Article published online: 2021-09-22

Physiology & Biochemistry Thieme

Speed of Movement, Fatness, and the Change in Cardiometabolic

Risk Factors in Children

Authors
Xianwen Shang1, Yanping Li2, Haiquan Xu3, Qian Zhang4, Ailing Liu4, Guansheng Ma5

Affiliations Supplementary Material is available under

1 Royal Melbourne Hospital, The University of Melbourne,
Melbourne, Australia
2 Department of Nutrition, Harvard University T H Chan
School of Public Health, Boston, United States
3 Institute of Food and Nutrition Development, Ministry of
Agriculture and Rural Affairs, Beijing, China
http://doi.org/10.1055/a-1308-2924
Abs tr ac t
We aimed to examine speed of movement and its interactive
association with fatness to changes in cardiometabolic risk fac-
tors over one year in children. The analysis included 8345 chil-

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4 Institute for Nutrition and Health, Chinese Center for dren aged 6–13 years. Cardiometabolic risk score was com-
Disease Control and Prevention National Institute for puted by summing Z-scores of waist circumference, the average
Nutrition and Health, Beijing, China of systolic and diastolic blood pressure, fasting glucose, high-
5 Department of Nutrition and Food Hygiene, Peking density lipoprotein cholesterol (multiplied by − 1), and triglyc-
University, Beijing, China erides. Both high baseline and improvement in speed of move-
ment were associated with favourable changes in percent body
Key words
fat, lipids, and cardiometabolic risk score. Percentages of the
speed of movement, fatness, cardiometabolic risk factors,
association between baseline speed of movement and chang-
moderation analysis, mediation analysis
es in cardiometabolic risk score, triglycerides, and high-densi-
accepted 26.10.2020 ty lipoprotein cholesterol explained by baseline BMI were
published online 22.09.2021 24.6 % (19.6–29.1 %), 26.2 % (19.7–31.1 %), and 12.5 % (9.6–
15.4 %), respectively. The corresponding number for percent
Bibliography body fat was 47.0 % (40.4–54.1 %), 43.3 % (36.7–51.7 %), and
Int J Sports Med 2022; 43: 317–327 29.8 % (25.0–34.6 %), respectively. Speed of movement medi-
DOI 10.1055/a-1308-2924 ated the association between fatness and cardiometabolic risk
ISSN 0172-4622 factors. Improved speed of movement was associated with a
© 2021. Thieme. All rights reserved. lower increase in blood pressure in obese children only. Speed
Georg Thieme Verlag KG, Rüdigerstraße 14, of movement is a strong predictor of changes in cardiometa-
70469 Stuttgart, Germany bolic risk factors. Fatness and speed of movement are interac-
tively associated with cardiometabolic risk factors. Speed of
Correspondence
movement may attenuate the positive association between
Prof. Guansheng Ma
fatness and blood pressure.
Department of Nutrition and Food Hygiene
Peking University
38 Xue Yuan Road
100191 Beijing
China
Tel.: + 86-10-82805266, Fax: + 86-10-82801620
mags@bjmu.edu.cn

Introduction
There were a pandemic and an increasing trend of obesity-related
cardiometabolic risk (CMR) factors globally [1, 2]. Obesity and re-
lated CMR factors, including high levels of plasma glucose, plasma
cholesterol, and blood pressure, contributed to more than half of
global mortality in 2013 [3]. The prevalence of overweight and obe-
sity in Chinese children aged 7 − 13 years increased from 5.9 % in
1991 − 1995 to 21.7 % in 2011 − 2015 [4]. As childhood CMR fac-
tors are highly likely to persist into adulthood [5, 6], it is urgent to
curb the increasing trend in the prevalence of CMR factors at an
early stage of life.
Physical fitness optimizes main stress-responsive systems, neu-
roendocrine and physiological responses, reduces inflammation,
and increases growth factor expression and neural plasticity, which

