Active as a child? That could make you healthier as old

If you are active at a very young age, you reduce the risk of heart problems and type 2 diabetes when you get old. You can be spared from great suffering and also: It will save society enormous costs. School plays an important role here, especially for those young people with the worst “cardiometabolic health profiles”.

Kids playing ball outdoors
Playing can be just as much excersize as traditional training. Picture from the ASK study. Photo: Skolefoto

This is presented in a study that Mette Stavnsbo will defend as part of her PhD at the Norwegian School of Sport Sciences (NIH) on 23 January.

Mette Stavnsbo portrait
Mette Stavnsbo is a fellow at The Norwegian School of Sport Sciences and Western Norway University of Applied Sciences (HVL)

Stavnsbo has studied how physical activity in young people affects the development of so-called “cardiometabolic risk factors”, in simple terms, the risk of developing type 2 diabetes or cardiovascular diseases as one gets older. (See fact box: Risk Factors)

It is already known that atherosclerosis (hardening of the arteries), at least during its early stages, can develop in people as young as 3 years old, and such deposits are among the main causes of cardiovascular diseases.

As you get older, they gradually get worse, but the speed at which they occur depends on lifestyle.

Obviously, the risk is also affected by a lot of other things throughout one’s life. Here, reduced risk assumes that one “lives the same life” as one would otherwise do.

Cardiovascular diseases


  • It is estimated that approximately 300,000 people live with type 2 diabetes in Norway alone. The number of new cases has doubled over the last 20 years.
  • Often caused by a combination of heredity, being overweight, poor diet and little exercise.
  • Type 2 diabetes can cause a variety of ailments, from fatigue and depression to serious complications such as kidney failure, blindness, amputations, cardiovascular diseases or premature death.
  • Cardiovascular diseases are among the most common causes of illness and death. The first signs of atherosclerosis can noticed very early on. From this stage, it gradually gets worse, but the speed at which it occurs depends on lifestyle.
  • Type 2 diabetes is another type of serious disorder that also affects very many people and which largely depends on the individual’s lifestyle.

Being more active in everyday life

In the study involving Year 5 pupils, more activity was incorporated in the everyday school life of a so-called test or “intervention group”:

The children, who were from various schools in Sogn and Fjordane, were allocated half an hour of activity three days a week in Norwegian, English and maths lessons - in the form of maths bingo or relay races with mathematic wheels that took place outdoors.
In addition, they were able to take an “active break” during the otherwise sedentary lessons by watching a “just dance” video, for example.
A third initiative was giving the pupils an active homework assignment, such as running five times around the house or skipping the “seven times table” with a skipping rope.

Before and after the seven month testing period (the intervention), the children were measured in relation to the various risk factors.

The results were positive, not least for the children who needed it most: A number of risk factors related to the development of cardiovascular diseases were clearly reduced in the children who had the worst health profiles.

“It was as expected. This also applies to people who are much older; several studies have shown that physical activity benefits the health of those who have the worst starting point the most.”

Normally, one could expect an improvement in all participants, or at least most of them.

The fact that this didn’t happen had its own, positive explanation:

Early warning

It turned out that the children from this Western Norwegian county were consistently and considerably more active and in better shape than “the international average child”.

“Activity levels and physical fitness are closely related to the risk of developing lifestyle diseases. Already having a poor health profile in childhood is an early warning sign of developing illness in later life. People who aren’t very active and in poor physical condition are particularly susceptible to lifestyle diseases”, says Stavnsbo.

“That is why childhood is an important period for establishing good habits, not least by engaging in physical activity to prevent lifestyle diseases.”

  • Comparing Norwegian children with other children around the world became possible because Stavnsbo, in addition to figures from ASK, also assembled large amounts of international reference material, a common standard for examining the health profile of children. Over 20,000 children and young people from the United States and Europe formed the basis to conduct a comparison of 14 different health variables. This is a separate article in the thesis.
Kids playing in the classroom
Active breaks in the classroom is one important way for the school to play a crucial role for the kids - even when they grow old. Photo: Skolefoto


Early atherosclerosis

According to Stavnsbo, atherosclerosis cannot be avoided as one gets older, but one can influence how quickly it develops.

