Decline in Physical Fitness From Childhood to Adulthood Associated With Increased Obesity and Insulin Resistance in Adults

  1. Terence Dwyer, MD, MPH1,2,
  2. Costan G. Magnussen2,
  3. Michael D. Schmidt, PHD2,
  4. Obioha C. Ukoumunne, PHD1,
  5. Anne-Louise Ponsonby, PHD1,2,
  6. Olli T. Raitakari, MD, PHD3,
  7. Paul Z. Zimmet, MD, PHD4,
  8. Steven N. Blair, PED5,
  9. Russell Thomson, PHD2,
  10. Verity J. Cleland, PHD6 and
  11. Alison Venn, PHD2
  1. 1Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Australia;
  2. 2Menzies Research Institute, University of Tasmania, Hobart, Australia;
  3. 3Department of Clinical Physiology, University of Turku, Turku, Finland;
  4. 4International Diabetes Institute, Melbourne, Australia;
  5. 5Arnold School of Public Health, University of South Carolina, South Carolina;
  6. 6Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, Australia.
  1. Corresponding author: Terence Dwyer, terry.dwyer{at}


OBJECTIVE To examine how fitness in both childhood and adulthood is associated with adult obesity and insulin resistance.

RESEARCH DESIGN AND METHODS A prospective cohort study set in Australia in 2004–2006 followed up a cohort of 647 adults who had participated in the Australian Schools Health and Fitness Survey in 1985 and who had undergone anthropometry and cardiorespiratory fitness assessment during the survey. Outcome measures were insulin resistance and obesity, defined as a homeostasis model assessment index above the 75th sex-specific percentile and BMI ≥30 kg/m2, respectively.

RESULTS Lower levels of child cardiorespiratory fitness were associated with increased odds of adult obesity (adjusted odds ratio [OR] per unit decrease 3.0 [95% CI 1.6–5.6]) and insulin resistance (1.7 [1.1–2.6]). A decline in fitness level between childhood and adulthood was associated with increased obesity (4.5 [2.6–7.7]) and insulin resistance (2.1 [1.5–2.9]) per unit decline.

CONCLUSIONS A decline in fitness from childhood to adulthood, and by inference a decline in physical activity, is associated with obesity and insulin resistance in adulthood. Programs aimed at maintaining high childhood physical activity levels into adulthood may have potential for reducing the burden of obesity and type 2 diabetes in adults.


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    • Received September 4, 2008.
    • Accepted December 15, 2008.
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  1. Diabetes Care vol. 32 no. 4 683-687
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