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Is Muscular Fitness Associated with Future Health Benefits in Children and Adolescents? A Systematic Review and Meta-Analysis of Longitudinal Studies
Abstract
Background No previous systematic review has quantitatively examined the association between muscular fitness during childhood and adolescence and health parameters later in life.Objective The aim was to systematically review and meta-analyze the current evidence for a prospective association between muscular fitness in childhood and adolescence and future health status.Methods Two authors systematically searched MEDLINE, EMBASE and SPORTDiscus electronic databases and conducted manual searching of reference lists of selected articles. Relevant articles were identified by the following criteria: apparently healthy children and adolescents aged 3-18 years with muscular fitness assessed at baseline (e.g., handgrip, standing long jump, sit-ups, among others), and a follow-up period of ≥ 1 year. The outcome measures were anthropometric and adiposity measurements and cardiometabolic, bone and musculoskeletal health parameters. Two authors independently extracted data.Results Thirty studies were included in the meta-analysis, yielding a total of 21,686 participants. The meta-analysis found a significant, moderate-large (p < 0.05) effect size between muscular fitness at baseline and body mass index (r = - 0.14; 95% confidence interval (CI) - 0.21 to - 0.07), skinfold thickness (r = - 0.32; 95% CI - 0.40 to - 0.23), homeostasis model assessment estimated insulin resistance (r = - 0.10; 95% CI - 0.16 to - 0.05), triglycerides (r = - 0.22; 95% CI - 0.30 to - 0.13), cardiovascular disease risk score (r = - 0.29; 95% CI - 0.39 to - 0.18), and bone mineral density (r = 0.166; 95% CI 0.086 to 0.243) at follow-up.Conclusion A prospective negative association was observed between muscular fitness in childhood/adolescence and adiposity and cardiometabolic parameters in later life, together with a positive association for bone health. There is inconclusive evidence for low back pain benefits.
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“Children and adolescents with better muscular fitness (eg, gained through exercises involving hand grip, standing, long jump and sit-ups) were shown to have better health outcomes (ie, lower levels of BMI and body fat, improvement in insulin resistance and lower levels of cardiovascular disease risk) in later life.68”
From Physical activity and health in Chinese children and adolescents: expert consensus statement (2020) (2020) · cites this paper as [68]
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“Muscular strength is also inversely related to CVD risk and mortality, insulin resistance, bone health, and adiposity [20].”
BackgroundInfluentialÁlvarez, C., Guzmán‐Guzmán, I. P., Román, P. Á. L., MONTILLA, J. A. P., Palomino‐Devia, C., Oyola, F. A. R., Paredes-Arévalo, L., Oyarzún, M. L., Obando-Calderón, I., Barria, M. A. C., et al. (2021) · Nutrients · doi:10.3390/nu13082672 · Cited by 13
“markers is a decrease in physical fitness, which is considered to be one of the most important health markers across the life course [23] because it is a powerful marker of health in early childhood and later in life [24,25].”
BackgroundMármol-Pérez, A., Gil-Cosano, J. J., Ubago‐Guisado, E., Llorente‐Cantarero, F. J., Pascual-Gázquez, J. F., Ness, K. K., Martínez‐Vizcaíno, V., Ruiz, J. R., & Gracia‐Marco, L. (2024) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2024.01.003 · Cited by 12
Nevill, A. M., Lang, J. J., Niemz, M., & Tomkinson, G. R. (2025) · Sports Medicine · doi:10.1007/s40279-025-02235-0 · Cited by 12
Leidy, H. J., & Gwin, J. A. (2020) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2020-0058 · Cited by 15
A 47-Year Comparison of Lower Body Muscular Power in Spanish Boys: A Short Report
Chulvi‐Medrano, I., Pombo, M., García, M. S., Rebullido, T. R., & Faigenbaum, A. D. (2020) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk5030064 · Cited by 12
“, muscular strength, muscular power and local muscular endurance) in children and adolescents are associated with poor motor competence, functional limitations and adverse health outcomes [1,2].”
