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DOI: 10.1016/j.jchb.2015.02.001
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JCHB-25379; No. of Pages 8 ARTICLE IN PRESS
HOMO - Journal of Comparative Human Biology xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
HOMO - Journal of Comparative

Human Biology
journal homepage: www.elsevier.com/locate/jchb
Cardiorespiratory endurance in relation to body

mass in Polish rural children: Preliminary report
E. Gajewska a, K. Kalińska a, P. Bogdański b, M. Sobieska a,∗
a
Chair for Rheumatology and Rehabilitation, Poznań University of Medical Sciences, 28 Czerwca 1956r
135/147, 61-545 Poznań, Poland
b
Department of Internal Medicine, Metabolic Disorders and Hypertension, Poznań University of Medical
Sciences, ul. Szamarzewskiego 62, 60-569, Poland
a r t i c l e i n f o a b s t r a c t
Article history: Physical fitness is generally viewed as having morphological,

Received 3 September 2014 muscular, motor, cardiovascular and metabolic components. Car-
Accepted 9 October 2014 diorespiratory fitness describes the capacity of the cardiovascular
Available online xxx
and respiratory systems to carry out prolonged strenuous exercise.
It is often considered as the most important indicator of health sta-
tus. The place of residence is seen as a factor that may influence
the feasibility of physically active lifestyles, and thus shaping car-
diorespiratory fitness. The study group consisted of 121 children
aged 10–16 years, including 60 girls and 61 boys. All of the children
lived in rural areas. The investigated group was divided according
to age and sex; body height and weight were measured and body
mass index (BMI) calculated. All children performed the Cooper’s
run test and the Ruffier’s test. The analysis of BMI for the nutritional
status of children in relation to the entire study group demonstrated
that 81 children had normal weight, 20 children were overweight
and 11 were obese, while 9 children were underweight. The studied
group of children showed on average very good and good perfor-
mance in the Cooper’s test, regardless of body weight, whereas the
results of the Ruffier’s test showed merely weak or medium car-
diorespiratory endurance, which was even worse in overweight or
obese children.
© 2015 Elsevier GmbH. All rights reserved.
∗ Corresponding author. Tel.: +48 618310244; fax: +48 618310244.