Shang X et al. Speed of Movement, Fatness, … Int J Sports Med 2022; 43: 317–327 | © 2021. Thieme. All rights reserved. 317
 Physiology & Biochemistry
may help protect against metabolic disorders including hyperten-
sion, diabetes, and metabolic syndrome [7]. Physical fitness has
been thought to be a powerful marker for health in children [8, 9].
Numerous studies have linked cardiorespiratory and muscular fit-
ness to CMR factors in children [10–13]. Speed of movement (SM)
as a physical fitness manifestation is of much less concern regard-
ing its association with CMR factors. However, better performance
in SM (PSM) is strongly associated with higher cardiorespiratory
and muscular fitness [14], lower body mass index (BMI) and waist
circumference [14, 15], and better bone health [16, 17]. This indi-
cates the potential beneficial effect of high PSM on CMR reduction.
However, only several studies in children or adolescents have
investigated the association between PSM and CMR, and the re-
sults are inconsistent [18–20]. Two cross-sectional studies in ado-
lescents have shown an inverse association between PSM and CMR
[19, 20], whereas a longitudinal analysis in 1138 European children
found that PSM was not significantly associated with CMR inde-
pendent of BMI [18]. These studies are limited by cross-sectional
design or small sample sizes and no such work in Chinese children
has been published. Therefore, more longitudinal research with
large sample sizes needs to examine whether PSM was indepen-
dently associated with CMR in children.
Emerging evidence reveals an obesity paradox in patients with
cardiovascular disease (CVD) that a better prognosis in mildly obese
CVD patients than their leaner counterparts was observed [21, 22].
This paradox may be largely explained by physical fitness; there-
fore, it is important to test whether the association between fat-
ness and CMR was mediated by PSM. Recent evidence has also
shown that fat-but-fit individuals may have good metabolic health
[23], which provides a rationale for examining whether the associ-
ation between PSM and CMR was moderated by fatness in children.
However, the mediation and moderation effect of fatness on the
association between PSM and CMR has not been reported in previ-
ous studies.
We examined whether baseline and change in PSM were inde-
pendently associated with the change in CMR in children. We also
analysed whether the association between PSM and change in CMR
was moderated or mediated by fatness and whether PSM altered
the association between fatness and CMR.
Materials and Methods
Study design
The present analysis was based on the nutrition-based comprehen-
sive intervention study on childhood obesity in China, which is a
multicentre, randomized cluster-controlled trial. The study was
conducted in six capital or provincial capital cities: Beijing, Shang-
hai, Chongqing, Jinan, Harbin, and Guangzhou. The design has been
detailed elsewhere [24]. The intervention included six 40-min nu-
trition lectures with each in one month of the first six months as
well as two times of ten minutes or one time 20 min of Happy 10
program per day (involves various physical activities such as games,
dance, and gymnastics) in the first ten months [24, 25]. Of 9867
healthy children who were assessed at baseline, those who did not
return at follow-up (n = 1295) or those who did not have SM tested
or had abnormal SM were excluded (n = 227). A total of 8345 chil-
318 Shang X et al. Speed of Movement, Fatness, … Int J Sports Med 2022; 43: 317–327 | © 2021. Thieme. All rights reserved.
Thieme
dren were included in the final analysis. Selection criteria for schools
included: 1) non-boarding schools, 2) the prevalence of obesity
above 10 %, and 3) more than 50 % of students having lunch in the
canteen at school. We excluded students who suffered from seri-
ous illnesses (such as congenital heart disease, fixation or joint re-
placement surgery), who could not withstand severe physical ac-
tivity or diet control, or who participated in other similar interven-
tion projects in the preceding year or planned to participate
within the next year.
Our study meets the ethical standards of the journal [26].
Physical fitness measurements
SM was tested using the 50-meter sprint run, a traditional method
in China [27]. Participants with appropriate shoes and clothing
were instructed to run in a straight line at the highest speed possi-
ble between marker cones. The test was recorded to the nearest
0.1 s (CASIO, HS-70W stopwatch, Boda Electronic Technology Co.,
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Ltd, Shenzhen, China). The result would be considered as one com-
ponent of the physical education score for the semester to moti-
vate all participants to try their best in the test. We computed PSM
by using 50 meters divided by test time (meters/second) with a
higher value representing better performance. Cardiorespiratory
fitness was evaluated using the 50-meter × 8 shuttle run and mus-
cular fitness using the standing long jump [27]. Age- and sex-spe-
cific Z scores for PSM, cardiorespiratory fitness, and muscular fit-
ness were used in the analysis.
Physical examinations and blood tests
Physical examinations and blood tests (10–14 h fasting beforehand)
were performed at both baseline (May 2009) and follow-up (May
2010) following standardized procedures by trained staff.
Height was measured to the nearest 0.1 centimetre using a free-
standing stadiometer (RGT-140, Wujin Hengqi Co. Ltd., Chang-
zhou, China) with the participants removing shoes and outer
clothes. Weight was measured to the nearest 0.1 kg using a bal-
ance-beam scale (GMCS-I, Xindong Huateng Sports Equipment Co.
Ltd., Beijing, China) with participants in light indoor clothing. BMI
was calculated as weight in kilograms divided by squared height in
meters. Waist circumference was measured midway between the
lowest rib and the superior border of the iliac crest on expiration to
the nearest 0.1 centimetre and the average of two measurements
was used.
Body composition was assessed using a single frequency (50 Hz)
hand to foot bioelectrical impendence device (ImpDF50, Imped-
imed Pty Ltd., Qld, Australia). Body fat mass was computed with
the prediction formula developed by Deurenberg et al. and percent
body fat (PBF) was then calculated as fat mass divided by body
weight [28]. Fatness refers to obesity markers, including BMI, waist
circumference, and PBF in the present study.
Systolic and diastolic blood pressure (SBP and DBP) were meas-
ured using a manual mercury sphygmomanometer (XJ300/40-1,
Shangda Medical Instrument Factory Co., Ltd, Shanghai, China) in
the seated position by trained nurses. Three measurements were
taken to the nearest two mmHg, and the average of last two was
used. Mean arterial pressure (MAP) was calculated as DBP + ([SBP-
DBP]/3).
 Fasting venous blood samples (5 mL) were collected in serum
separator tubes between 7:30 AM and 8:30 AM in the morning by
trained nurses. These blood samples were then transported, clot-
ted for 20 − 30 min, and centrifuged for 10–15 min at 3200 RPM.
Blood samples for glucose tests were transported to the clinical
laboratory in a cooler at 4 °C. Other blood samples were stored
in − 70 °C freezers until further testing. Fasting glucose concentra-
tions were measured immediately using the glucose-oxidize meth-
od (Daiichi Pharmaceutical Co., Ltd, Tokyo, Japan). Fasting insulin
was measured using the immunoenzymatic method (analyzer
AXSYM, Abbott Co., Ltd, Japan). The homeostatic model assess-
ment of insulin resistance (HOMA-IR) was calculated as (fasting in-
sulin [µU/L] × fasting glucose [mg/dL])/405. Plasma triglycerides,
total cholesterol, high-density lipoprotein cholesterol (HDL-C),
low-density lipoprotein cholesterol (LDL-C) were measured with
7080 Automatic Analyzer (Daiichi Pharmaceutical Co., Ltd, Tokyo,
Japan).
CMR score (CMRS) was calculated by summing age- and sex-
specific Z scores of waist circumference, the average of SBP and
DBP, fasting glucose, HDL-C (multiplied by − 1), and triglycerides
[29, 30]. Waist circumference was removed from this score in the
mediation analysis for PSM and fatness with CMRS given the high
correlation between waist circumference and BMI/PBF. Values of
triglycerides, insulin, and HOMA-IR were log-transformed.
Covariates
Dietary intake was assessed using 24-h diet recalls for three con-
secutive days. Physical activity was assessed using a validated ques-
tionnaire, from which metabolic equivalent (MET) was calculated
[31]. Puberty status was recorded by investigators during the in-
terview when physical examinations were conducted. Birthweight,
household income, parental education, and parental height and
weight were reported by the parents.
Statistical analysis
We presented continuous variables as means ± standard deviations
(SDs) and categorical variables as frequency and percentage.
ANOVA was used to test whether baseline characteristics differed
across quintiles of PSM for continuous variables and the Chi-square
test for categorical variables.
General linear regression models (GLM) were used to test the
associations between PSM and BMI/PBF.
Changes in CMR factors and PSM were calculated by subtract-
ing the results at baseline from those at follow-up. We did the anal-
ysis in boys and girls mixed given the interaction between sex and
PSM was not significant for most CMR factors (▶Table 1S). We used
GLM to test the association between changes in CMR factors and
baseline/change in PSM. The multivariable model was adjusted for
classes in schools as clustering effects and characteristics of the in-
dividuals including age, sex, BMI, cardiorespiratory fitness, muscu-
lar fitness, physical activity, energy intake at baseline, puberty,
birthweight, household income, mother’s education, father’s ed-
ucation, mother’s BMI, and father’s BMI as fixed effects.
Moderation analysis was conducted to test whether the associ-
ation between PSM and CMR was different across BMI groups. GLM
was used to examine whether the association between PSM and
Shang X et al. Speed of Movement, Fatness, … Int J Sports Med 2022; 43: 317–327 | © 2021. Thieme. All rights reserved.
changes in CMR factors was modified by BMI. Children were divi­
ded into normal weight, overweight, and obesity groups using BMI
according to the International Obesity Task Force standard [32].
Mediation analysis was used to test how much of the effect of
PSM on CMR was explained by fatness. The mediation effect of BMI/
PBF on the association between PSM and changes in CMR factors
was analysed using GLM. Percentages of the total effect of PSM on
CMR mediated by BMI/PBF were computed [33, 34]. We used the
following criteria to establish mediation: 1) the exposure was sig-
nificantly associated with the outcome, 2) the mediator was signif-
icantly associated with the exposure, 3) the mediator was signifi-
cantly associated with the outcome, 4) the association between
the exposure and outcome was attenuated by the mediator. We
also examined whether the association between fatness and chang-
es in CMR factors was mediated by PSM.
Sensitivity analysis was performed to test the association be-
tween the change in PSM and changes in CMR factors in the control
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group given the significant interaction between intervention and
the change in PSM for changes in some CMR factors (▶Table 2S).
Analyses were performed using SAS version 9.4 (SAS Institute
Inc.), and all P-values were two-tailed.
Results
Study population
We included 8345 children (49.3 % girls) aged 9.07 ± 1.42 (6–13)
years in the final analysis. Dropouts were more likely to be boys, in
high grade, and older, and have lower total cholesterol and HDL-C
than those included in the analysis (▶Table 3S).
Compared with children in the lowest quintile of baseline PSM,
those in the highest quintile had lower BMI, waist circumference,
PBF, SBP, DBP, MAP, total cholesterol, triglycerides, LDL-C, insulin,
HOMA-IR, CMRS, and higher HDL-C and fasting glucose at baseline
(all P-values < 0.05, ▶ Table 1).
Fatness and speed test performance
The mean PSM at baseline was 4.87 ± 0.57 meters/second, and it
increased by 0.23 ± 0.53 meters/second during follow-up. Both BMI
and PBF at baseline were inversely correlated with baseline PSM in
both boys (R2 = 0.084 for BMI, 0.129 for PBF) and girls (R2 = 0.025
for BMI, 0.057 for PBF, ▶ Fig. 1).
PSM and changes in CMR factors
High baseline PSM was associated with favourable changes in PBF,
triglycerides, HDL-C, and CMRS in the multivariable analysis. The
inverse association between baseline PSM and changes in SBP, in-
sulin, and HOMA-IR was significant before but not after adjustment
for baseline BMI. Improved PSM was associated with favourable
changes in BMI, waist circumference, PBF, SBP, DBP, MAP, LDL-C,
triglycerides, fasting glucose, and CMRS in the multivariable-anal-
ysis (▶Table 2).
Moderation analysis
An inverse association between the change in PSM and changes in
SBP, DBP, and MAP was observed in obese children only (all P-inter-
action < 0.05). The inverse association between the change in PSM
319
 Physiology & Biochemistry Thieme

