Reduced Peak Bone Mass in Young Adults With Low Motor Competence.

Although suboptimal bone health has been reported in children and adolescents with low motor competence (LMC), it is not known whether such deficits are present at the time of peak bone mass. We examined the impact of LMC on bone mineral density (BMD) in 1043 participants (484 females) from the Raine Cohort Study. Participants had motor competence assessed using the McCarron Assessment of Neuromuscular Development at 10, 14, and 17 years, and a whole-body dual-energy X-ray absorptiometry (DXA) scan at 20 years. Bone loading from physical activity was estimated from the International Physical Activity Questionnaire at the age of 17 years. The association between LMC and BMD was determined using general linear models that controlled for sex, age, body mass index, vitamin D status, and prior bone loading. Results indicated LMC status (present in 29.6% males and 21.9% females) was associated with a 1.8% to 2.6% decrease in BMD at all load-bearing bone sites. Assessment by sex showed that the association was mainly in males. Osteogenic potential of physical activity was associated with increased BMD dependent on sex and LMC status, with males with LMC showing a reduced effect from increasing bone loading. As such, although engagement in osteogenic physical activity is associated with BMD, other factors involved in physical activity, eg, diversity, movement quality, may also contribute to BMD differences based upon LMC status. The finding of lower peak bone mass for individuals with LMC may reflect a higher risk of osteoporosis, especially for males; however, further research is required. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

The Relationship Between Perceptions of Physical Self-Worth, Subdomain Importance, and Physical Fitness in Adolescents With Low Motor Competence: An Exploratory Study.

Purpose: Adolescent perceptions of their physical self-worth (PSW) and the component domains draw upon physical attributes, such as motor competence, physical fitness, and self-perceptions, which in turn enhance the desire to engage in physical activity. Whilst these relationships have been researched in populations with typical motor development, little is known of the interplay of these contributors to PSW with those with low motor competence (LMC). Even less is known of how importance placed on particular physical subdomains may be used by the adolescent with LMC to mitigate negative effects on their perceptions of PSW. Method: Thirty-four adolescents with low motor competence, 25 boys and 9 girls (Mage = 13.89 yrs, SD = 1.49), completed the McCarron Assessment of Neuromuscular Development (MAND), the Children's Physical Self-Perception Questionnaire (C-PSPP) and a range of physical fitness tests. Results: All self-perception subdomain score was lower than importance ratings. Physical fitness measures were also low but were not significantly associated with PSW. However, the higher importance scores relative to physical self-perceptions resulted in greater discrepancy scores in all subdomains. Conclusion: Adolescents with LMC have low PSW, and low self-perceptions relative to importance ratings for most physical self-subdomains. These discrepancies, rather than actual fitness, potentially reduce their motivation to be physically active.

Association between Motor Planning and the Frontoparietal Network in Children: An Exploratory Multimodal Study.

OBJECTIVE: Evidence from adult literature shows the involvement of cortical grey matter areas of the frontoparietal lobe and the white matter bundle, the superior longitudinal fasciculus (SLF) in motor planning. This is yet to be confirmed in children. METHOD: A multimodal study was designed to probe the neurostructural basis of childhood motor planning. Behavioural (motor planning), magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) data were acquired from 19 boys aged 8-11 years. Motor planning was assessed using the one and two colour sequences of the octagon task. The MRI data were preprocessed and analysed using FreeSurfer 6.0. Cortical thickness and cortical surface area were extracted from the caudal middle frontal gyrus (MFG), superior frontal gyrus (SFG), precentral gyrus (PcG), supramarginal gyrus (SMG), superior parietal lobe (SPL) and the inferior parietal lobe (IPL) using the Desikan-Killiany atlas. The DWI data were preprocessed and analysed using ExploreDTI 4.8.6 and the white matter tract, the SLF was reconstructed. RESULTS: Motor planning of the two colour sequence was associated with cortical thickness of the bilateral MFG and left SFG, PcG, IPL and SPL. The right SLF was related to motor planning for the two colour sequence as well as with the left cortical thickness of the SFG. CONCLUSION: Altogether, morphology within frontodorsal circuity, and the white matter bundles that support communication between them, may be associated with individual differences in childhood motor planning.

Self-Report Motor Competence in Adolescents Aged 12-18 Years in Regional and Rural Victoria (Australia).