BackgroundSospedra, C. B., Adelantado‐Renau, M., Beltran‐Valls, M. R., & Moliner‐Urdiales, D. (2021) · Annals of Human Biology · doi:10.1080/03014460.2022.2032337 · Cited by 12
Pengaruh Kebugaran Jasmani, Status Gizi, dan Motivasi Belajar terhadap Hasil Belajar PJOK
Idham, Z., Neldi, H., Komaini, A., Sin, T. H., & Damrah, D. (2022) · Jurnal Basicedu · doi:10.31004/basicedu.v6i3.2196 · Cited by 12
Huhtiniemi, M., Sääkslahti, A., Tolvanen, A. J., Lubans, D. R., & Jaakkola, T. T. (2023) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.14410 · Cited by 12
Fraser, B. J., Blizzard, L., Schmidt, M. D., Dwyer, T., Venn, A., & Magnussen, C. G. (2019) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.13529 · Cited by 12
Fitness, body composition, and metabolic risk scores in children and adolescents: the UP&DOWN study
Sánchez‐Delgado, A., Pérez‐Bey, A., Izquierdo‐Gómez, R., Jiménez-Iglesias, J., Marcos, A., Gómez‐Martínez, S., Girela‐Rejón, M. J., Veiga, Ó. L., & Castro‐Piñero, J. (2022) · European Journal of Pediatrics · doi:10.1007/s00431-022-04707-1 · Cited by 15
“On the other hand, increased MF through resistance training promotes increased insulin sensitivity, which also affects the risk of MetS [19], a possible mechanism through which high MF may influence insulin resistance is by stimulating proteins in the insulin-signalling cascade [66].”
BackgroundMethodBettio, C., Banchelli, F., Salsi, V., Vicini, R., Crisafulli, O., Ruggiero, L., Ricci, G., Bucci, E., Angelini, C. I., Berardinelli, A. L., et al. (2024) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-023-07150-x · Cited by 11
Zhao, R., Li, X., Wang, J., Zhang, L., & Gao, Z. (2024) · BMC Public Health · doi:10.1186/s12889-024-17660-5 · Cited by 11
“The development of cardiovascular, obesity, mental health, and bone health is closely correlated with muscle strength, which is a physical fitness factor that rises steadily with age [61–63].”
BackgroundBarahona, R. B., Delgado‐Floody, P., & Martínez‐Salazar, C. (2020) · Endocrinología Diabetes y Nutrición · doi:10.1016/j.endinu.2020.02.005 · Cited by 11
Pedretti, A., Mello, J. B., Gaya, A. R., Pedretti, A., & Gaya, A. C. A. (2020) · Revista Brasileira de Atividade Física & Saúde · doi:10.12820/rbafs.25e0131 · Cited by 11
Hutzler, Y. S., Barak, S., Aubert, S., Arbour‐Nicitopoulos, K. P., Tesler, R., Sit, C. H. P., Silva, D. A. S., Asunta, P., Požėrienė, J., López‐Gil, J. F., et al. (2023) · Adapted Physical Activity Quarterly · doi:10.1123/apaq.2022-0123 · Cited by 11
Babiloni-López, C., Fritz-Silva, N., Ramírez‐Campillo, R., & Colado, J. C. (2023) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000004635 · Cited by 14
“Considering the particularities of reduced sample sizes in the field (2), a meta-analysis for a given outcome was conducted if at least 3 studies provided sufficient data for the calculation of ES (38,61,83).”
BackgroundSortwell, A., Ramírez‐Campillo, R., Murphy, A. J., Newton, M. J., Hine, G., & Piggott, B. (2024) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk9040272 · Cited by 18
Elsabour, A. K. A., Zakaria, H. M., Fahmy, E. M., Khalil, A. S. A., Alwhaibi, R. M., Ragab, W. M., & Taha, S. I. (2025) · Medicina · doi:10.3390/medicina61020223 · Cited by 10
“…in post-treatment mean scores of anteroposterior stability, mediolateral stability, and overall stability, these findings align with those of [10,20], However, our study makes a novel contribution by extending these benefits to a stroke population, where balance impairments are a leading cause…”
Fraser, B. J., Blizzard, C. L., Tomkinson, G. R., Dwyer, T., Venn, A., & Magnussen, C. G. (2025) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaf102 · Cited by 10
Kidokoro, T., & Edamoto, K. (2021) · Journal of Sports Science and Medicine · doi:10.52082/jssm.2021.404 · Cited by 10
Gerardo Weisstaub, N., Bravo, M. A. G., García‐Hermoso, A., Salazar, G., & López‐Gil, J. F. (2022) · Translational Pediatrics · doi:10.21037/tp-22-25 · Cited by 10
“The independent biological influence of cardiorespiratory fitness (CRF) and muscular fitness (MF) on CMR has been verified in children and adolescents (18,19).”