E-mail address: msobieska@ump.edu.pl (M. Sobieska).
http://dx.doi.org/10.1016/j.jchb.2015.02.001
0018-442X/© 2015 Elsevier GmbH. All rights reserved.
Please cite this article in press as: Gajewska, E., et al., Cardiorespiratory endurance in relation
to body mass in Polish rural children: Preliminary report. HOMO - J. Comp. Hum. Biol. (2015),
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2 E. Gajewska et al. / HOMO - Journal of Comparative Human Biology xxx (2015) xxx–xxx
Introduction
Over the last few decades obesity has become increasingly prevalent in children in Poland, European
countries and the United States, as described by Ogden et al. (2012). Being overweight is related to
the increased risk of chronic diseases (civilization diseases) and psychosocial problems, as proposed
by American Academy of Pediatrics (2003) (Anderson and Butcher, 2006). From the public health
perspective, this is currently one of the most serious global challenges for social and health policies
(Currie et al., 2004). In this context particular attention should be drawn to communities at risk of
social inequality, such as the inhabitants of rural areas.
Some experts agree that the epidemic of obesity both in children and adults is mainly due to the
positive energy balance resulting from the low level of physical activity and poor eating habits. Regular
physical activity is considered to be one of the key factors in weight control and essential means
of prevention of chronic diseases among children (Currie et al., 2004). The period of adolescence is
particularly important in the context of the formation of physical activity habits. Their associations
with the risk of being overweight and obesity are evident (Hands et al., 2011). Following the guidelines,
children and adolescents should be physically active at least 60 min per day (Currie et al., 2004). Both
moderate and intense physical efforts are needed to increase the energy expenditure, improve body
composition, and to maximize the health effects for the cardiorespiratory system (Dencker et al., 2006).
Physical fitness is generally viewed as having morphological, muscular, motor, cardiovascular and
metabolic components, as suggested by Shephard and Bouchard (1994). Cardiorespiratory fitness (CRF)
or maximal aerobic power, the capacity of the cardiovascular and respiratory systems to carry out
prolonged strenuous exercise, is often considered as the most important marker of the health status
(Ortega et al., 2008).
CRF is one of the most important indicators of the efficiency of the cardiorespiratory system. Accord-
ing to the World Health Organization, the best indicator of cardiorespiratory fitness is the maximal
oxygen consumption (VO2max ) – the greatest rate at which a person is able to consume oxygen dur-
ing sustained, exhaustive exercise (Shephard et al., 1968). Shuttle tests and tests carried out using a
treadmill and a cycloergometer seem to be the most reliable tests in terms of the CRV assessment
(Pate et al., 2012). Examples of such tests are Cooper’s run/walk test, and the Ruffier’s test, popular in
medical practice. Both are indicated as measures of the cardiopulmonary capacity in healthy children
(Edouarda et al., 2007). The Ruffier’s test is still used in the assessment of cardiorespiratory endurance
in adolescents (Bruneau et al., 2009). Likewise, the walk/run Cooper’s test is applied in the assessment
of cardiorespiratory endurance in school children (Barlow and Dietz, 2002; Drinkard et al., 2001).
A high level of physical fitness among children and adolescents is related to more favorable health
effects, including reduced risks of obesity, cardiovascular diseases, skeletal disorders and mental ill-
ness, as studied by Ruiz et al. (2007a). A higher level of cardiorespiratory fitness is related to more
favorable cardiovascular profiles and more favorable metabolic profiles in children and adolescents
(Hurtig-Wennlöf et al., 2007; Ruiz et al., 2006, 2007a). The level of cardiovascular fitness among
young people is also inversely related to risk factors of cardiovascular diseases such as low levels
of inflammatory markers and homocysteine (Ruiz et al., 2007b).
The correlation between cardiorespiratory endurance and health effects among adults is well
known, and as far as children and the youth are concerned this is a fairly new area of research. The
correlation with such risk factors as obesity and cardiometabolic risk factors is particularly well docu-
mented by Farpour-Lambert et al. (2009) and Puder et al. (2011). There is also an indication of potential
correlations between CRV and risk factors related to the functioning of lungs, to depression, positive
self-image and to bone health, as suggested by Dunton et al. (2007) and Stella et al. (2005).
The place of residence is seen as a factor that may influence the feasibility of physically active
