An Update on Secular Trends in Physical Fitness of Children and Adolescents from 1972 to 2015: A Systematic Review.

BACKGROUND: There is evidence that physical fitness of children and adolescents (particularly cardiorespiratory endurance) has declined globally over the past decades. Ever since the first reports on negative trends in physical fitness, efforts have been undertaken by for instance the World Health Organization (WHO) to promote physical activity and fitness in children and adolescents. Therefore, it is timely to re-analyze the literature to examine whether previous reports on secular declines in physical fitness are still detectable or whether they need to be updated.
OBJECTIVES: The objective of this systematic review is to provide an 'update' on secular trends in selected components of physical fitness (i.e., cardiorespiratory endurance, relative muscle strength, proxies of muscle power, speed) in children and adolescents aged 6-18 years. DATA SOURCES: A systematic computerized literature search was conducted in the electronic databases PubMed and Web of Science to locate studies that explicitly reported secular trends in physical fitness of children and adolescents. STUDY ELIGIBILITY CRITERIA: Studies were included in this systematic review if they examined secular trends between at least two time points across a minimum of 5 years. In addition, they had to document secular trends in any measure of cardiorespiratory endurance, relative muscle strength, proxies of muscle power or speed in apparently healthy children and adolescents aged 6-18 years. STUDY APPRAISAL AND SYNTHESIS
METHODS: The included studies were coded for the following criteria: nation, physical fitness component (cardiorespiratory endurance, relative muscle strength, proxies of muscle power, speed), chronological age, sex (boys vs. girls), and year of assessment. Scores were standardized (i.e., converted to z scores) with sample-weighted means and standard deviations, pooled across sex and year of assessment within cells defined by study, test, and children's age.
RESULTS: The original search identified 524 hits. In the end, 22 studies met the inclusion criteria for review. The observation period was between 1972 and 2015. Fifteen of the 22 studies used tests for cardiorespiratory endurance, eight for relative muscle strength, eleven for proxies of muscle power, and eight for speed. Measures of cardiorespiratory endurance exhibited a large initial increase and an equally large subsequent decrease, but the decrease appears to have reached a floor for all children between 2010 and 2015. Measures of relative muscle strength showed a general trend towards a small increase. Measures of proxies of muscle power indicated an overall small negative quadratic trend. For measures of speed, a small-to-medium increase was observed in recent years. LIMITATIONS: Biological maturity was not considered in the analysis because biological maturity was not reported in most included studies.
CONCLUSIONS: Negative secular trends were particularly found for cardiorespiratory endurance between 1986 and 2010-12, irrespective of sex. Relative muscle strength and speed showed small increases while proxies of muscle power declined. Although the negative trend in cardiorespiratory endurance appears to have reached a floor in recent years, because of its association with markers of health, we recommend further initiatives in PA and fitness promotion for children and adolescents. More specifically, public health efforts should focus on exercise that increases cardiorespiratory endurance to prevent adverse health effects (i.e., overweight and obesity) and muscle strength to lay a foundation for motor skill learning.