Kim, S. Y., Lee, J., & Kim, Y. H. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17145021 · Cited by 10
Ushio, K., Mikami, Y., Obayashi, H., Fujishita, H., Fukuhara, K., Sakamitsu, T., Hirata, K., Ikuta, Y., Kimura, H., & Adachi, N. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10112272 · Cited by 10
“Pediatric obesity causes decreased muscular fitness [1–4] and leads to metabolic syndrome and cardiovascular disease in the present [1,4,5] or future [6,7].”
BackgroundThe relationship between the digit ratio ( 2D : 4D ) and vertical jump performance in young athletes
Disterhaupt, J. W., Fitzgerald, J. S., Rhoades, J. L., & Tomkinson, G. R. (2021) · American Journal of Human Biology · doi:10.1002/ajhb.23679 · Cited by 10
“In addition, explosive strength is significantly associated with current and future health (e.g., cardiometabolic disease risk, adiposity, bone mass; García-Hermoso et al., 2019), which suggests that athletes with lower 2D:4Ds are healthier.”
BackgroundAlbornoz-Guerrero, J., Zapata‐Lamana, R., Reyes‐Molina, D., Cigarroa, I., García-Pérez-de-Sevilla, G., & García-Merino, S. (2021) · Children · doi:10.3390/children8090734 · Cited by 10
“Higher muscle strength and healthier body composition in childhood are associated with a healthier cardiovascular profile throughout life, in addition to lower all-cause mortality in adulthood [14,15,47,55].”
BackgroundSolera-Sanchez, A., Adelantado‐Renau, M., Moliner‐Urdiales, D., & Beltran‐Valls, M. R. (2021) · European Journal of Sport Science · doi:10.1080/17461391.2021.2012596 · Cited by 10
Lovecchio, N., Vandoni, M., Codella, R., Rovida, A., Pellino, V. C., Giuriato, M., Klug, M. G., & Tomkinson, G. R. (2022) · Journal of Sports Sciences · doi:10.1080/02640414.2023.2165007 · Cited by 10
“Our fi ndings may be important to public health and sport because CRE is signi fi cantly associated with current and future health as well as sporting success (Armstrong et al., 2011; García-Hermoso et al., 2019; Högström et al., 2016; Raghuveer et al., 2020; Smith et al., 2014).”
BackgroundPoon, E. T., Tomkinson, G. R., Lang, J. J., Huang, Y., & Wong, S. H. (2023) · Journal of Sports Sciences · doi:10.1080/02640414.2023.2268350 · Cited by 9
“…potential implications for public health given the significant associations between children’s physical fitness and health-related outcomes now and in the future (Garcia-Hermoso et al., 2019; Hogstrom et al., 2019; Kodama et al., 2009; Ortega et al., 2008; Smith et al., 2014; Soysal et al., 2021).”
BackgroundRocliffe, P., Tapia‐Serrano, M. Á., García‐González, L., Adamakis, M., Walsh, L., Bannon, A., Mulhall, E., Sherwin, I., O’Keeffe, B. T., McNamara, P., et al. (2024) · Adolescent Research Review · doi:10.1007/s40894-023-00231-x · Cited by 26
Huerta‐Uribe, N., Hormazábal‐Aguayo, I., Muñoz‐Pardeza, J., Chueca-Guindulain, M. J., Berrade‐Zubiri, S., Sesma, C. A., Sánchez, E. B., Ezzatvar, Y., Sepulveda, R. A. Y., Izquierdo, M., et al. (2024) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2024-002177 · Cited by 10
“37 Our results also showed that maintaining a high level of handgrip strength was associated with a lower likelihood of being classified as having a high CMR. Previous longitudinal analyses remain conflicted, with some suggesting a protective cardiovascular effect 38 while others show no impact.”