Background: Poor motor skills are an increasing issue for adolescents in our local communities. In regional Victoria, almost 20% of children starting school in 2018 were considered at risk or developmentally vulnerable in the domain of physical health and wellbeing. Purpose: The aim of the current study was to examine factors (how adolescents perceive their fine and gross motor skills, activities of daily living, comparison to peers) of motor competence that may be important to adolescents in regional Victoria, Australia, using the Adolescent Motor Competence Questionnaire (AMCQ). Methods: A sample of 183 Australian adolescents ([138 females (Mage = 15.59 years, SD = 1.56); 45 males, (Mage = 15.82 years, SD = 1.95); 12-18 years old] completed the AMCQ. Results: The mean AMCQ score was 87.86 (SD = 7.55), with no significant difference between males (M = 89.67 SD = 7.29) and females [M = 87.28 SD = 7.56; t (181 = 1.86 p =.065)]. A Principal Component Analysis (PCA), extracted five factors (Eiqenvalue of 1.389) explaining 43.46% of variance, representing, Ball Skills and Kinesthesis; Activities of Daily Living; Fine Motor and Gross Motor; Proprioception and Exteroception; Public Performance. Conclusion: The results highlight key factors important in describing an adolescent's motor competence within regional Victoria. With physical health a priority in local communities, understanding these factors is an important first, that which may inform development of physical activity interventions for adolescents.

Impact of a multimodal exercise program on tibial bone health in adolescents with Development Coordination Disorder: an examination of feasibility and potential efficacy.

OBJECTIVES: Developmental coordination disorder (DCD) compromises bone health purportedly due to lower levels of physical activity. The potential of an exercise intervention to improve bone health parameters in adolescents with DCD has not previously been studied. This study thus aimed to determine the impact of a multimodal exercise intervention on bone health in this population at-risk of secondary osteoporosis. METHODS: Twenty-eight adolescents (17 male, 11 female) aged between 12-17 years (Mage=14.1) with DCD participated in a twice weekly, 13-week generalised multimodal exercise intervention. Peripheral quantitative computed tomography scans of the tibia (4% and 66%) were performed over a six month period. Generalised estimating equations were used to examine the impact of fitness measures on bone parameters over time. RESULTS: An overall improvement trend was observed for bone health, with significant increases at the 66% tibial site for bone mass (4.12% increase, dcohen=0.23, p=0.010) and cortical area (5.42% increase, η2 =12.09, p=0.014). Lower body fitness measures were significantly associated with improvements in bone health parameters, tempered by the degree of motor impairment. CONCLUSION: A multimodal exercise intervention may be effective in improving bone health of adolescents with DCD. Given the impact of motor impairments, gains may be greater over an extended period of study.

Does level of motor competence affect the associations between identity health and self-perceptions in adolescents?

BACKGROUND: Adolescence is a particularly important time for the development of self-perceptions and identity as many environmental and personal factors are influential. One relatively unexplored factor is level of motor competence. AIM: To examine the relationship between identity health and self-perceptions in male and female adolescents with low motor competence (LMC) compared to typically developing (TD) adolescents. METHOD: Adolescents (N = 160, 64.4% males, Mage = 14.45 yrs., SD = 0.75) completed the Adolescent Motor Competence Questionnaire (AMCQ), Assessment of Identity Development in Adolescence (AIDA), and Harter's Self-Perception Profile for Adolescents (SPPA). Based on the AMCQ score, the sample was grouped into LMC and TD. Pearson's product moment correlations between the AIDA and SPPA subscales were derived for gender, competence groups, and gender x competence sub-groups. RESULTS: Overall, males had lower AIDA scores (healthier identity) than the females and significant associations with all self-perception domains. For females, only scholastic and social competence, physical appearance, behavioural conduct, close friendship and Global Self-worth (GSW) domains were significantly related to their AIDA score. The adolescents in the LMC group had higher AIDA scores (less-healthier identity) and fewer self-perception domains [scholastic competence, physical appearance, behavioural conduct, close friendships and GSW] were associated to their AIDA scores. For the TD group, all self-perception domains were significantly correlated with their AIDA scores. When grouped by gender and motor competence, the TD males had the healthiest identity scores which were strongly associated with all self-perception subdomains. For males with LMC, only scholastic competence, behavioural conduct and GSW domains were significantly related with their identity score. Females from both competence groups reported significant associations between physical appearance, close friendships, behavioural conduct, and social competence domains with their identity scores. Scholastic competence was also significantly associated with identity only for females with LMC. CONCLUSION: Positive self-perceptions across a range of domains are associated with a healthier identity, but differ according to level of motor competence and gender. For those with LMC, the self-perception subdomains unrelated to physical activity and sport, such as school-based aspects were associated with a healthier identity. These findings should guide school based interventions to provide support in these domains in order to strengthen self-worth and identity health.

