title: Factors associated with low fitness in adolescents--a mixed methods study.
abstract: BACKGROUND
  Fitness and physical activity are important for cardiovascular and mental health but activity and fitness levels are declining especially in adolescents and among girls. This study examines clustering of factors associated with low fitness in adolescents in order to best target public health interventions for young people.
  
  
  METHODS
  1147 children were assessed for fitness, had blood samples, anthropometric measures and all data were linked with routine electronic data to examine educational achievement, deprivation and health service usage. Factors associated with fitness were examined using logistic regression, conditional trees and data mining cluster analysis. Focus groups were conducted with children in a deprived school to examine barriers and facilitators to activity for children in a deprived community.
  
  
  RESULTS
  Unfit adolescents are more likely to be deprived, female, have obesity in the family and not achieve in education. There were 3 main clusters for risk of future heart disease/diabetes (high cholesterol/insulin); children at low risk (not obese, fit, achieving in education), children 'visibly at risk' (overweight, unfit, many hospital/GP visits) and 'invisibly at risk' (unfit but not overweight, failing in academic achievement). Qualitative findings show barriers to physical activity include cost, poor access to activity, lack of core physical literacy skills and limited family support.
  
  
  CONCLUSIONS
  Low fitness in the non-obese child can reveal a hidden group who have high risk factors for heart disease and diabetes but may not be identified as they are normal weight. In deprived communities low fitness is associated with non-achievement in education but in non-deprived communities low fitness is associated with female gender. Interventions need to target deprived families and schools in deprived areas with community wide campaigns.
authors: Richard
authors: R
authors: Charlton
authors: Michael B
authors: MB
authors: Gravenor
authors: Anwen
authors: A
authors: Rees
authors: Gareth
authors: G
authors: Knox
authors: Rebecca
authors: R
authors: Hill
authors: Muhammad A
authors: MA
authors: Rahman
authors: Kerina
authors: K
authors: Jones
authors: Danielle
authors: D
authors: Christian
authors: Julien S
authors: JS
authors: Baker
authors: Gareth
authors: G
authors: Stratton
authors: College of Medicine, Swansea University, Swansea SA2 8PP, UK. s.brophy@swansea.ac.uk.
authors: Sinead
authors: S
authors: Brophy
mesh_terms: D000124:Achievement; D000293:Adolescent; D002648:Child; D002784:Cholesterol / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000209:etiology*; D004522:Educational Status; D015444:Exercise; D005190:Family; D005260:Female; D006293:Health Promotion; D006297:Health Services Accessibility; D006331:Heart Diseases / Q000097:blood / Q000209:etiology*; D006801:Humans; D007328:Insulin / Q000097:blood; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000150:complications; D050177:Overweight; D010809:Physical Fitness; D011203:Poverty; D012016:Reference Values; D012307:Risk Factors; D012574:Schools
chemical_list: D007328:Insulin; D002784:Cholesterol