descriptive statistical analysis of the data was processed using mean and standard deviation for the continuous variables and calculation of frequency and percentage for the discrete or categorical variables. The statistical procedures used were Student's t-test for independent groups (comparison of eutrophic and overweight/obese groups) for the anthropometric and cardiorespiratory parameters of the TC6', Fisher's Exact test to buy the frequencies between sex, sexual maturation and physical activity and, finally, the Pearson correlation test to correlate the different anthropometric variables with the parameters of the adolescents functional capacity. In all tests, a significance level of 5% (p ≤0.05) was considered.


RESULTS

The present study considered a sample composed of 85 adolescents, 64.7% female, with ages ranging from 11 to 14 years (mean of 12.4 years). As to age, schoolchildren were categorized into 11 years (n= 18); 12 years (n= 30); 13 years (n= 22); 14 years old (n= 15), with 72% being eutrophic and 28% being overweight.

Table 1 showed the characteristics of adolescents regarding sex, sexual maturation and physical activity practice. There were no statistically significant differences between the groups stratified by BMI. In Table 2 there were significant differences between groups, regarding body weight, CA, CP, BMI and cutaneous folds, with the exception of height. On average, the overweight group presented high values of anthropometric parameters and body composition when purchased with the eutrophic group.






No significant differences were found between HR and PAD before the TC6', neither PAD, HR and SpO2 after the TC6'. Significant differences (p ≤ 0.05) were observed between the variables of PAS, FR and SpO2 pre-test and PAS and FR post-walk test. The mean of the overweight group was higher than the eutrophic group, indicating that overweight and obese adolescents suffered greater cardiorespiratory repercussion before and after the walking test (Table 3). In general, the eutrophic present better cardiorespiratory fitness. There was no significant difference between the groups in the mean distance traveled (SD). Although the values presented in the table didn´t present significant value (p ≤ 0.05), the adolescents were walking within the expected mean for this population during the TC6' '.




Table 4 presents the results of the analysis of correlations between anthropometric variables and the parameters of pre and post-treadmill cardiopulmonary fitness. Generally, although significant, correlations were considered weak (correlation coefficient r ≤ 0.05). It was found that there was correlation between BMI with PAS, FR and SpO2 before the test and PAS after the walking test. The AC showed correlation with PAS before and PAS and PAD after the test. Evaluating the increased CP value, it was also verified that there was correlation with PAS, PAD and SpO2 before and PAS after the test. In the evaluation of the DCT, there was a significant positive correlation with the increase of the PAS, FR and SpO2 pre-test, and PA and FC post-test. DCS with PAS pre-test and PAS, FC and FR post-test and, finally, DCP correlated with HR and FR after the walking test. These results explain the negative impact of high anthropometric parameters on cardiorespiratory fitness and, consequently, an unsatisfactory functional capacity during the test.




DISCUSSION

The purpose of this study was to verify the association of anthropometric parameters with the cardiorespiratory fitness of adolescents through the TC6'. The test proved to be reproducible in healthy adolescents, although the performance of both groups was similar in relation to PD. This corroborates with other research already performed in Brazil14, which evaluated the applicability of the test to estimate the distance to be covered in the Brazilian population14. It also found no significant difference in PD, demonstrating that test performance and cardiorespiratory fitness didn´t interfere with walking distance due to changes in energy expenditure14.

A study carried out at the Center for Health Care of the Elderly (CASI) in Piripiri (PI) also found association with high body mass index and low performance of the functional capacity of individuals with different age groups during the TC6'1. In this study, 70% of the participants were hypertensive and 62.5% were diabetic and the participants were walking within the mean predicted in the literature1,14. The mean PD of the elderly participants was similar to the present study, despite the differences related to the included population. Such justification can be understood by factors that may influence the performance of adolescents in the TC6', including puberty and growth spurt, due to the great influence of the size of the past and the speed on the PD in the test15,16. Inherent aspects of school age related to difficulties in learning, interest, and motivation during the test also need to be considered in the results through encouraging phrases in different periods of time.

The present study revealed a worrying fact that 28% of adolescents were classified as overweight / obese. Obesity verified in the present study showed a prevalence similar to that observed in the city of Florianópolis (SC), where children from seven to 14 years of age from public schools were analyzed. In this study, it was observed that approximately 23% of the youngsters were overweight or obese and predisposed to risk factors for metabolic and cardiovascular diseases and their relationship with poor performance in the TC6'16. Another study analyzed 29 healthy Brazilian children aged 6 to 14 years and verified the reproducibility of the TC6' in this group, where the similarity in the behavior of the physiological parameters and in the mean of PD during the test was observed9.

