Criterion-referenced mCAFT cut-points to identify metabolically healthy cardiorespiratory fitness among adults aged 18-69 years: an analysis of the Canadian Health Measures Survey

This study aimed to develop and validate health-related criterion-referenced cut-points for the modified Canadian Aerobic Fitness Test (mCAFT), a field-based measure to predict cardiorespiratory fitness among adults (18-69 years). Criterion-referenced mCAFT cut-points were developed using nationally representative data from cycles 1(2007-2009) and 2 (2009-2011) of the Canadian Health Measures Survey (CHMS). Receiver operating characteristic curves were used to identify age-and sex-specific cut-points for measured waist circumference, blood pressure, and high-density lipoprotein. Cut-points were validated against metabolic syndrome using a fasted subsample (n = 1093) from cycle 5 (2016-2017). For the main analyses, 4967 participants (50% women) were retained. The mCAFT cut-points ranged from 28 to 43 mLkg(-1).min(-1) (area under the curve (AUC): 0.60-0.87) among men, and 23 to 37 mL.kg(-1).min(-1) (AUC: 0.61-0.86) among women. The likelihood of meeting the new mCAFT cut-points decreased with an increase in the presence of metabolic risk factors. In total, 54% (95% confidence interval: 42% to 67%) of Canadian adults met the new mCAFT cut-points in 2016-2017. This study developed and validated the first health-related criterion-referenced mCAFT cut-points for metabolic health among Canadian adults aged 18-69 years. These mCAFT cut-points may be useful in health surveillance, clinical, and public health settings. Novelty We developed and validated new criterion-referenced cut-points for the mCAFT to help identify adults at potential risk of poor metabolic health. These new cut-points could help support national health surveillance efforts.