Cardiovascular Health and Children

Cardiovascular exercise should be a family thing!

Improving the cardiovascular health of children has many benefits. Some of them immediate, and some long-term gains. Here’s an overview of the benefits:

Immediate benefits:

Improved physical performance and injury risk reduction

Just like adults, children have the capacity to develop their energy systems. Completing exercise activity each day has been shown to:

• Improve cardiovascular and respiratory function by maximising the heart’s volume and the lung’s efficiency. Children’s energy systems are different to adults. They have less well developed anaerobic systems (high intensity) prior to puberty. Therefore they rely heavily on aerobic capacity to support them during intense work periods. Developing aerobic capacity will help children exercise at higher intensity levels for longer.

• Becoming more skilled at movements, as well as stronger through those movements, corresponds with injury risk reduction. Eccentric loading especially through downhill running may well help towards mitigating injury risk in team sports and other childhood play,

Improved studies

Much research has been done into whether cardiovascular exercise improves children’s ability to study. Here are the key findings:

• Improved Attention: Children who engage in regular aerobic exercise show better sustained attention and faster information processing.

• Enhanced Memory & Learning: Cardiovascular exercise supports neurogenesis, producing new brain cells in the hippocampus, which is responsible for memory and learning.

• Better Academic Performance: Higher physical fitness is associated with better grades, particularly in mathematics and reading, as it improves cognitive flexibility and problem-solving skills.

• Classroom Behavior: Active breaks or "brain gyms" help children manage energy levels and reduce disruption, leading to better on-task behavior.

• Long-Term Impact: Consistent physical activity during childhood is associated with higher concentration levels later in life

Improved self confidence

Self confidence in children can be boosted by cardiovascular exercise through:

• Boosted Self-Image: Regular physical activity helps children feel more positive about themselves and their abilities.

• Sense of Mastery: Developing skills in sports or aerobic activities helps children feel accomplished, which boosts their self-worth.

• Reduced Stress: Exercise acts as an outlet for stress, anxiety, and depression, which in turn improves overall mood and confidence.

• Social Development: Active children often have better social skills, leading to better peer acceptance, which can boost confidence.

Improved physiology

Key Physiological Improvements include:

• Cardiovascular & Respiratory Health: Strengthens the heart muscle and increases lung efficiency, improving blood flow and oxygen delivery to tissues.

• Metabolic Function: Helps maintain healthy blood sugar levels and supports healthy body composition.

• Musculoskeletal Strength: Activities like running and jumping build strong bones and muscles.

• Neurological Development: Higher cardiovascular fitness is linked to improved cognitive function, specifically working memory, attention, and executive functions and foundation movement patterning.

Improved sociological fitness

• Improved Emotional Regulation: If properly delivered and supervised, physical activity helps children handle frustration and stress, reducing negative behaviors.

• Enhanced Teamwork: Structured exercise and team sports (e.g. football) teach cooperation, sharing, and social interaction.

• Higher Self-Esteem: Regular activity reduces anxiety, improves mental health, and boosts confidence, which are critical for social interactions.

• Better Peer Connections: Increased, regular physical activity has been shown to improve social-emotional competence and strengthen relationships with peers. 

Acquisition of life-long habits

Although there is limited research in this area, it is believed that by instilling in children the virtues of cardiovascular exercise at a young age, they grow up with a predisposition to exercise in later-life. However, care must be taken to ensure that the exercise is appropriately pitched to the child’s ability level and that it is fun!

Long term benefits:

Improved Longevity and disease risk reduction:

Research indicates that increasing your adult VO2 Max (the maximum amount of oxygen your body can utilise during exercise) is associated with significant longevity benefits, with studies suggesting each 1 ml/kg/min increase in VO2 Max can add approximately 45 days to life expectancy, and for every 3.5 ml/kg/min you raise it, you get a 13-15% lower mortality risk!. It therefore stands to reason that the process of maximising VO2 Max should start during childhood.

The above charts show average values for VO2 Max - from it you can see that for males, the average figure is just under 45, and for females, the average figure is somewhere around 39. We can also see that VO2 Max values much higher than that are attainable. It is estimated that people currently living a sedentary lifestyle, may be able to improve their VO2 Max through appropriate training by as much as 25%. This could, in theory lead to around a 1.5 years improvement in longevity with a much more disease-free outlook! NB, there are genetic caps on how much we can improve our VO2 Max - so going from poor to excellent may be a step too far for the majority of people.

The current state of childhood activity

With these the afore-mentioned factors in mind, it therefore seems of immense value to instil in children the knowledge and motivation for them to maintain high cardiovascular fitness levels beyond childhood. Historically, this has not happened. Fitness levels of children in the UK plunged through the 90’s, 00’s and 10’s - likely due to the emergence of digital technologies and the pull of less active lifestyles.