  • A number of risk factors are related to the development of cardiovascular diseases and type 2 diabetes, among other things. These include blood pressure, obesity, adverse levels of blood lipids and insulin resistance, and not least: poor physical condition.
  • Seeing as the same risk factors have been measured in a number of international studies, Stavnsbo was able to develop large amounts of international reference material that she then compared with the data from the ASK study.
  • There is a clear correlation between children’s physical condition and risk factors related to cardiovascular diseases. Stavnsbo’s study shows that children in the worst physical condition also have the most unfavourable risk profile. However, these same children also have the most to gain from increased physical activity.

“With a poor diet and an inactive lifestyle, the development of atherosclerosis will accelerate. It can, in turn, lead to cardiovascular diseases.”

Autopsies have shown that children as young as 3 years old develop growing signs of atherosclerosis. At the same time, studies show that children gradually become less physically active as they grow older.

“Therefore, one should stimulate children into becoming more physically active. One must create good habits at an early age”, says Mette Stavnsbo.

“In this sense, school is very important. School influences everyone, regardless of social background, religion or habits. Seen from a public health perspective, school is therefore a very important arena for physical activity.”

A simple but great investment

According to Stavnsbo, more activity in everyday school life will be a good investment, especially in the long run. Both socio-economically and individually.

“The costs of diabetes and cardiovascular diseases are enormous. Prevention is a lot cheaper than reparation.

“But will ‘good habits’ during childhood years actually be something youth continue with? It is known that young people gradually become less active as they grow older?”

“We hope and think so. If one hour of compulsory physical activity is incorporated into primary and lower secondary schools every day, it can help more children and young people meet health authority recommendations. It’s all about finding fun and inclusive activities. Hopefully, this will also stimulate people’s desire to be more active in their spare time.”

“A bit too healthy”

The Year 5 pupils from Sogn and Fjordane were not really the most ideal subjects to use in this trial. Basically, they were too active and in good shape already.

Kids rolling manysided blocks on an outdoor field
Outdoor playing - from the ASK study. Photo: Skolefoto


  • Mette Stavnsbo is a doctoral research fellow at The Norwegian School of Sport Sciences and Western Norway University of Applied Sciences (HVL). She is an assistant professor at the Department of Sport, Food and Natural Sciences at HVL.
  • She will be defending her doctoral thesis on 23 January at NIH:
    “Cardiometabolic risk factors in children - Reference values, association with cardiorespiratory fitness and effects of the Active Smarter Kids (ASK) physical activity intervention”
  • Her studies are included in, among other things, the large ASK study, which examines the effects of increased physical activity on school performance, well-being and risk factors that can lead to the development of lifestyle diseases.

“These children were actually better than the average in Norway and not least internationally”, says Mette Stavnsbo.

Probably, this was also the reason why increased activity during the testing period had no overall effect on the risk factors; only those with the worst health profiles really gained from the increased activity.

“We reached an upper limit, so to speak, where even more activity had little effect. It also turned out that the control group was about as active as the trial group. Therefore, the premise for making a change in the group was weakened.”

Helped the inactive and girls the most

This was the reason why Stavnsbo divided the children into smaller groups, revealing that the children who had the worst health profiles at the start, improved the most during the trial period.

It also showed that girls experienced a greater effect from increased activity than boys. The main reason behind this was most likely that they were already less active and in correspondingly poor physical condition.

Several studies have shown that young people become less active as they grow older: In the spring of 2019, the so-called UngKan3 study showed that children in general have not become less active than in the past (with the exception of the Year 9 group), but they are becoming more lazy as they grow older.

It has also become apparent that few young people meet the recommendations of the World Health Organisation (WHO) and the Norwegian Directorate of Health (HDir) in being active at least one hour each day.




Mette Stavnsbo will be publicly defending her thesis at the Norwegian School of Sport Sciences (NIH) on 23 January.

“Physical fitness and cardiometabolic risk factors"
or with the full title:
"Cardiometabolic risk factors in children - Reference values, association with cardiorespiratory fitness and effects of the Active Smarter Kids (ASK) physical activity intervention"

The disputation is open to the public.