Characterisation of peripheral bone mineral density in youth at risk of secondary osteoporosis - a preliminary insight.

OBJECTIVES: To describe peripheral long bone material and structural differences in youth at risk of secondary osteoporosis across disease-specific profiles. METHODS: Upper- and lower limbs of children and adolescents were scanned at 4% distal and 66% mid-shaft sites using peripheral Quantitative Computed Tomography sub-categorised as (1) increased risk of secondary osteoporosis (neuromuscular disorders; chronic diseases; endocrine diseases; inborn errors of metabolism; iatrogenic conditions), (2) low motor competence and (3) non-affected controls. RESULTS: Children with disease-specific profiles showed a range of bone deficits compared to the control group with these predominantly indicated for neuromuscular disorders, chronic diseases and low motor competence. Deficits between upper arm and lower leg long bone parameters were different for disease-specific profiles compared to the control group. Endocortical radius, muscle area, and mid-cortical ring density were not significantly different for any disease-specific profile compared to the control group for any bone sites. CONCLUSIONS: Neuromuscular disorders, chronic diseases and low motor competence have a strong correlation to bone health for appendicular bone parameters in youth, suggesting a critical mechanical loading influence which may differ specific to disease profile. As mechanical loading effects are observed in regional bone analyses, targeted exercise interventions to improve bone strength should be implemented to examine if this is effective in reducing the risk of secondary osteoporosis in youth.

The Influence of Motor Competence on Adolescent Identity Health: A Mixed Method Study.

Our identity develops with age, and many impacting factors will determine whether it is healthy or unhealthy. A particularly fragile phase of identity development occurs during adolescence when level of motor competence may be influential, yet is rarely considered. Purpose: The purpose of this study was to examine male and female adolescent's perceptions towards their motor competence and identity development. In-depth information was also collected to understand what factors are important towards identity development during adolescence. Method: An explanatory sequential mixed methods study was used to examine the extent motor competence influenced the health of an adolescent's identity. A sample of 160 adolescents (male n = 103, female n = 57, Mage = 14.45 SD = .75) completed the Adolescent Motor Competence Questionnaire (AMCQ) and the Assessment of Identity Development in Adolescence (AIDA). The AMCQ scores were used to group the participants into high (HMC = > 83) and low (LMC = < 83) motor competence. Results: More females had less-healthy identities than males and those with LMC had less-healthy identities than those with HMC. Subsamples of 17 participants were interviewed in order to explain these results. The most at risk group, females with LMC, identified negative peer comparisons, poor social support and higher stress levels to achieve academic performance as key challenges. Conclusions. Well-designed support services for those with LMC, especially for the females should incorporate activities to develop individual competency and close friendships.

Examining complexity in grip selection tasks and consequent effects on planning for end-state-comfort in children with developmental coordination disorder: A systematic review and meta-analysis.

This is the first review to provide both a systematic and meta-analytic approach to characterizing motor planning deficits in children with Developmental Coordination Disorder (DCD). Task complexity appears to be a key factor affecting motor planning in children with DCD. However, the different task-related factors and how they affect motor planning ability has not been examined. By systematically reviewing ten studies examining motor planning in children aged 4- to 14 years with and without DCD using grip selection tasks, task complexity was determined according to grip choices, level of precision, number of action steps and degree of rotation. A meta-analysis (N = 607; DCD = 255) revealed that, overall, those with DCD were 6.8% less likely to plan motor actions comfortably than typically developing children. This ability was moderated by task complexity (I2 = 66.7%), with performance differences ranging from 2.33% for low (g = 0.21) to 13.77% (g = 0.79) for high complexity. The results confirmed that children with DCD are able to plan for comfortable end states for tasks with simple and medium complexity level. When task complexity increased, compared to typically developing children, the motor planning ability of those with DCD was affected to a significantly greater extent. These findings provide important implications for both behavioral and neurological interventions.

Exploring the influence of self-perceptions on the relationship between motor competence and identity in adolescents.