▶Table 1 Baseline characteristics by quintiles of performance in speed of movement at baseline.

Performance in speed of movement at baseline * P-trend†

Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5
Age (years) 8.90 ± 1.42‡ 9.13 ± 1.46 9.15 ± 1.41 9.10 ± 1.37 9.10 ± 1.43 < 0.001
BMI (kg/m2) 17.91 ± 3.93 17.33 ± 3.29 16.91 ± 2.99 16.39 ± 2.46 16.23 ± 2.10 < 0.001
Waist circumference (cm) 60.06 ± 11.21 58.69 ± 9.35 57.26 ± 8.28 55.97 ± 6.99 55.39 ± 6.13 < 0.001
PBF ( %) 26.02 ± 4.94 24.90 ± 4.62 23.98 ± 4.62 23.03 ± 4.30 22.14 ± 4.34 < 0.001
SBP (mm Hg) 100.18 ± 11.19 99.76 ± 11.07 99.43 ± 10.72 99.60 ± 10.66 98.93 ± 10.26 0.002
DBP (mm Hg) 63.47 ± 9.62 63.44 ± 9.24 63.01 ± 9.13 63.31 ± 8.86 62.92 ± 8.64 0.0818
MAP (mm Hg) 75.68 ± 9.38 75.54 ± 9.09 75.13 ± 8.88 75.38 ± 8.72 74.91 ± 8.46 0.014
Total cholesterol (mmol/L) 4.10 ± 0.74 4.12 ± 0.80 4.12 ± 0.78 4.05 ± 0.77 4.03 ± 0.77 < 0.001
HDL-C (mmol/L) 1.45 ± 0.31 1.45 ± 0.30 1.49 ± 0.30 1.48 ± 0.30 1.49 ± 0.31 < 0.001
LDL-C (mmol/L) 2.15 ± 0.64 2.17 ± 0.65 2.16 ± 0.63 2.10 ± 0.60 2.05 ± 0.61 < 0.001
Triglyceride (mmol/L) 0.86 ± 0.49 0.83 ± 0.46 0.80 ± 0.41 0.79 ± 0.40 0.76 ± 0.39 < 0.001
Fasting glucose (mmol/L) 4.46 ± 0.59 4.48 ± 0.57 4.51 ± 0.56 4.58 ± 0.53 4.59 ± 0.53 < 0.001
Log insulin 1.72 ± 0.68 1.66 ± 0.63 1.62 ± 0.58 1.57 ± 0.59 1.51 ± 0.58 < 0.001

