• Maria Reyes Beltran-Valls, Mireia Adelantado-Renau, Jorge Mota, and Diego Moliner-Urdiales.
• LIFE Research Group, University Jaume I, Castellón de la Plana, Spain.
• Am J Prev Med. 2021 Sep 1; 61 (3): 410-417.

IntroductionThis study aims to investigate the individual and combined associations of physical activity, sedentary time, diet, and sleep at baseline on cardiorespiratory fitness at 24-month follow-up in adolescents.MethodsThe DADOS (Deporte, ADOlescencia y Salud) prospective cohort study was performed between 2015 and 2017. Analyses were conducted in 2020 and included 189 adolescents aged 13.9 (SD=0.3) years at baseline. Vigorous physical activity, total sedentary time, and sleep duration were evaluated by GENEActiv accelerometer. Sleep quality and adherence to a Mediterranean diet were evaluated by questionnaires. Cardiorespiratory fitness was assessed by the 20-meter shuttle run test. A healthy lifestyle index was created by including positive scores for each individual behavior, and 3 categories of achievement (≤1, 2, ≥3) were established.ResultsPerforming high vigorous physical activity and low screen time at baseline were individually associated with the likelihood of achieving high cardiorespiratory fitness at follow-up (OR=3.33 and 3.09, respectively). ANCOVA indicated that adolescents with a healthy lifestyle index ≥3 at baseline showed higher cardiorespiratory fitness at follow-up than those with a healthy lifestyle index of 2 and ≤1 (74.4 [SE=1.5] vs 68.9 [SE=1.4] and 67.8 [SE=1.5] laps, respectively; p<0.01). Adolescents with a healthy lifestyle index ≥3 at baseline were more likely to have high cardiorespiratory fitness at follow-up (OR=3.10) than their peers with ≤1.ConclusionsThe results showed a cumulative impact of baseline health-related behaviors on cardiorespiratory fitness at 24-month follow-up in adolescents. These findings underline the key role of promoting a healthy lifestyle to improve adolescents' health.Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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