Choi, S. M., Tomkinson, G. R., Lang, J. J., Cadenas‐Sánchez, C., Dong, H., Lei, S., & Poon, E. T. (2025) · Journal of Sports Sciences · doi:10.1080/02640414.2025.2505384 · Cited by 9
“…demographic are less consistently documented, handgrip strength remains a significant predictor of overall and future muscular strength (Dooley et al., 2020; Fraser et al., 2021), bone and cardiometabolic health (Ortega et al., 2012), and early mortality (García-Hermoso et al., 2019) in later life.”
Association between handgrip strength and cardiovascular risk factors among Korean adolescents
Kim, K. K., Lee, K. R., & Hwang, I. C. (2020) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2020-0167 · Cited by 9
“A recent meta-analysis of longitudinal studies indicated a negative association between muscular fitness in childhood/adolescence and CVD parameters in later life [5].”
BackgroundLu, J., Sun, H., Liu, N., Qiu, J., & Xia, X. (2022) · PeerJ · doi:10.7717/peerj.14133 · Cited by 9
A Trend Analysis of Adherence to the Muscle Strengthening Exercise Guidelines in US Adolescents
Chen, S., Yan, J. H., & Zhao, Y. (2022) · International Journal of Public Health · doi:10.3389/ijph.2022.1605022 · Cited by 10
“Beyond the efforts of surveillance and monitoring on trends in MSE in adults, less is studied on people under 18 years, even though children and adolescents can benefit from sufficient MSE [11, 12].”
BackgroundContreras-Osorio, F., Ramírez‐Campillo, R., Cerda-Vega, E., Campos-Jara, R., Martínez‐Salazar, C., Reigal, R. E., Morales‐Sánchez, V., Araya-Sierralta, S., & Campos‐Jara, C. (2022) · Sustainability · doi:10.3390/su142215158 · Cited by 11
Youth Physical Activity Is All About the “F-Words”
Faigenbaum, A. D., Rebullido, T. R., & Chulvi‐Medrano, I. (2020) · Strength and conditioning journal · doi:10.1519/ssc.0000000000000530 · Cited by 12
Santaliestra-Pasías, A. M., Moreno, L. A., Gracia‐Marco, L., Buck, C., Ahrens, W., Henauw, S. D., Hebestreit, A., Kourides, Y. A., Lauria, F., Lissner, L., et al. (2021) · Pediatric Obesity · doi:10.1111/ijpo.12819 · Cited by 8
Helping Children with Obesity “Move Well” To Move More: An Applied Clinical Review
Tsiros, M. D., Vincent, H. K., Getchell, N., & Shultz, S. P. (2021) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000861 · Cited by 9
“The incorporation of both aerobic and strength training modalities ormovements is important to improve both cardiorespiratory fitness and muscle strength (102), which in turn is beneficial for adiposity and cardiometabolic health (1,103).”
Background
Metadata
- Authors
- García-Hermoso, A., Ramírez-Campillo, R., & Izquierdo, M.
- Venue
- Sports Medicine
- Published
- 2019-04-05
- Volume
- 49
- Issue
- 7
- Pages
- 1079-1094
- ISSN
- 0112-1642 (ISSN-L)
- 1179-2035
- OpenAlex
- W2935554824
- Cited by
- 512
- References
- 82
- Citations by year
- 2026: 45 · 2025: 56 · 2024: 81 · 2023: 75 · 2022: 90 · 2021: 93 · 2020: 57 · 2019: 14
- FWCI
- 7.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Academica-e (Universidad Pública de Navarra) (acceptedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Social Sciences › Psychology › Developmental and Educational Psychology › Children's Physical and Motor Development
- Keywords
- muscular fitness, childhood, adolescence, body mass index, adiposity, cardiometabolic health, insulin resistance, triglycerides, cardiovascular risk, bone mineral density, musculoskeletal health, low back pain, grip strength, sit-ups, standing long jump, skinfold thickness
- MeSH terms
- Adolescent, Anthropometry, Child, Health Status, Humans, Physical Fitness, Bone Density, Body Mass Index, Adiposity, Muscle Strength
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