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Log HOMA-IR − 2.79 ± 0.71 − 2.85 ± 0.68 − 2.89 ± 0.62 − 2.92 ± 0.63 − 2.97 ± 0.62 < 0.001
CMRS 0.05 ± 2.57 − 0.15 ± 2.41 − 0.34 ± 2.38 − 0.30 ± 2.31 − 0.44 ± 2.25 < 0.001
Energy (kcal/day) 1272.73 ± 440.59 1295.25 ± 472.45 1279.12 ± 478.44 1256.08 ± 459.32 1230.40 ± 472.58 < 0.001
Physical activity (MET/week) 655.19 ± 499.15 640.16 ± 512.84 620.20 ± 482.63 641.15 ± 524.69 640.47 ± 509.22 0.47
Sex 0.87
Boys 843 (50.6) § 846 (51.1) 826 (50.6) 866 (50.5) 848 (50.5)
Girls 823 (49.4) 808 (48.9) 805 (49.4) 849 (49.5) 831 (49.5)
Grade < 0.001
One 464 (27.9) 335 (20.3) 295 (18.1) 284 (16.6) 301 (17.9)
Two 330 (19.8) 387 (23.4) 361 (22.1) 418 (24.4) 374 (22.3)
Three 366 (22.0) 324 (19.6) 372 (22.8) 404 (23.6) 367 (21.9)
Four 337 (20.2) 350 (21.2) 370 (22.7) 388 (22.6) 393 (23.4)
Five 169 (10.1) 258 (15.6) 233 (14.3) 221 (12.9) 244 (14.5)
Puberty 0.83
Yes 1582 (95.0) 1538 (93.0) 1521 (93.3) 1613 (94.1) 1582 (94.2)
No 84 (5.0) 116 (7.0) 110 (6.7) 102 (5.9) 97 (5.8)
Birth weight < 0.001
< 2500 g 42 (2.5) 43 (2.6) 41 (2.5) 53 (3.1) 39 (2.3)
2500–3999 g 840 (50.4) 996 (60.2) 1019 (62.5) 1067 (62.2) 1075 (64.0)
≥ 4000 g 108 (6.5) 120 (7.3) 99 (6.1) 118 (6.9) 111 (6.6)
Missing 676 (40.6) 495 (29.9) 472 (28.9) 477 (27.8) 454 (27.0)
Mother’s BMI < 0.001
< 24 kg/m2 743 (44.6) 946 (57.2) 964 (59.1) 1080 (63.0) 1055 (62.8)
24–27.9 kg/m2 242 (14.5) 212 (12.8) 201 (12.3) 178 (10.4) 194 (11.6)
≥ 28 kg/m2 40 (2.4) 32 (1.9) 34 (2.1) 30 (1.7) 13 (0.8)
Missing 641 (38.5) 464 (28.1) 432 (26.5) 427 (24.9) 417 (24.8)
Father’s BMI < 0.001
< 24 kg/m2 508 (30.5) 653 (39.5) 671 (41.1) 756 (44.1) 718 (42.8)
24–27.9 kg/m2 392 (23.5) 421 (25.5) 424 (26.0) 433 (25.2) 459 (27.3)
≥ 28 kg/m2 125 (7.5) 116 (7.0) 104 (6.4) 99 (5.8) 85 (5.1)
Missing 641 (38.5) 464 (28.1) 432 (26.5) 427 (24.9) 417 (24.8)
Mother’s education < 0.001
< 7 years 108 (6.5) 137 (8.3) 148 (9.1) 170 (9.9) 140 (8.3)
7–12 years 649 (39.0) 763 (46.1) 747 (45.8) 789 (46.0) 820 (48.8)
≥ 13 years 256 (15.4) 265 (16.0) 273 (16.7) 299 (17.4) 268 (16.0)
Missing 653 (39.2) 489 (29.6) 463 (28.4) 457 (26.6) 451 (26.9)
Father’s education < 0.001

320 Shang X et al. Speed of Movement, Fatness, … Int J Sports Med 2022; 43: 317–327 | © 2021. Thieme. All rights reserved.
▶Table 1 Continued.
Baseline characteristics by quintiles of performance in speed of movement at baseline.

Performance in speed of movement at baseline * P-trend†

Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5
< 7 years 52 (3.1) 83 (5.0) 87 (5.3) 104 (6.1) 77 (4.6)
7–12 years 653 (39.2) 774 (46.8) 783 (48.0) 839 (48.9) 851 (50.7)
≥ 13 years 307 (18.4) 311 (18.8) 304 (18.6) 319 (18.6) 309 (18.4)
Missing 654 (39.3) 486 (29.4) 457 (28.0) 453 (26.4) 442 (26.3)
Household income per month < 0.001
< 750 RMB 129 (7.7) 161 (9.7) 129 (7.9) 135 (7.9) 144 (8.6)
751–1500 RMB 340 (20.4) 395 (23.9) 367 (22.5) 425 (24.8) 384 (22.9)
1501–2500 RMB 261 (15.7) 307 (18.6) 330 (20.2) 330 (19.2) 331 (19.7)
≥ 2501 RMB 270 (16.2) 295 (17.8) 328 (20.1) 353 (20.6) 349 (20.8)
Missing 666 (40.0) 496 (30.0) 477 (29.2) 472 (27.5) 471 (28.1)
Intervention 0.004
No 607 (36.4) 801 (48.4) 820 (50.3) 826 (48.2) 706 (42.0)
Yes 1059 (63.6) 853 (51.6) 811 (49.7) 889 (51.8) 973 (58.0)

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BMI, body mass index; CMRS, cardiometabolic risk score; DBP, diastolic blood pressure; HDL-C, high-density lipoprotein cholesterol; HOMA-IR,
homeostatic model assessment of insulin resistance; LDL-C, low-density lipoprotein cholesterol; MAP, mean arterial pressure; SBP, systolic blood
pressure. * Quintiles were calculated based on age- and sex-specific Z score of performance in speed of movement (meters/second). †ANOVA was used to
test the difference of continuous variables across quintile of performance in speed of movement and Chi-square for categorical variables. ‡All such data
were mean ± standard deviation. §All such data were frequency (percentage).