BACKGROUND AND AIMS: A relationship exists between an adolescent's level of motor competence and the health of their identity. As those with low motor competence (LMC) form less healthy identities, the aim of this study was to investigate if self-perceptions mediated the negative impact of LMC on identity health. METHODS: Adolescents (N = 160) completed the Adolescent Motor Competence Questionnaire (AMCQ), Assessment of Identity Development in Adolescence (AIDA) and the Self Perception Profile for Adolescence (SPPA). The mediating effect of their self-perceptions on the relationship between motor competence and identity health was examined in several ways: for the total sample, between male and females, and level of motor competence. Two motor competence groups were formed by dichotomizing their AMCQ scores (< 83 = LMC). RESULTS: There was an indirect effect of self-perceptions of social competence, physical appearance, romantic appeal, behavioural conduct, close friendships and global self-worth on the relationship between motor competence and identity health for the total sample (N = 160, 64.4% males, Mage = 14.45 SD = .75, 12 to 16 years). No indirect effects were significant for females however close friendships and global self-worth were significant for the males. When the sample was grouped for motor competence, indirect effects of social competence, athletic competence, physical appearance, behavioural conduct, and global self-worth were significant for the high motor competence (HMC) group. The only self-perception significant for the LMC group was close friendships. CONCLUSION: Self-perceptions in several domains mediated the relationship between motor competence and identity health, and these differed for level of motor competence but not gender. Those with LMC who had a higher self-perception in the close friendships domain had a healthier identity. Designing physical activity programs that focus on skill development and forming close friendships are important for adolescents with LMC.

Motor planning with and without motor imagery in children with Developmental Coordination Disorder.

Children with Developmental Coordination Disorder (DCD) demonstrate inefficient motor planning ability with a tendency to opt for non-optimal planning strategies. Motor imagery can provide an insight to this planning inefficiency, as it may be a strategy for improving motor planning and thereby motor performance for those with DCD. In this study, we investigated the prevalence of end-state-comfort (ESC) and the minimal rotation strategy using a grip selection task in children with DCD with and without motor imagery instructions. Boys with (n = 14) and without DCD (n = 18) aged 7-12 years completed one, two and three colour sequences of a grip selection (octagon) task. Two conditions were examined; a Motor Planning (MP) condition requiring only the performance of the task and a Motor Imagery and Planning (MIP) condition, which included an instruction to imagine performing the movement before execution. For the MP condition, children with DCD ended fewer trials in ESC for the one (p = 0.001) and two colour (p = 0.002) sequences and used a minimal rotation strategy more often than those without DCD. For the MIP condition, the DCD group significantly increased their use of the ESC strategy for the one colour sequences (p = 0.014) while those without DCD improved for the two colour (p = 0.008) sequences. ESC level of the DCD group on the MIP condition was similar to those without DCD at baseline for all colour sequences. Motor imagery shows potential as a strategy for improving motor planning in children with DCD. Implications and limitations are discussed.

Suboptimal bone status for adolescents with low motor competence and developmental coordination disorder-It's sex specific.

BACKGROUND: Australian adolescents with low motor competence (LMC) have higher fracture rates and poorer bone health compared to European normative data, but currently no normative data exists for Australians. AIMS: To examine whether there were bone health differences in Australian adolescents with LMC or Developmental Coordination Disorder (DCD) when compared to typically developing age-matched Australian adolescents. METHODS AND PROCEDURES: Australian adolescents aged 12-18 years with LMC/DCD (n = 39; male = 27; female = 12) and an Australian comparison sample (n = 188; boys = 101; girls = 87) undertook radial and tibial peripheral Quantitative Computed Tomography (pQCT) scans. Stress Strain Index (SSI (mm3)), Total Bone Area (TBA (mm2)), Muscle Density (MuD [mgcm3]), Muscle Area (MuA [cm2]), Subcutaneous Fat Area (ScFA [cm2]), Cortical Density (CoD [mgcm3]), Cortical Area (CoD [mm2]), cortical concentric ring volumetric densities, Functional Muscle Bone Unit Index (FMBU: (SSI/bone length)) and Robustness Index (SSI/bone length^3), group and sex differences were examined. OUTCOME AND RESULTS: The main finding was a significant sex-x-group interaction for Tibial FMBU (p = .021), Radial MuD (p = .036), and radial ScFA (p = .002). Boys with LMC/DCD had lower tibial FMBU scores, radial MuD and higher ScFA than the typically developing age-matched sample. CONCLUSION AND IMPLICATIONS: Comparisons of bone measures with Australian comparative data are similar to European findings however sex differences were found in the present study. Australian adolescent boys with LMC/DCD had less robust bones compared to their well-coordinated Australian peers, whereas there were no differences between groups for girls. These differences may be due to lower levels of habitual weight-bearing physical activity, which may be more distinct in adolescent boys with LMC/DCD compared to girls.