So… it is encouraging to read in Sport England’s report (4th December 2025), that:

‘...the number of children and young people playing sport and taking part in physical activity in England is at the highest level since we started our Active Lives Survey in 2017-18. 

Our latest Active Lives Children and Young People Survey Report*, which we’ve published today, shows that there are more than half a million (580,000) more children meeting the Chief Medical Officers’ (CMO) guidelines of taking part in an average of 60 minutes or more of sport and physical activity every day than there were seven years ago – an increase of 5.8%.

This reflects significant progress, especially considering the huge disruption caused by the Covid-19 pandemic, and is testament to the hard work of schools, sports clubs and many organisations across the sport and physical activity sector.’   

However, the report also shows that less than half of all children (49.1%) meet the CMO’s guidelines of 60 active minutes per day and that significant inequalities remain; less affluent families and those from non-white backgrounds lose out the most. This underscores how much there is still to be done to ensure that every child in England enjoys the physical and mental health benefits of participating in exercise and activity. 

Below are some additional facts and stats showing the job that still needs to be done:

• Rise from Lows: Children in England are the most active they have been since 2017, with 3.6 million (49.1%) meeting guidelines in 2024-25, representing a 5.8% increase since the survey began.

• Stagnant Progress: While some reports indicate recent growth, others suggest progress has flatlined recently, with around 51-52% of children still not meeting the minimum 60-minute daily activity target.

• Persistent Inactivity: Approximately 29% of children in England are considered inactive, doing less than 30 minutes of physical activity per day.

• Inequality Gaps: Children from the least affluent families are less likely to be active (45% met guidelines) compared to the most affluent (58% met guidelines).

• Age-Related Declines: Activity levels drop significantly as children get older, with children in years 3-6 showing lower activity levels compared to those in years 1-2. A separate study found children do over an hour less physical activity a week by age 11 than they did at age 6.

• Regional Disparities: London continues to struggle, with over half (53%) of young people in the capital not meeting recommended activity levels, displaying no year-on-year improvement.

  
  

The following have been cited as important drivers of activity by children: 

• Schools and Clubs: The increase in activity is attributed to positive contributions from schools, clubs, and community organisations.

• Impact of Pandemic: Activity levels are recovering after being heavily disrupted by the COVID-19 pandemic.

• Parental Misconception: Roughly 81% of parents underestimate how much physical activity children actually need, which impacts overall engagement. 

  
  

*For more detailed, data-driven insights into children's activity levels across England, you can explore the Active Lives Children and Young People Survey provided by Sport England.

Improving participation rates

Below are five tactics that could be used to improve participation rates in exercise and activity:

1. Make children aware of the opportunities they have for activity in their area, and actively encourage them to ‘give things a try’. 

   1. Directly informing children via newsletters and flyers.

   2. Discussing with children what further opportunities there are for activity

2. Educate parents and guardians so that they understand the importance and the volume of exercise and activity. Explain to them how activity can be incorporated into busy lives and how alternatives to sedentary behaviour should be sought out and pro-actively encouraged to children..

3. Offer age-specific opportunities for play and activity. Children can be very specific about whether an activity is pitched perfectly for them, so care should be taken to plan and advertise sessions appropriately.

4. Create inclusive and open environments. Consider not just the ‘perceived average’ child, but the also the children at the far ends of the various spectrums. 

5. Ensure physical literacy as early in life as possible! Giving children excellent movement capacity early on in life (1-9 years old especially) helps children feel at ease as they get older when they participate in activities or sports that are more technically challenging. Physical literacy should include: Running, jumping throwing, catching, striking and swimming amongst others.

What cardiovascular training should look like for children

Cardiovascular training won't look the same for all children. Every young person has their own perception on what is fun and achievable. So care must be taken to individualise activities for every single child! The following recommendations should be used as a basis for planning your sessions but you should also include lots of flexibilities.

Key Points for Coaches

Coaches need to consider all of the FFITT principles when planning cardiovascular exercise for children:

Fun

Not much explanation required here! Remember that as coaches to young people, we’re trying to do two jobs;  offer immediate physical activity increases, support a lifelong habit formation!