and the change in CMRS was more evident in overweight children
(▶ Fig. 2.).
Mediation analysis
Mediation analysis indicated that baseline BMI explained 24.6 %,
26.2 %, and 12.5 % of the total effect of baseline PSM on the chang-
es in CMRS, triglycerides, and HDL-C, respectively. The correspond-
ing number for baseline PBF was almost doubled (47.0 %, 43.3 %,
and 29.8 %, respectively). The percentage of the total effect of base-
line BMI on changes in CMRS, triglycerides, and HDL-C explained
by baseline PSM was 6.0 %, 4.8 %, 11.8 %, respectively. Baseline PSM
explained 7.6–14.8 % of the association between baseline PBF and
changes in CMRS, triglycerides, and HDL-C (▶Fig. 3).
Sensitivity analysis
Similar results for the association between the change in PSM and
changes in CMR factors were found in the control group compared
with those in the total population (▶Table 4S).
Discussion
In this longitudinal analysis with a large sample size in children, we
found high baseline PSM was associated with favourable changes
in CMRS, PBF, HDL-C, and triglycerides independent of fatness, car-
diorespiratory fitness, and muscular fitness. Improved PSM was as-
sociated with favourable changes in fatness, SBP, DBP, MAP, LDL-C,
triglycerides, fasting glucose, and CMRS. Both BMI and PBF were
major mediators for the association between PSM and CMR factors
with PBF explaining around two times of total effect than BMI. The
association of improved PSM with favourable changes in blood pres-
sure was stronger in obese children.
Cross-sectional studies have shown a high correlation between
PSM and body composition [14, 15, 18, 35]. Likely, we found lower
baseline BMI/PBF was associated with higher baseline PSM. A cross-
sectional study of 1140 Canadian children aged 7–10 years showed
PSM was inversely associated with BMI and waist circumference
[15]. Data from the IDEFICS study of 1138 European children aged
6–11 years demonstrated an inverse association between waist cir-
cumference and PSM [18]. A national reprehensive analysis of
107,206 Chinese children found that overweight and obesity were
associated with lower PSM [14]. Less is known about the associa-
tion between PSM and PBF in children. Our analysis showed that
both low baseline PBF and a low increase in PBF were associated
with increased PSM during follow-up. In line with this, a cross-sec-
tional study of 278 adolescents aged 13–18 years demonstrated
PSM was positively correlated with lean mass [36]. Our study with
a large sample size found both BMI and PBF were inversely associ-
ated with the change in PSM with baseline PBF being a stronger
predictor. Notably, a linear relationship between PBF and PSM but
a non-linear relationship between BMI and PSM was observed in
our study. The non-linear relationship between BMI and PSM may
be due to the fact that very low BMI represents a status of malnu-
trition resulting in poor PSM in children.
There are several potential pathways to the association between
PSM and cardiometabolic health. High PSM represents higher lev-
els of physical activity, which are associated with better metabolic
health in children [37]. In addition, high PSM may be associated
with increased metabolic resilience resulting in beneficial effects
on metabolic health [7]. The beneficial effect of high PSM on bone
health and body lean mass [16, 17, 36, 38] also suggests its poten-
tial favourable effects on CMR reduction. Previous clinical trials have
demonstrated that sprint interval running increases fat loss [39]
and insulin sensitivity [40], and reduces resting heart rate and
blood pressure in overweight or obese adults [41]. This indicates
that high PSM may have the potential to improve metabolic health
in children.

Shang X et al. Speed of Movement, Fatness, … Int J Sports Med 2022; 43: 317–327 | © 2021. Thieme. All rights reserved. 321
 Physiology & Biochemistry Thieme

a b
0.4 0.4
0.3 0.3

Z-score of PSM at baseline (SD)

Z-score of PSM at baseline (SD)

a
0.2 0.2
0.1 0.1 a a
ab
0.0 0.0 a
– 0.1 abc – 0.1
abcd abc
– 0.2 – 0.2
– 0.3 – 0.3 abcd
– 0.4 – 0.4
Boys* Boys*
– 0.5 abcd – 0.5
Girls* Girls*
– 0.6 – 0.6 abcd
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Q
BMI Z-score at baseline (SD) PBF Z-score at baseline (SD)

c d
0.8 0.8
Change in Z-score of PSM (SD)

Change in Z-score of PSM (SD)

0.7 0.7

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0.6 0.6 a

0.5 a
0.5
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0.4 ab 0.4
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Boys* Boys*
Girls* abcd 0.2 Girls* abcd
0.2
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BMI Z-score at baseline (SD) PBF Z-score at baseline (SD)

e f
Change in Z-score of PSM (SD)

Change in Z-score of PSM (SD)

0.6 0.6

0.5 0.5

a
a
ab
Boys* Boys* ab
0.4 0.4
Girls* a Girls
1

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Change in BMI Z- score (SD) Change in PBF Z- score (SD)

▶Fig. 1 Fatness and performance in speed of movement in boys and girls. BMI, body mass index; PBF, percent body fat; PSM, performance in speed
of movement; SD, standard deviation. * represents a significant linear trend of PSM associated with quintiles of BMI or PBF. GLM was used to esti-
mate means and standard errors for each quintile of BMI/PBF adjusted for classes in school as clustering effects and age (additional adjustment for
BMI and PSM at baseline for changes) as fixed effects. abcdBonferroni Post-hoc test was used to examine the difference between every two quintiles of
BMI/PBF with a indicating significance compared with Quintile 1, b indicating significance compared with Quintile 2, c indicating significance com-
pared with Quintile 3, and d indicating significance compared with Quintile 4.

