US Youth Cardiorespiratory Fitness Levels: Challenges and Solutions

The article by Dr Pate and colleagues¹ fills in a long overdue gap in contemporary US youth cardiorespiratory fitness evaluation. It also confirms what those of us directly involved in youth fitness and performance have known for many years: a majority of contemporary American youth is physically unfit. As pointed out by the authors, the association between low youth cardiorespiratory fitness and a plethora of cardiometabolic risk factors has been well documented in the literature. Unfortunately, while much has been said and written about the causes, few real-life, sustained solutions have been identified so far. Therefore, immediate and specific action to improve US youth cardiorespiratory fitness is urgently needed.

Ideally, age-appropriate cardiorespiratory fitness programs should be readily available to virtually all American youth, regardless of age, sex, race/ethnicity, socioeconomic status, or geographic location. They should be cost-effective and sustained year round in an adult-supervised, safe, and enjoyable environment.

A few school-based programs have been proven successful in developing youth cardiorespiratory fitness.² Unfortunately, until high-quality physical education becomes a high-priority curriculum component in every American school, such programs will remain exceptions rather than rules.³ Under such circumstances, it is important to start by recognizing and fully using other readily available resources.

At least 2 nationwide programs with a fitness focus on youth (aged ≤18 years) already exist in the United States through USA Track & Field (USATF) and the Amateur Athletic Union (AAU). These organizations are the country's current and former governing body of athletics (track and field), respectively.^{4 - 5} Both offer grassroots athletics programs for US children and adolescents. Unlike other sports, athletics is accessible, relatively inexpensive, and focuses on developing objectively measured, individual physical fitness, rather than complex techniques and game strategies. After all, the 1-mile run, used for field assessment of cardiorespiratory fitness, is one of the many athletics events. Both AAU and USATF youth programs are structured on 5 to 9 age divisions. Based on zip code, youngsters may join one of the clubs in their geographical area. It is important to emphasize that the AAU program adopted a “Sports for all, forever” philosophy inclusive of and continuous to all youth, regardless of athletic ability. Except for the local (association) level, however, USATF is placing a higher focus on performance. Youngsters may choose to participate in one or both programs, depending on their initial fitness level, annual progress, and individual objectives. Annually organized local, association, regional, and national competitions are highly enjoyable and constitute specific means of monitoring fitness progress by the individual athletes, teams, coaches, families, and friends. Increased awareness among pediatric health care professionals, and ultimately US youth and their parents, regarding such readily available, inclusive, sustainable, albeit not ideal, programs may help alleviate the low cardiorespiratory fitness levels of American youngsters.

Correspondence: Dr Nasca, Beth Israel Deaconess Medical Center and Harvard Medical School, 185 Pilgrim Rd, DEAC 304D, Boston, MA 02215 (mnasca@bidmc.harvard.edu).

Financial Disclosure: None reported.