In the analyzed adolescents, greater body weight was observed by BMI, elevation of CP, increase in skinfold values and sedentary behavior. These findings corroborate with the results of a study carried out in Paraná, where students aged 7 to 10 years were evaluated, identifying an overweight health risk4. Another study observed a higher percentage of obese children between nine and 10 years in public schools15. A similar study conducted in children aged 7 to 10 in Florianópolis used the sum of four skinfolds, and found that BMI had a better diagnostic performance in screening for excess body fat16. These authors pointed out a significant association between low cardiorespiratory fitness and high adiposity value, independently of the sex of the adolescents analyzed.

CP can be increased in nutritional assessment, being an anthropometric measure that allows the identification of overweight and obesity in children and adolescents17. Based on these results, there was an association between CP and PAS before and after the TC6', which indicates that CP is also established as an indicator of adiposity in Brazilian adolescents and that changes can negatively impact blood pressure and can be used as a indicator of metabolic syndromes. This finding agrees with a study carried out in the Northeast of Brazil, where 1474 adolescents were evaluated and CP showed a significant correlation with systolic blood pressure17. Few pediatric studies have explored PC and the mechanisms involved to justify the association with cardiometabolic risk factors.

In this study the subscapular skinfold was used as central adiposity and the tricipital skin fold (TCD) as peripheral adiposity. The DCT presented correlation with the cardiorespiratory parameters of PAS and post-test. This finding may be influenced by the low level of physical activity or attributed to the stage of sexual maturation, since fat deposition begins with greater emphasis at the onset of puberty18. These results agree with the study carried out in Pelotas (RS), in which the percentage of TCD was elevated by 20.2% in both sexes and associated with high BMI, also associated with puberty and low level of physical activity19.

Regarding the differences in the cardiovascular responses, the adolescents had a higher cardiorespiratory requirement during the TC6', which revealed higher values of HR, blood pressure and SpO2. This increase observed in the pediatric population may be compensatory for a lower cardiac volume and lower systolic volume3. Although the O2 pulse is only an indirect estimate of the systolic volume, it is suggested that this finding may be related to the lower systolic volume and lower venous return3. In addition, the present study revealed high values of RF, which shows that the ventilatory pattern in the pediatric population depends on the maturational pattern. Within the same context, one study pointed out that cardiorespiratory and metabolic responses during the progressive effort test are different in children compared to adults. These differences may suggest that children have lower cardiovascular and respiratory efficiency3.

Using questionnaires to assess the level of physical activity, we observed that only 29% of the students performed extracurricular physical activity. The practice of physical activity is an important component for more daily energy expenditure6. This corroborates with other studies already done with adolescents from Brazil15 and from other countries, such as Portugal8, where there was also an association between cardiorespiratory resistance and greater percentage to acquire comorbidities related to physical inactivity and, consequently, low functional capacity20.

Obesity has a multifactorial etiology with hereditary, environmental, behavioral, cultural, and socioeconomic determinants that interact and potentiate20. Other changes at the psychosocial level also decrease quality of life and increase the number of inadequate responses4. The identity and self-image disorders associated with low self-esteem in obese children and adolescents are also significant, being victims of both external prejudices and prejudice itself. Situations of physical activities or relationships with other individuals may represent a reason for social escape, which may contribute to trigger behaviors associated with social phobia or even symptoms that fit the diagnosis of depression20.

Based on the results found, it was verified that the present study contributes to the literature regarding the detection of juvenile obesity and preventive assessments of the health risks of Brazilian schoolchildren. It is also important to note that the results are applicable to the sample studied, and that generalizations are limited due to the size of the sample. In addition, other parameters of functional capacity were not evaluated in the current research, such as ability to run, lift from the floor or expirometric evaluations to test exercise tolerance. These parameters can be investigated in future studies with the same theme.

Finally, the study ratified the need for actions to promote health at school, showing the importance of including physical activity and its influence on the cardiorespiratory component during childhood and adolescence in the school period.


CONCLUSION

Based on the study, it was concluded that anthropometric parameters influenced functional capacity. There was no impact of overweight on the functional ability of adolescents to walk, since both groups walked similar values in PD. It is believed that high anthropometric parameters of BMI, waist circumference, neck circumference and triceps skin fold are associated with the negative impact on the cardiorespiratory capacity of adolescents before and after the walking test.


REFERENCES

1. Andrade TM, Alves ELM, Figueiredo MLF, Batista MEM, Alves CMS. Avaliação da capacidade funcional de idosos por meio do teste de caminhada de seis minutos J. Res.: fundam. care. online 2015; 7(1): 2042-2050.

2. Victo ER, Ferrari GLM, Junior JPS, Araújo TL, Matsudo VKR. Indicadores de estilo de vida e aptidão cardiorrespiratória de adolescentes. Rev Paul Pediatr 2017; 35(1): 61-68.