We found the potential beneficial effect of better PSM on CMRS, sociated with an increased future cardiovascular risk [20]. A recent
PBF, HDL-C, and triglycerides independent of fatness, cardiorespi- cross-sectional study of 1851 French youths aged 12.3 years found
ratory fitness, and muscular fitness although the magnitude for PBF an inverse association between future cardiovascular risk and PSM
and triglycerides was relatively small. Several cross-sectional stud- [19]. However, the future cardiovascular risk was defined by a
ies have demonstrated that PSM was inversely associated with CMR healthy cardiorespiratory fitness level rather than measured CMR.
factors [18–20]. The cross-sectional analysis of the IDEFICS study Vanhelst et al. also reported that PSM was inversely associated with
showed that PSM was inversely associated with CMR factors inde- HDL-C [19]. This is controversial to the positive association be-
pendent of BMI [18]. Another cross-sectional study of 2859 Span- tween baseline PSM and the change in HDL-C in our study, but con-
ish adolescents aged 13–18 years showed that low speed was as- sistent with our finding regarding the inverse association between

322 Shang X et al. Speed of Movement, Fatness, … Int J Sports Med 2022; 43: 317–327 | © 2021. Thieme. All rights reserved.
▶Table 2 Changes in cardiometabolic risk factors associated with performance in speed of movement.

Performance in speed of movement at baseline (Z-score) Change in performance in speed of movement (Z-score) *
Partici- Age- and sex-adjusted Multivariable-adjusted Partici- Age- and sex-adjusted Multivariable-adjusted
pants β (95 % CI) β (95 % CI)† pants β (95 % CI) β (95 % CI)†
Change in BMI 8242 − 0.0304 − 0.0122 7406 − 0.0370 − 0.0283
( − 0.0438, − 0.0170)‡ ( − 0.0278, 0.0033) ( − 0.0526, − 0.0214)‡ ( − 0.0443, − 0.0124)‡
Change in waist 8210 − 0.0222 − 0.0042 7374 − 0.0524 − 0.0372
circumference ( − 0.0331, − 0.0114)‡ ( − 0.0165, 0.0080) ( − 0.0653, − 0.0395)‡ ( − 0.0500, − 0.0245)‡
Change in PBF 8031 − 0.0529 − 0.0513 7218 − 0.0715 − 0.0754
( − 0.0703, − 0.0356)‡ ( − 0.0714, − 0.0311)‡ ( − 0.0918, − 0.0513)‡ ( − 0.0961, − 0.0547)‡
Change in SBP 8220 − 0.0431 − 0.0020 7390 − 0.0486 − 0.0351
( − 0.0647, − 0.0215)‡ ( − 0.0277, 0.0236) ( − 0.0748, − 0.0224)‡ ( − 0.0619, − 0.0083)‡
Change in DBP 8230 − 0.0041 0.0247 7398 − 0.0389 − 0.0324
( − 0.0255, 0.0172) ( − 0.0011, 0.0505) ( − 0.0651, − 0.0127)‡ ( − 0.0595, − 0.0052)‡
Change in MAP 8219 − 0.0212 0.0153 7390 − 0.0452 − 0.0364
( − 0.0427, 0.0002) ( − 0.0105, 0.0411) ( − 0.0715, − 0.0189)‡ ( − 0.0635, − 0.0093)‡
Change in total 7742 − 0.0189 − 0.0171 6955 − 0.0284 − 0.0142 ( − 0.0345,
cholesterol ( − 0.0355, − 0.0023)‡ ( − 0.0373, 0.0031) ( − 0.0481, − 0.0087)‡ 0.0061)

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Change in 7734 0.1609 0.1208 6950 − 0.0314 − 0.0396
HDL-C (0.1373, 0.1846)‡ (0.0920, 0.1497)‡ ( − 0.0597, − 0.0030)‡ ( − 0.0688, − 0.0105)‡
Change in 7743 0.0043 0.0387 6955 − 0.0391 − 0.0234
LDL-C ( − 0.0141, 0.0227) (0.0162, 0.0613) ( − 0.0616, − 0.0166)‡ ( − 0.0466, − 0.0001)
Change in 7747 − 0.0814 − 0.0474 6959 − 0.0794 − 0.0404
triglyceride ( − 0.1027, − 0.0602)‡ ( − 0.0728, − 0.0221)‡ ( − 0.1048, − 0.0539)‡ ( − 0.0662, − 0.0146)‡
Change in 7743 0.0260 0.0095 ( − 0.0129, 6956 − 0.0404 − 0.0789
fasting glucose (0.0081, 0.0440)‡ 0.0318) ( − 0.0626, − 0.0182)‡ ( − 0.1019, − 0.0560)‡
Change in 6851 − 0.0786 − 0.0239 ( − 0.0645, 6145 − 0.0360 ( − 0.0779, − 0.0020 ( − 0.0440,
insulin ( − 0.1133, − 0.0440)‡ 0.0167) 0.0058) 0.0400)
Change in 6844 − 0.0685 − 0.0221 ( − 0.0615, 6139 − 0.0467 − 0.0179 ( − 0.0586,
HOMA-IR ( − 0.1021, − 0.0350)‡ 0.0173) ( − 0.0872, − 0.0063)‡ 0.0228)
Change in 7068 − 0.2587 − 0.1452 6374 − 0.1702 − 0.1415
CMRS§ ( − 0.3139, − 0.2035)‡ ( − 0.2090, − 0.0813)‡ ( − 0.2355, − 0.1049)‡ ( − 0.2062, − 0.0767)‡

BMI, body mass index; CMRS, cardiometabolic risk score; DBP, diastolic blood pressure; HOMA-IR, homeostatic model assessment of insulin resistance;
HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MAP, mean arterial pressure; SBP, systolic blood pressure; SE,
standard error. * Changes in CMR factors and performance in speed of movement (age- and sex-adjusted Z-scores) were calculated by subtracting the
results at baseline from those at follow-up. †GLM was used to estimate multivariable-adjusted β (95 % CI) of the association between cardiometabolic risk
factors and change in PSM. Multivariable was adjusted for children within classes in school as clustering effects and characteristics of the individuals
including age, sex, intervention, BMI, corresponding cardiometabolic risk factor, puberty, grade, intervention, BMI, cardiorespiratory fitness, muscular
fitness, physical activity, energy intake, birthweight, household income, mother’s education, father’s education, mother’s BMI, and father’s BMI as fixed
effects. ‡Indicates significant associations. Benjamin-Hochberg procedure was used to control the false discovery rate at level 5 % for multiple compari-
sons with the P-value cut-off point of significance for age- and sex-adjusted analysis (baseline PSM), multivariable-adjusted analysis (baseline PSM),
age- and sex-adjusted analysis (change in PSM), multivariable-adjusted analysis ( change in PSM), was 0.0393, 0.0179, 0.0464, and 0.0357, respectively.
§CMRS was calculated by summing age- and sex-specific Z scores of waist circumference, the average of SBP and DBP, fasting glucose, HDL-C (multiplied

by − 1) and triglyceride.

