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  • Clinical Research Article
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Daily steps, cardiorespiratory fitness, and remnant cholesterol in schoolchildren: mediation effects for cardiovascular prevention

Pediatric Research volume 98, pages 672–679 (2025)Cite this article

Abstract

Background

To analyse the associations between daily steps, cardiorespiratory fitness (CRF), and remnant cholesterol in schoolchildren and to investigate whether the association between daily steps and remnant cholesterol is mediated by CRF.

Methods

This cross-sectional study involved 394 schoolchildren (aged 9–12 years, 53.0% girls) from Cuenca, Spain. Daily steps were measured using the Xiaomi MI Band 3, CRF was assessed using the 20-m shuttle run test, and remnant cholesterol was calculated from total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. Mean differences in CRF and remnant cholesterol by daily steps and CRF categories were tested using analysis of covariance. Mediation analysis models examined whether CRF mediates the association between daily steps and remnant cholesterol.

Results

Children taking 12,000 and 9000 steps/day had higher CRF (p < 0.001) and lower remnant cholesterol (p = 0.034), respectively. Those with CRF > 47.59 kg/ml/min had lower remnant cholesterol (p = 0.009). CRF mediated the association between 1000 steps/day and remnant cholesterol (indirect effect = –0.027 (–0.055,–0.007)).

Conclusions

Both daily steps and CRF are associated with remnant cholesterol. Promoting an increase in daily steps may be a practical and promising strategy to increase CRF and, given its mediating role, to improve remnant cholesterol to prevent cardiometabolic risk in schoolchildren.

Impact

  • What’s known: Remnant cholesterol is a critical indicator of cardiovascular disease risk in the early atherosclerosis.

  • What’s new: In schoolchildren, increased daily physical activity is significantly associated with higher cardiorespiratory fitness and lower remnant cholesterol, especially walking >9000 steps/day and >12,000 steps/day, respectively.

  • What’s relevant: Encouraging schoolchildren to take more daily steps may be a promising strategy to increase cardiorespiratory fitness and, given its mediating role, to improve remnant cholesterol to prevent cardiometabolic risk.

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Fig. 1
Fig. 2: Scatterplot showing bivariate correlation coefficients (r) between steps/day and CRF (VO2 max; maximal oxygen intake), body mass index (BMI), remnant cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and total cholesterol.
Fig. 3: Mean differences in cardiorespiratory fitness and remnant cholesterol using analysis of covariance models.
Fig. 4: Simple mediation model of the association between 1000 steps/day increment and remnant cholesterol using CRF (VO2 max; ml/kg/min) as a mediator and controlling for age, sex, and body mass index.

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Data availability

The datasets used and/or analysed in this study are available from the corresponding author upon reasonable request.

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Funding

This work was supported by the Ministry of Economy and Competitiveness-Carlos III Health Institute, and Health Outcomes-Oriented Cooperative Research Networks cofunded with European Union–NextGenerationEU (RD21/0016/0025) and by the Ministry of Science, Innovation and Universities-Carlos III Health Institute and FEDER funds (PI19/01126). Eva Rodríguez-Gutiérrez is supported by a grant from the University of Castilla-La Mancha (2022-UNIVERS-11373), and Bruno Bizzozero-Peroni is supported by a grant from the Universidad de Castilla‐La Mancha co-financed by the European Social Fund (2020-PREDUCLM-16746). Irene Martínez-García is supported by a grant from the Ministry of Science, Innovation and Universities (FPU21/06866). Valentina Díaz-Goñi is supported by a grant from the National Agency for Research and Innovation of Uruguay (POS_EXT_2023 _1_175630). The other authors received no additional funding.

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Authors and Affiliations

  1. Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain

    Eva Rodríguez-Gutiérrez, Vicente Martínez-Vizcaíno, Bruno Bizzozero-Peroni, Valentina Díaz-Goñi, Irene Sequí-Domínguez, Sergio Núñez de Arenas-Arroyo, Mairena Sánchez-López, Carlos Pascual-Morena & Ana Torres-Costoso

  2. Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Cuenca, Spain

    Eva Rodríguez-Gutiérrez, Irene Sequí-Domínguez & Sergio Núñez de Arenas-Arroyo

  3. Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile

    Vicente Martínez-Vizcaíno

  4. Instituto Superior de Educación Física, Universidad de la República, Rivera, Uruguay

    Bruno Bizzozero-Peroni

  5. Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha – Campus Cuenca, Cuenca, Spain

    Irene Martínez-García & Irene Sequí-Domínguez

  6. CarVasCare Research Group, Universidad de Castilla-La Mancha, Cuenca, Spain

    Irene Martínez-García

  7. Facultad de Educación, Universidad de Castilla-La Mancha, Ciudad Real, Spain

    Mairena Sánchez-López

  8. Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha – Campus Albacete, Albacete, Spain

    Carlos Pascual-Morena

  9. Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Toledo, Spain

    Ana Torres-Costoso

Authors
  1. Eva Rodríguez-Gutiérrez
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  2. Vicente Martínez-Vizcaíno
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  5. Irene Martínez-García
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  6. Irene Sequí-Domínguez
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  10. Ana Torres-Costoso
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Contributions

Eva Rodríguez-Gutiérrez conceptualized and designed the study, drafted the initial manuscript, and critically reviewed and revised the manuscript. Vicente Martínez-Vizcaíno designed the the data collection instruments, collected data, and critically reviewed and revised the manuscript. Bruno Bizzozero-Peroni and Valentina Díaz-Goñi carried out the initial analyses, and critically reviewed and revised the manuscript. Irene Martínez-García, Irene Sequí-Domínguez, and Sergio Núñez de Arenas-Arroyo collected data, and critically reviewed and revised the manuscript. Mairena Sánchez-López and Carlos Pascual-Morena designed the study, collected data, and critically reviewed and revised the manuscript. Ana Torres-Costoso coordinated and supervised data collection, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Vicente Martínez-Vizcaíno.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study protocol was approved by the Clinical Research Ethics Committee of the Hospital Virgen de la Luz in Cuenca (REG: 2019/PI1519). After the Board of Governors of each school approved the study, a letter was sent to the parents of all 4th, 5th and 6th graders inviting them to a meeting. At this meeting, we explained the objectives of the study and asked for written approval for their children’s participation. All procedures performed in this study were in accordance with the Declaration of Helsinki and its later amendments or comparable ethical standards for experiments involving humans.35

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Rodríguez-Gutiérrez, E., Martínez-Vizcaíno, V., Bizzozero-Peroni, B. et al. Daily steps, cardiorespiratory fitness, and remnant cholesterol in schoolchildren: mediation effects for cardiovascular prevention. Pediatr Res 98, 672–679 (2025). https://doi.org/10.1038/s41390-024-03779-z

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