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Area-level Socioeconomic Environment and Cardiorespiratory Fitness in Youth


Medicine & Science in Sports & Exercise: December 2019 - Volume 51 - Issue 12 - p 2474–2481
doi: 10.1249/MSS.0000000000002066

Introduction Cardiorespiratory fitness is one of the most important markers of cardiometabolic health and is a strong predictor of cardiovascular disease and all-cause mortality across the lifespan. However, little is known regarding the relationship of area-level socioeconomic environment on cardiorespiratory fitness during childhood and adolescence.

Purpose To examine the relationship between area-level socioeconomic environment and cardiorespiratory fitness in a diverse sample of school-age youth; and to determine the extent to which grade level, sex, race/ethnicity, and student poverty status moderate this relationship.

Methods South Carolina FitnessGram data for school year 2015 to 2016 were obtained for 44,078 youth. Cardiorespiratory fitness was determined using Progressive Aerobic Cardiovascular Endurance Run or 1-mile run/walk test. Area-level socioeconomic environment was expressed as a composite index score at the census tract level using data from the American Community Survey. Multilevel logistic regression analyses were conducted, controlling for individual-level characteristics and nesting within schools and districts. Interaction terms were then introduced to the model to examine their effect of multiple sociodemographic moderators.

Results Approximately half of the sample had inadequate cardiorespiratory fitness for health. The odds of achieving the Healthy Fitness Zone for cardiorespiratory fitness decreased by approximately 25% to 34% with increasing deprivation of the area-level socioeconomic environment, after controlling for covariates. The association between area-level socioeconomic environment and cardiorespiratory fitness also varied significantly by sex, grade level, and race/ethnicity subgroups.

Conclusions Cardiorespiratory fitness was positively associated with area-level socioeconomic environment; however, the relationship varied by demographic characteristics. These results highlight the importance of examining the influence of area-level socioeconomic environment on health across the life span. Additional research is needed to explore how area-level socioeconomic environment may impact evidence-based efforts to improve youth cardiorespiratory fitness levels.

1Department of Exercise Science, University of South Carolina, Columbia, SC

2Institute of Health Research, Kaiser Permanente of Colorado, Denver, CO

Address for correspondence: Morgan Clennin, M.P.H., Ph.D., Department of Exercise Science, University of South Carolina, Suite 212, 921 Assembly St., Columbia, SC 29208; E-mail:

Submitted for publication January 2019.

Accepted for publication June 2019.

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Online date: June 14, 2019

© 2019 American College of Sports Medicine