change in PSM and change in HDL-C. A longitudinal analysis based
on the IDEFICS study did not find an inverse association between
PSM and CMR factors independent of BMI [18]. We found improved
PSM was independently associated with favourable changes in fat-
ness, blood pressure, LDL-C, triglycerides, fasting glucose, and
CMRS. The reason why PSM is more predictive of CMR factors in
our study may be attributed to the larger sample size and different
tests used for assessing PSM. Our findings suggest PSM is a strong
predictor for changes in CMR factors independent of fatness. As
PSM can be more easily assessed compared with cardiorespiratory
fitness and may be a more reliable marker of CMR factors, there is
a potential for the application as a widespread assessment tool.
To our knowledge, no previous study has reported the extent to
which the association between PSM and CMR was explained by fat-
ness. A cross-sectional study of 278 adolescents aged 13–18 years
have shown that physical fitness effect on bone mass is mediated
by lean mass [36]. Furthermore, a longitudinal analysis of the IDEFI-
CS study showed that the inverse association between change in
PSM and CMRS was attenuated to be non-significant after adjust-
ment for BMI [18]. This suggests the association between PSM and
CMR largely depended on fatness. We found that BMI was a major
mediator for the association between PSM and CMR factors while
PBF explained almost two times the total effect than BMI did. This
may be due to the stronger association between PBF and PSM in
our study. Although whether fatness was a mediator for the asso-

Shang X et al. Speed of Movement, Fatness, … Int J Sports Med 2022; 43: 317–327 | © 2021. Thieme. All rights reserved. 323
 Physiology & Biochemistry Thieme

Participant Multivariable-adjusted β (95 % CI)* P value†

Association Interaction
Change in SBP 0.0096
‡
Normal weight 5 967 – 0.0107 (– 0.0350, 0.0137) 0.39

Overweight 1 020 – 0.0180 (– 0.0801, 0.0441) 0.57

Obesity 403 – 0.1181 (– 0.2221, – 0.0141) 0.0262

Change in DBP < 0.0001

Normal weight 5 973 – 0.0170 (– 0.0414, 0.0074) 0.17

Overweight 1 021 – 0.0331 (– 0.0980, 0.0317) 0.32

Obesity 404 – 0.1846 (– 0.2899, – 0.0793) 0.0007

Change in MAP < 0.0001

Normal weight 5 965 – 0.0158 (– 0.0403, 0.0086) 0.20

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Overweight 1 021 – 0.0279 (– 0.0916, 0.0358) 0.39

Obesity 404 – 0.1718 (– 0.2763, – 0.0672) 0.0014

Change in CMRS 0.0021

Normal weight 5 549 – 0.0581 (– 0.1407, 0.0245) 0.17

Overweight 955 – 0.3075 (– 0.5237, – 0.0913) 0.0054

Obesity 356 – 0.3027 (– 0.6910, 0.0857) 0.13

– 0.8 – 0.6 – 0.4 – 0.2 0.0 0.2

▶Fig. 2 Association between the speed of movement and change in cardiometabolic risk factors modified by BMI. BMI, body mass index; DBP,
diastolic blood pressure; MAP, mean arterial pressure; PBF, percent body fat; PSM, performance in speed of movement; SBP, systolic blood pressure;
SD, standard deviation * GLM was used to test whether the association between change in PSM and change in SBP, DBP, MAP, and CMRS was modi-
fied by BMI. The analysis was adjusted for children within classes in school as clustering effects and characteristics of the individuals including age,
sex, intervention, BMI, corresponding cardiometabolic risk factor, puberty, grade, intervention, BMI, cardiorespiratory fitness, physical activity,
energy intake, birthweight, household income, mother’s education, father’s education, mother’s BMI, and father’s BMI as fixed effects. †P values for
association refers to the association between changes in SBP, DBP, MAP, and CMRS and change in PSM, while P values for interaction indicate the
interaction between change in PSM and baseline BMI for changes in CMR factors. ‡Children were divided into normal weight, overweight, and obe-
sity groups using BMI according to the International Obesity Task Force standard.

ciation between PSM and CMR has not been reported previously,
several cross-sectional studies in children have highlighted the im-
portance of BMI as a mediator for the association between cardi-
orespiratory fitness and CMR [42–44]. Our data further showed
that PSM was a significant mediator for the association between
BMI/PBF and CMR factors. This highlights the importance of the in-
teractive effect of PSM and fatness on the changes in CMR factors.
The moderation effect of fatness for the association between
PSM and CMR has not been reported in previous studies. A cross-
sectional study found the association between cardiorespiratory
fitness and CMR was more likely to be manifested in obese children
[43]. Likely, we observed an inverse association between improved
PSM and the change in blood pressure in obese children only. Data
from the HEALTHY Study observed an additive effect of BMI and
cardiorespiratory fitness on the change in HDL-C [45]. We found
the potential beneficial effect of improved PSM on the change in
CMRS was more evident in overweight children. More research, es-
pecially longitudinal studies, are needed to warrant our findings.
Our study highlights the importance of better PSM for the im-
provement of CMR factors in children. Power training, including
jumps, hops, bounds, and skips, may be a safe program to improve
the ability to increase PSM [46]. Particularly, these exercises have
been shown to be beneficial for neuromuscular performance
[47, 48]. This suggests children will benefit from these power ex-
ercises in PSM then resulting in better metabolic health. Our mod-
eration analysis also demonstrates that the potential benefits of
power training may be more evident in children with higher BMI.
The strengths of our study included its large sample size, mul-
tiple CMR factors analysed, and various covariates adjusted for. To
our knowledge, this is the first longitudinal study to examine
whether the association between PSM and CMR was modified/me-
diated by fatness. Our study has several limitations. First, the fol-
low-up of our study is relatively short to judge the effect of PSM on
CMR factors. Second, children included in the analysis were more
likely to be boys and older than those lost to follow-up, although
they did not differ in PSM and CMRS at baseline. This might slight-