lifestyles, and thus shaping cardiorespiratory fitness (Allender et al., 2008). It has been believed that
children from urban areas are more at risk of obesity than those from rural areas; it is due to easier
access to the goods of civilization associated with a sedentary lifestyle and with the limited time for
fun/outdoor activities. However, it seems that rural areas have ceased, in this respect, to give way to
cities.
The cardiorespiratory endurance of Polish school children was previously studied by Przeweda ˛ and
Dobosz (2003), but the study was limited to the Cooper’s test. According to this study the fitness results
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E. Gajewska et al. / HOMO - Journal of Comparative Human Biology xxx (2015) xxx–xxx 3
Table 1
Demographics (f – female, m – male).
Age Sex Height (m) Weight (kg)
Mean SD Mean SD
10 f (n = 3) 1.43 0.06 33 4
m (n = 2) 1.55 0.09 53 22
11 f (n = 12) 1.47 0.08 40 14
m (n = 9) 1.53 0.07 44 9
12 f (n = 11) 1.54 0.07 47 8
m (n = 10) 1.56 0.04 45 8
13 f (n = 11) 1.62 0.06 53 9
m (n = 13) 1.64 0.05 53 9
14 f (n = 5) 1.66 0.06 62 14
m (n = 11) 1.75 0.07 67 13
15 f (n = 11) 1.66 0.07 56 14
m (n = 9) 1.75 0.07 62 12
16 f (n = 7) 1.74 0.06 66 6
m (n = 7) 1.84 0.06 66 9
decreased in comparison to the previous data and pointed to worse achievements of girls and boys
from urban areas in comparison to rural inhabitants. However, in the last years, a tendency toward
increasing body mass and decreasing physical activity has been observed also among school children
living outside the cities. Therefore the present research was conducted among school children from
rural areas, to study not only the current physical fitness, but also the ability of the whole body of a
child to cope with physical exercise.
Materials and methods
The study group consisted of 121 children aged 10–16 years, including 60 girls and 61 boys. All
of the children lived in rural areas. In order to exclude the influence of other environmental factors,
the study was performed in one school, thus the sample size reflects a typical size of a rural primary
school in Poland. The investigated group was divided according to age and sex, body height and body
weight were taken into consideration (Table 1). The qualifying criterion for the group was age, as
fitness assessment using Cooper’s test can only be applied to children at the age of at least 10 years.
Weight was assessed to the nearest 0.1 kg using a certified electronic scale (Tanita electronic scale
BWB-800 MA Wunder SA.BI. Srl), with the participant wearing sports clothing and no shoes. Height
to the nearest 0.01 m was measured using a stadiometer (Holtain Ltd., Crymych, Pembs. UK). BMI
was calculated for each child. Then, the results of BMI were compared with the data in the tables of
percentile charts described by Palczewska and Niedźwiecka (2001) and on this basis it was determined
whether a child had normal body weight, was overweight, obese, or was underweight. According to
the values provided in the percentile charts, overweight is diagnosed between percentiles 85 and 95,
and obesity when the value is equal to or above percentile 95 (Palczewska and Niedźwiecka, 2001).
Fitness tests – procedure
The first test carried out in the study group, was the Ruffier’s test. Heart rate was measured three
times, each time for 15 s. Before the test, resting heart rate was measured in a sitting position on
the floor in a gym hall. Then, the participant performed 30 squats. Squats were performed in full, i.e.
from full extension to maximum flexion of the lower extremities. The investigator set the pace for
the squats. Immediately following the test, the post-exercise heart rate was also measured in a sitting
position for 15 s. Then the child rested for 1 min and the heart rate was measured again, after the
rest, and also for 15 s. All measurements of the heart rate were recorded in the previously prepared
table. The result of each measurement of the heart rate was multiplied by 4 and used in the formula
determining the Ruffier’s index (Bruneau et al., 2009). The assessment of the results of the Ruffier’s
index was qualified as follows: 0 – very good, 1–5 – good, 6–10 – average, above 10 – poor.
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Table 2
Body mass index (BMI) according to age and sex (f – female, m – male).
Age (years) Sex BMI
Normal Obesity Overweight Underweight
10 f 3 0 0 0
m 1 1 0 0
11 f 7 2 1 2
m 6 1 2 0
12 f 8 1 2 0
m 5 0 3 2
13 f 8 1 2 0
m 8 0 4 1
14 f 3 1 1 0
m 8 2 1 0
15 f 7 2 0 2
m 8 0 1 0
16 f 5 0 2 0
m 4 0 1 2
The next test conducted was the Cooper’s test, otherwise known as the 12-min run test. The children
under investigation, depending on their capabilities, were running, trotting or marching for 12 min
around the perimeter of the gym hall. They could perform each of these activities in one sequence
or in an alternating mode. Each lap in the gym hall was 60 m. Each participant counted the number