Time for change: Fitness and strength can be improved and sustained in adolescents with low motor competence.

BACKGROUND: There are few exercise interventions focused on adolescents with low motor competence and most interventions are short with little follow up and engagement over time. METHODS AND PROCEDURES: Fifty-eight adolescents with low motor competence (39 males, Mean Age = 13.6, SD = 1.4 years) attended an exercise clinic twice a week for each 13 week program. Two programs ran each year, and participants attended for as long as they felt progress was made or they turned 18 years of age. Performance on the Multistage Fitness Test (MSFT), Curl-ups, Grip Strength, 1RM Leg press and Chest Press, Vertical Jump and Standing Broad Jump (SBJ) were recorded pre and post each program for up to six years. Linear Mixed Modelling (LMM) determined changes in fitness measures over time whilst adjusting for gender, age and Neuromuscular Developmental Index (McCarron, 1997). RESULTS: All fitness measures increased, and specifically four of the seven fitness outcomes showed significant improvement over time (MSFT,p = 0.011; curl-ups, p < 0.001, grip strength p = 0.003, and SBJ p = 0.006). CONCLUSION: An individually tailored regular exercise program in a supportive environment can achieve exercise adherence and sustainable improvements in fitness outcomes for adolescents with low motor competence. Future research should consider the addition of a comparison LMC control group to increase understanding of the intervention effect.

Investigating motor planning in children with DCD: Evidence from simple and complex grip-selection tasks.

Several studies suggest that children with Developmental Coordination Disorder (DCD) may be able to plan simple movements as well as their peers, but experience increasing difficulties as the movements become complex. The present study aimed to clarify the nature of motor planning in DCD, including a putative deficit, by being the first to investigate motor planning using converging measures of simple and complex motor planning in a single sample of children with DCD. Boys aged between 8 and 12 years with (n = 10) and without DCD (n = 17) completed three commonly used 'simple' (bar grasping, sword, and bar transport tasks) measures and one 'complex' (octagon task) measure of end-state-comfort (ESC), a classic measurement of motor planning ability. To achieve ESC when manipulating an object, a person may choose to start with an uncomfortable grip in order to end the movement in a comfortable position. Results indicate that the participants with DCD planned for ESC as efficiently as their peers when performing the 'simple' measures of ESC but were significantly less likely to end their performances in ESC than those without DCD for the more 'complex' octagon task. Taken together, our data suggest that school-aged children with DCD may be able to plan simple movements as efficiently as their peers, but have more difficulty doing so for multi-movement or complex sequences. Based on the assumption that the efficiency of such motor planning is dependent on the integrity of internal modelling systems, we argue that our study provides indirect support for the internal modelling deficit hypothesis.

The General Motor Ability Hypothesis: An Old Idea Revisited.

While specific motor abilities have become a popular explanation for motor performance, the older, alternate notion of a general motor ability should be revisited. Current theories lack consensus, and most motor assessment tools continue to derive a single composite score to represent motor capacity. In addition, results from elegant statistical procedures such as higher order factor analyses, cluster analyses, and Item Response Theory support a more global motor ability. We propose a contemporary model of general motor ability as a unidimensional construct that is emergent and fluid over an individual's lifespan, influenced by both biological and environmental factors. In this article, we address the implications of this model for theory, practice, assessment, and research. Based on our hypothesis and Item Response Theory, our Lifespan Motor Ability Scale can identify motor assessment tasks that are relevant and important across varied phases of lifespan development.

Please Don't Move-Evaluating Motion Artifact From Peripheral Quantitative Computed Tomography Scans Using Textural Features.

Most imaging methods, including peripheral quantitative computed tomography (pQCT), are susceptible to motion artifacts particularly in fidgety pediatric populations. Methods currently used to address motion artifact include manual screening (visual inspection) and objective assessments of the scans. However, previously reported objective methods either cannot be applied on the reconstructed image or have not been tested for distal bone sites. Therefore, the purpose of the present study was to develop and validate motion artifact classifiers to quantify motion artifact in pQCT scans. Whether textural features could provide adequate motion artifact classification performance in 2 adolescent datasets with pQCT scans from tibial and radial diaphyses and epiphyses was tested. The first dataset was split into training (66% of sample) and validation (33% of sample) datasets. Visual classification was used as the ground truth. Moderate to substantial classification performance (J48 classifier, kappa coefficients from 0.57 to 0.80) was observed in the validation dataset with the novel texture-based classifier. In applying the same classifier to the second cross-sectional dataset, a slight-to-fair (κ = 0.01-0.39) classification performance was observed. Overall, this novel textural analysis-based classifier provided a moderate-to-substantial classification of motion artifact when the classifier was specifically trained for the measurement device and population. Classification based on textural features may be used to prescreen obviously acceptable and unacceptable scans, with a subsequent human-operated visual classification of any remaining scans.