3. Prado DML, Braga AMFW, Maria Urbana Pinto Rondon, ALF, Matos LNJM, Negrão CE, Trombetta IC. Comportamento Cardiorrespiratório em Crianças Saudáveis durante o Exercício Progressivo Máximo. Functional Arq Bras Cardiol 2015; 104(1): 67-77.

4. Montoro APPN, Leite CR, Espíndola JA, Alexandre JM. Aptidão física relacionada à saúde de escolares com idade de 7 a 10 anos. Arquivos Brasileiros de Ciências da Saúde. Health Sciences. 2016; 41(1): 29-33.

5. Tebar WR, Vanderlei LCM, Scarabotollo CCS, Zanuto EF, Saraiva BTC, Delfino LD, Christofaro DGD. Obesidade abdominal: prevalência, fatores sócio demográfico e de estilo de vida associados em adolescentes. J Hum Growth Dev 2017; 27(1): 56-63.

6. Organização Mundial de Saúde. prevenindo e controlando a epidemia global. Relatório da Consultadoria da OMS, Genebra, 2002.

7. Brazil. Vigilância de fatores de risco e proteção para Doenças Crônicas por inquérito telefônico (VIGITEL) 2017 maio- junho [acesso 2017 Mai 12]. Disponível em: http://portalsaude.saude.gov.br/index.php/oministerio/principal/secretarias/job/webradio/28111-vigitel-2016-obesidade-entre-brasileiros-faz-elevar-casos-de-diabetes-e-hipertensao

8. Okuro RT, Schivinski CIS. Teste de caminhada de seis minutos em pediatria: relação entre desempenho e parâmetros antropométricos. Fisioter Mov 2013; 26(1):219-28.

9. Martins R, Gonçalves RM, Mayer AF, Schivinski CIS. Confiabilidade e reprodutibilidade do teste de caminhada de seis minutos em crianças saudáveis. Fisioter Pesq 2014; 21(3): 279-284.

10. Organização Mundial de Saúde (OMS). IMC por idade (5 a 19 anos). 2007. Disponível em: http://www.who.int/growthref/who2007_bmi_for_age/en/

11. Lopes AL, Ribeiro, GS. Antropometria aplicada à saúde e ao desempenho esportivo: uma abordagem a partir da metodologia ISAK. Rio de Janeiro, Editora Rubio, 2014.

12. Associação Brasileira de Empresas de Pesquisa (ABEP) [homepage on the Internet]. Critério de Classificação Econômica Brazil. 2008 [acesso 2017 Jun 11]. Disponível em: http://www.abep.org/criterio-brasil

13. American Thoracic Society. ATS Statement: Guidelines for the Six-minute Walk Test. Am J Respir Crit Care Med 2002; 166(1): 111-117.

14. Britto FR, Sousa LAP. Teste de Caminhada de Seis Minutos Uma Normatização Brasileira. Fisio terap Mov, Curitiba 2006; 19(4): 49-54.

15. Aquino ES, Mourão FAG, Souza RKV, Glicério BM, Coelho CC. Analise comparativa do teste de caminhada de seis minutos em criança e adolescentes saudáveis. Rev Bras Fisioter 2010; 14(1): 75-80.

16. Brito LM S, MIKSZA ACP, Boguszewski MCS. Aptidão cardiorrespiratória e nível de atividade física em adolescentes de escolas em tempo integral no estado do Paraná. Estudo Rio de Janeiro. Rev Adolesc Saúde, Rio de Janeiro 2017; 14 (1): 22-28.

17. Souza MFC, Gurgel RQ, Barreto IDC, Shanmugam S. Neck circumference as screening measure for identifying adolescents with overweight and obesity. J Hum Growth Dev 2016; 26(2): 260-266.

18. Duquia RP, Reichert SCDFF, Madruga SW, Duro LN, Menezes AMB, Araujo CL. Epidemiologia das pregas cutâneas tricipital e subescapular elevadas em adolescentes. Cad S Pub, Rio de Janeiro 2008; 24(1); 113-121.

19. Santos S, Gaillard R, Oliveira A, Barros H, Hofman A, Franco OH,Jaddoe VWV. Subcutaneous Fat Mass in Infancy and Cardiovascular Risk Factors at School-Age: The Generation R Study. J Obesity 2016; 24(2): 424-429.

20. Camarinha B, Graça P, Nogueira PJ. A Prevalência de Pré-Obesidade-Obesidade nas Crianças do Ensino Pré-Escola e Escolar na Autarquia de Vila Nova de Gaia, Portugal. Rev Cient Ordem Med 2016; 29 (1): 31-40.
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