324 Shang X et al. Speed of Movement, Fatness, … Int J Sports Med 2022; 43: 317–327 | © 2021. Thieme. All rights reserved.
 † Percentage of total effect P value for
Mediator Exposure Outcome Direct effect (95 % CI)* Indirect effect (95 % CI) explained by mediator (95 % CI) mediation

‡
Baseline BMI Baseline PSM Change in CMRS – 0.138 (– 0.175 to – 0.102) – 0.045 (– 0.053 to – 0.036) 24.6 (19.6 – 29.1) < 0.0001

Baseline BMI Baseline PSM Change in triglycerides – 0.045 (– 0.06 to – 0.031) – 0.016 (– 0.019 to – 0.012) 26.2 (19.7 – 31.1) < 0.0001

Baseline BMI Baseline PSM Change in HDL-C 0.091 (0.074 – 0.107) 0.013 (0.01 – 0.016) 12.5 (9.6 – 15.4) < 0.0001

Baseline PBF Baseline PSM Change in CMRS – 0.096 (– 0.134 to – 0.058) – 0.086 (– 0.099 to – 0.074) 47 (40.4 – 54.1) < 0.0001

Baseline PBF Baseline PSM Change in waist circumference – 0.008 (– 0.016 to 0) – 0.007 (– 0.008 to – 0.005) 46.7 (33.3 – 53.3) < 0.0001

Baseline PBF Baseline PSM Change in triglycerides – 0.034 (– 0.049 to – 0.019) – 0.026 (– 0.031 to – 0.022) 43.3 (36.7 – 51.7) < 0.0001

Baseline PBF Baseline PSM Change in HDL-C 0.073 (0.056 – 0.09) 0.031 (0.026 – 0.036) 29.8 (25.0 – 34.6) < 0.0001

Baseline PSM Baseline BMI Change in CMRS 0.328 (0.289 – 0.367) 0.021 (0.015 – 0.028) 6.0 (4.3 – 8.0) < 0.0001

Baseline PSM Baseline BMI Change in triglycerides 0.119 (0.104 – 0.134) 0.006 (0.004 – 0.009) 4.8 (3.2 – 7.2) < 0.0001

Baseline PSM Baseline BMI Change in HDL-C – 0.097 (– 0.114 to – 0.08) – 0.013 (– 0.016 to – 0.01) 11.8 (9.1 – 14.5) < 0.0001

Baseline PSM Baseline PBF Change in CMRS 0.326 (0.287 – 0.365) 0.027 (0.016 – 0.037) 7.6 (4.5 – 10.5) < 0.0001

Baseline PSM Baseline PBF Change in triglycerides 0.102 (0.087 – 0.118) 0.009 (0.005 – 0.013) 8.1 (4.5 – 11.7) < 0.0001

Baseline PSM Baseline PBF Change in HDL-C – 0.116 (– 0.133 to – 0.098) – 0.02 (– 0.025 to – 0.015) 14.8 (11.1 – 18.5) < 0.0001

Change in BMI Change in PSM Change in waist circumference – 0.017 (– 0.025 to – 0.01) – 0.005 (– 0.009 to – 0.001) 22.7 (4.5 – 40.9) 0.026

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Change in BMI Change in PSM Change in triglycerides – 0.034 (– 0.05 to – 0.017) – 0.002 (– 0.004 to 0) 6.3 (0 – 9.4) 0.0231

Change in BMI Change in PSM Change in HDL-C – 0.03 (– 0.045 to – 0.015) – 0.002 (– 0.003 to 0) 5.6 (0 – 11.1) 0.0274

Change in PBF Change in PSM Change in waist circumference – 0.017 (– 0.025 to – 0.009) – 0.004 (– 0.006 to – 0.001) 19.0 (4.8 – 28.6) 0.0027

Change in PBF Change in PSM Change in total cholesterol – 0.026 (– 0.039 to – 0.012) – 0.001 (– 0.002 to 0) 3.7 (0 – 7.4) 0.0106

Change in PSM Change in BMI Change in triglycerides 0.081 (0.066 – 0.096) 0.001 (0 – 0.002) 1.2 (0 – 2.4) 0.0439

0.0 10.0 20.0 30.0 40.0 50.0 60.0

▶Fig. 3 Mediation analysis for speed of movement and fatness with the change in cardiometabolic risk factors. BMI, body mass index; CI, confi-
dence interval; CMRS, cardiometabolic risk score; HDL-C, high-density lipoprotein cholesterol; PBF, percent body fat; PSM, speed test perfor-
mance. * Direct effect represents the direct association between exposures and outcomes using GLM adjusted for children within classes in school as
clustering effects and characteristics of the individuals including age, sex, intervention, BMI, corresponding cardiometabolic risk factor, puberty,
grade, intervention, BMI, cardiorespiratory fitness, physical activity, energy intake, birthweight, household income, mother’s education, father’s
education, mother’s BMI, and father’s BMI as fixed effects. †Indirect effect represents the association between exposures and outcomes via media-
tors using GLM adjusted for covariates in Model 3 of ▶Table 2. ‡CMRS was calculated by summing age- and sex-specific Z scores of the average of
SBP and DBP, fasting glucose, HDL-C (multiplied by − 1) and triglycerides. Waist circumference was not taken into consideration for calculating this
score in the mediation analysis for PSM and BMI with CMRS given the high correlation between waist circumference and BMI.

ly limit the generalisability of our findings. Third, the intervention References

was treated as a covariate in the analysis, although the interaction
between intervention and change in PSM was significant for some
CMR factors. However, our analysis in the control group showed
similar results to those of the total population.
In conclusion, PSM is a strong predictor of changes in CMR fac-
tors. BMI was a major mediator for the association between PSM
and CMR factors, and the percentage of total effect mediated by
PBF was almost doubled than by BMI. PSM may attenuate the pos-
itive association between fatness and blood pressure.
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