The Relationship Between Motor Skills, Social Problems, and ADHD Symptomatology: Does It Vary According to Parent and Teacher Report?

OBJECTIVE: This study investigated the relationship between motor performance; attentional, hyperactive, and impulsive symptoms; and social problems. Correlations between parents' versus teachers' ratings of social problems and ADHD symptomatology were also examined. METHOD: A total of 129 children aged 9 to 12 years were included. ADHD symptoms and social problems were identified based on Conners' Rating Scales-Revised: L, and the McCarron Assessment of Neuromuscular Development was used to assess motor skills. RESULTS: After controlling for ADHD symptomatology, motor skills remained a significant predictor of social problems in the teacher model but not in the parent model. After controlling for motor skills, inattentive (not hyperactive-impulsive) symptoms were a significant predictor of social problems in the parent model, whereas hyperactive-impulsive (not inattentive) symptoms were a significant predictor of social problems in the teacher model. CONCLUSION: The findings suggested that intervention strategies should consider the interaction between symptoms and environmental contexts.

Actual competence, rather than perceived competence, is a better predictor of physical activity in children aged 6-9 years.

There is a limited understanding about the relative importance of perceived and actual competence on emergent physical activity levels in children and whether there is a difference in their development and strength between boys and girls. This study used a single-cohort, multiple age group design to monitor physical activity, actual motor competence (AMC) and perceived competence (PC) on four occasions over 18 months in 6-to 9-year-old boys and girls (N = 201). Physical activity was measured by 7-day daily step counts (pedometer) and activity diary. AMC was assessed by mastery of skill criteria for 4 motor skills; run, overhand throw, standing broad jump, and line walk. PC was measured with the Self Description Questionnaire-I. Linear Mixed Model analysis revealed that AMC, Gender and School significantly impacted physical activity levels longitudinally in these children. AMC made a greater contribution (9-30%) to physical activity levels than PC (0-5%), and at an earlier age in boys (7 years) than girls (9 years). The need to acknowledge these developing distinctions in considering emergent physical activity levels has important implications for childhood learning environments and physical activity interventions.

Fatness and Fitness With Cardiometabolic Risk Factors in Adolescents.

Context: The relative importance of fitness and fatness with cardiometabolic risk factors is uncertain during the crucial developmental stage of late adolescence. Objective: We aimed to compare the concurrent influences of cardiorespiratory fitness and fatness in relationship to cardiometabolic risk factors in adolescents from the Western Australian Pregnancy Cohort Study. Design, Setting, and Participants: Cross-sectional analysis was performed on 1128 participants with complete blood pressure (BP) data and 963 participants with complete blood biochemistry at 17 years of age. Fatness (waist circumference) and cardiorespiratory fitness (physical work capacity 170) were assessed as continuous measures to avoid the use of arbitrary cut points. Analyses used linear regression models adjusted for sex and potential lifestyle confounders. Main Outcome Measure: Cardiometabolic risk factors. Results: Fatness was positively associated with systolic BP (coefficient, 0.19; P < 0.001; ß coefficient, 0.20), triglycerides (log coefficient, 0.009; P < 0.001; ß coefficient, 0.24), low-density lipoprotein cholesterol (coefficient, 0.005; P = 0.007; ß coefficient, 0.10), and high-sensitivity C-reactive protein (log coefficient, 0.05; P < 0.001; ß coefficient, 0.35). There were no significant effects of fitness on any of these measures. A positive association between homeostasis model of assessment for insulin resistance and fatness (log coefficient, 0.02; P < 0.001; ß coefficient, 0.33) was attenuated by fitness (log coefficient, -0.0.18; P < 0.001; ß coefficient, -0.18). Fatness was inversely associated with high-density lipoprotein cholesterol (HDL-C) in both sexes (coefficient, -0.006; P < 0.001; ß coefficient, -0.23), whereas fitness was positively associated with HDL-C only in females (coefficient, 0.08; P = 0.03; ß coefficient, 0.15). Conclusions: The adverse effects of central adiposity seen across a broad range of cardiometabolic risk factors were only partially ameliorated by fitness in this adolescent population.