Improving National Fitness: An Updated Review on Cardiovascular Disease Risk Screening and Exercise Training in School-Aged Children in the U.S.

To synthesize contemporary evidence on school-feasible cardiovascular disease (CVD) risk screening and exercise training (ET) for U.S. children (ages 6–17) and to outline a pragmatic national framework that prioritizes fitness over size-based metrics.

Anthropometric indicators such as body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) remain practical, low-cost tools for identifying obesity-related cardiometabolic risk in schools. When complemented by blood pressure (BP) measurement, they provide a more complete profile. However, all anthropometric and hemodynamic measures are inferior to cardiorespiratory fitness (CRF), which more strongly predicts future CVD risk and all-cause mortality. Both aerobic ET (aET) and resistance ET (rET) independently enhance CRF and muscular strength (MusS), yielding additive cardiometabolic benefits independent of weight loss. Implementation remains limited by reduced physical education (PE) time (PET), fragmented data systems, and insufficient teacher training.

A unified national framework emphasizing CRF as a clinical vital sign, standardized screening, and structured ET in schools offers a low-cost, high-impact strategy to curb pediatric CVD risk. Policy efforts should promote validated field tests, teacher training, and integration with pediatric care networks. Shifting the focus from weight reduction to fitness optimization after establishing proper technique reduces stigma, boosts participation, and fosters lifelong physical literacy. Embedding evidence-based screening and ET into educational infrastructure could redefine preventive cardiology, positioning schools as a foundation of cardiovascular health promotion.