Frequency

According to the NHS, Children and young people need to do 2 types of physical activity each week:

• aerobic exercise

• exercises to strengthen their muscles and bones

Children and young people aged 5 to 18 should:

• aim for an average of at least 60 minutes of moderate or vigorous intensity physical activity a day across the week

• take part in a variety of types and intensities of physical activity across the week to develop movement skills, muscles and bones

• reduce the time spent sitting or lying down and break up long periods of not moving with some activity. Aim to spread activity throughout the day

Children and young people aged 5 to 18 who are living with a disability should:

• aim to do 20 minutes of physical activity a day, splitting this into smaller chunks of activity throughout the day if needed

• do challenging but manageable strength and balance activities 3 times a week

As children engage in more sport, and start training towards performance, the volume of cardiovascular training can be reduced in an inverse relationship with the higher intensities at which they are training. This will often mean having ‘active recovery’ days to allow their bodies to; adapt to the training stresses, recuperate energy supplies - especially the replenishing of glycogen stores in the muscles and liver; allow their overall energy to be boosted so that they don’t suffer from fatigue and subsequent drops in performance both physically and academically.

Intensity

Children require greater exercise intensities than adults to elicit improvements in aerobic capacity. High-intensity, intermittent exercise has been shown to be a time efficient strategy to increase aerobic fitness, (and sprint speed and agility) in this population, primarily because it enables higher intensity work to be repeatedly performed compared to steady state exercise.

Coaches should be aware that youths are characterised by a quicker ability to recover from high-intensity exercise, and may therefore respond better than adults to shorter rest periods. This is in part due to their lower anaerobic capacity meaning that even at high exertion levels, children are actually still working aerobically - which has greater recoverability.

An example of high intensity work could be a repeated sprint shuttle. This design demands minimum equipment or facilities and can be implemented into a fun game scenario. Incorporation of several lanes of different lengths etc, allows the tailoring of the shuttle for each individual within a group. Sport specific skills could also be employed in this design, whilst the work:rest intervals (1:1 – 1:6) would allow the coach to provide any feedback.

Time

Though NHS guidelines advocate for one hour per day of activity - this can be flexible and should exercise should be prescribed based on previous exercise history. For example, a sedentary child may begin with 15-20 minutes per day activity, whereas a more highly trained child could do much more. In endurance sports it is not uncommon for older children to complete upwards of ten hours of cardiovascular training each week. 

Obviously, with this increased volume, comes a huge increase in the need for fuel and for rest. A balanced diet with increased calories would be advised for highly active children along with more sleep and rest. 

During the teenage growth spurt, high volumes of training are not recommended. It is far more important that a child uses their calorie intake for growth and development, rather than fuelling exercise!

One way to ensure that the correct volume of exercise is prescribed, is to keep a log of feedback from the child on their energy levels etc. A coach should also pay careful attention to the child’s performance and if in doubt, cut activity levels.

Type

All properly planned cardiovascular exercise is a benefit to children. Modalities can be swapped around - there is no real need for ‘early specialisation’ apart from possibly swimming. Higher intensity exercise can be prescribed and may be more beneficial as previously explained. Where possible, ‘training’ should be mixed in with cardiovascular ‘games’ to keep sessions fun.

High intensity cardiovascular exercise and risk

Coaches should note that current evidence does not indicate that well designed and supervised resistance training or high-intensity cardiovascular exercise will cause injury or growth and maturation issues in children. A much higher risk is the implementation of unsupervised training regimes which incorporate a higher risk from poor exercise form, as well as from the potential for a training frequency and maximal loads which are inappropriate, not individualised and therefore not recommended. 

CRY Charity logo

Occasionally, you will hear of children having cardiac episodes during sport. According to the CRY charity, 1/100 screens of young people's CV system show a condition that requires monitoring and may cause problems later on in life. 1/300 screens show a potentially life-threatening condition. Each week, 12 young people die of undiagnosed heart conditions. It is therefore of paramount important that you mitigate risk as a coach by completing PARQ forms that are specifically for children and completed with the parent or guardian. Though no form-filling can be 100% fool-proof, keeping records like this do minimise risk and also hold up your duty of care.

In order to minimise risk, care should be taken of the following:

• Complete a PARQ for each child.

• Coaches should understand the GAS principle. The ‘Alarm’ phase should not be so great as to be detrimental to a child, Equally, the ‘adaptation’ and ‘super-compensation’ phases should be adequate for full recovery between exercise bouts. Over-reaching should be limited and over-training completely avoided!

• Extra care should be taken as a child approaches the growth spurt. A potential way to understand a child’s growth status is to take regular seated and stood height measurements and plot the changes over time. These can help you understand a term called ‘Peak Height Velocity’. You will see increases if you keep the measurements spaced approximately four weeks apart.

• Take children’s feedback seriously. They will often verbalise their fatigue levels - but only if you ask the right questions. Don’t just ask ‘how tired are you?’ - children will often say ‘i’m fine’ because they want to do the activity. Instead ask questions such as ‘how recharged was your battery overnight?’. This takes the emphasis away from ‘fatigue’ and focuses on what they do have.

I hope you’ve found this article helpful. Please feel free to write a comment if you have any questions or you feel I have missed something important!

Thanks for reading!

Paul