of laps he/she ran, trotted or marched and these numbers were recorded in the previously prepared
table. The number of laps was multiplied by 60 m and thus, the distance covered by a participant was
obtained. The assessment of the covered distance was compared with the standards for the results
according to the sex and age of a child as proposed by Barlow and Dietz (2002), Drinkard et al. (2001)
and Osiński (2000).
The results were statistically analyzed using the Statistica 10.0 software. Nonparametric statistics
were used: medians with quartiles for the description of the studied sample and the Kruskal–Wallis’s
test for the study of the differences between the groups distinguished with BMI values.
Results
The analysis of BMI for the nutritional status of children in relation to the entire study group
demonstrated that 81 children had normal weight, 20 children were overweight and 11 were obese,
while 9 children were underweight (Table 2).
The largest number of the participants, 46%, in the Ruffier’s test were assessed as “poor”, then 40%
as “average”, while only 14% were assessed as “good”. None of the children were scored as “very good”.
The individual results for age and sex are shown in Table 3.
Most children in the Cooper’s test, 45%, achieved the score of “excellent”, 19% the score “very good”,
20% “good” and 13% the score “pass”, while 3% of the children received the score of “satisfactory”. The
results for each sex and by age are presented in Table 4.
Then, the result of the Cooper’s test was assessed taking into account the nutritional status of a
child. Children with obesity clearly showed poorer results than their peers with normal body weight.
Overweight children often fell within the normal range, although some of the results were poorer as
compared to individuals with normal body weight. However, it can be observed that individuals with
normal body weight also achieved mediocre results at p = 0.0248 (Fig. 1).
In the Ruffier’s test it has been also observed that obese children performed much worse than the
rest of the group, but what was important, most children with normal weight as well as overweight
and obese children achieved the results of “average” (6–10 points) or “poor” (above 10 points). Only
17 individuals (14%) in the sample taking the test reached the score of “good.” The difference between
the groups was close to statistically significant at p = 0.0722 (Fig. 2).
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Table 3
Number of children, divided into age categories, who achieved in the Ruffier’s test the results of: poor, average or good (f –
female, m – male).
Age Sex Poor Average Good
10 f 2 1 0
m 2 0 0
11 f 6 4 2
m 3 5 1
12 f 2 7 2
m 5 2 3
13 f 5 5 1
m 7 4 2
14 f 2 2 1
m 8 2 1
15 f 6 4 1
m 1 7 1
16 f 6 1 0
m 1 4 2
Discussion
The risk of obesity in the Polish population is growing rapidly, as in many other countries joining
the richer world (International Obesity Task Force, Childhood Report., 2004; Małecka-Tendera et al.,
2005). It is worth noting that even if the variables of the body weight for the investigated children
still remain comparable to age and sex reference values, cardiorespiratory endurance is already worse
than reported for healthy population, adjusted for age, which should be a serious warning for parents
and those working with the youth.
Physical activity is inversely proportional to being overweight and obese in adolescents as docu-
mented by Lubans et al. (2011) and it has a bearing on physical fitness. Specific tests, such as Eurofit
test (Sobieska et al., 2013), Cooper’s test or Ruffier’s test are used for the measurement of physical
fitness (Barlow and Dietz, 2002; Bruneau et al., 2009; Osiński, 2000). Eurofit measures agility, power,
endurance, cardiorespiratory endurance, strength, muscle endurance, flexibility, speed and balance,
while the latter two are used in measurements of the cardiopulmonary capacity. In studies of larger
groups carrying out the Eurofit test is difficult, also because this test is time-consuming and it causes
fatigue in participants after executing all stages of the test. Therefore, often only the Cooper’s test is
used in screening test studies, especially if the assessment involves not the overall physical fitness, but
only its selected aspect, namely performance. In this study, the Cooper’s test has been used, instead of
the long Eurofit test, as the aim was not the assessment of the overall performance, but a comparison of
Table 4
Cooper’s test assessment by sex (f – female, m – male) and age.
Age Sex Satisfactory Pass Good Very good Excellent
10 f 0 1 0 0 2
m 0 0 1 0 1
11 f 0 0 2 1 9
m 0 1 1 0 7
12 f 0 2 4 3 2
m 1 2 1 0 6
13 f 0 2 4 3 2
m 0 2 3 4 4
14 f 0 1 1 2 1
m 0 0 2 6 3
15 f 3 0 0 2 6
m 0 1 0 1 7
16 f 0 3 4 0 0
m 0 1 1 1 4
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Cooper's test results

4500
4000
3500
Cooper's test - distance
3000
2500
2000
1500
Median
1000 25%-75%
normal BMI obesity overweight underweight Min - Max
Fig. 1. Results of the Cooper’s test, expressed in meters each child was able to run or walk within 12 min, divided according to
body mass index (BMI) of each child. Children with obesity were less fit than their pears.
how much the current performance is linked to the metabolic readiness for physical effort, depending
on the nutritional status.
Based on this study it is worth noting that, while children have shown very good and good per-
formance in the Cooper’s test, their performance in the Ruffier’s test raised concern. Children were
able to perform physical exercise, but they did not have any reserves of strength. Ruffier’s test results
Ruffier's test results

20
18
16
14
12
Ruffier's test
10
2
Median
0 25%-75%
normal BMI obesity overweight underweight Min - Max
Fig. 2. Results of the Ruffier’s test, divided according to body mass index (BMI) of each child. Higher value denotes worse
cardiorespiratory endurance. Children with obesity achieved worse results, but the general endurance is low.
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showed that these children did not exercise regularly, and their respiratory system and circulation
were not trained for regular physical exercise, even at such low intensity. This may mean that as they
tire easily, they will make this effort less and less willingly, it will be easier for them to give up physical
exercise for less strenuous forms of leisure time, and they will finally abandon it completely. It has
been shown in adult athletes that the regular training improves cardiorespiratory endurance, and this
can be captured by the Ruffier’s test (Cisse et al., 2006). Studies conducted among older age groups
have shown that with age fitness parameters such as speed, strength and cardiorespiratory capacity
deteriorate, while static force is constant and increases with age (Sobieska et al., 2013), and may even
be greater in people who are overweight or obese. No similar studies related to children, and based
on both Cooper’s and Ruffier’s tests were found in the literature.
It should be noted that the group of children under investigation was not obese in its majority. Thus,
it is difficult to talk about any devastating impact of obesity on the parameters of their performance.
Even more so, however, the results are disturbing because, most probably, children who are not making
a physical effort will be at risk of obesity, and then their desire for taking up sports will certainly not
increase, and their energy balance will be increasingly worse.
The results show once again that children who live outside urban areas are not at lower risk of
immobility, and the resulting destructive consequences of it, than the children who live in cities. This
has been also shown in previous studies, in which the metabolic consequences of obesity were more
pronounced in rural children than in their urban peers (Gajewska et al., 2014). It is also worth noting
that the consequences of obesity in the form of disordered parameters indicative of inflammation
involved boys more frequently than girls (Gajewska et al., 2014).
In conclusion, it may be stated that the studied group of children showed on average very good and
good performance in the Cooper’s test, regardless of body weight, whereas the results of the Ruffier’s
test showed merely weak or medium cardiorespiratory capacity, which was worse in overweight and
obese children.
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Cardiorespiratory endurance in relation to body

Article in HOMO - Journal of Comparative Human Biology · February 2015

Ewa Gajewska Pawel Bogdanski

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Contents lists available at ScienceDirect

HOMO - Journal of Comparative

Cardiorespiratory endurance in relation to body

Article history: Physical ﬁtness is generally viewed as having morphological,

∗ Corresponding author. Tel.: +48 618310244; fax: +48 618310244.

Age Sex Height (m) Weight (kg)

Materials and methods

Fitness tests – procedure

Age (years) Sex BMI

Normal Obesity Overweight Underweight

Age Sex Poor Average Good

Age Sex Satisfactory Pass Good Very good Excellent

Cooper's test results

Ruffier's test results

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