The United States ranked 47th out of 50th in a standardized running test, and research suggests that income inequality could play a role.

By Amanda MacMillan
Updated September 30, 2016
Design Pics/Ben Welsh/Getty Images

Think U.S. kids are ahead of the curve? Not when it comes to being physically fit. When researchers recently studied the aerobic fitness levels of children and youth in 50 countries, the United States came in fourth—from last.

The new analysis, led by researchers from the University of North Dakota and the Children’s Hospital of Eastern Ontario, highlights a striking difference between America, which placed 47th, and Canada, which placed 19th.

As a measure of aerobic fitness levels, the researchers looked at the results of a 20-meter shuttle-run test—also called the beep test—from 1.1 million kids, ages 9 to 17, from around the world.

The test involves running back and forth across a 20-meter distance. Runners start off slow and gradually get faster, keeping up with a series of beeps that indicate when to start each round. When they can no longer beat the beep, they drop out.

It’s the most popular field-based test, and the most standardized around the world, to measure aerobic fitness levels in children.

The countries that scored highest on the test were, in order, Tanzania, Iceland, Estonia, Norway, and Japan. Bringing up the rear were the Republic of Korea, the United States, Latvia, Peru, and Mexico. The full results were published this week in the British Journal of Sports Medicine.

“If all the kids in the world were to line up for a race, the average American child would finish at the back of the pack,” said senior study author Grant Tomkinson, Ph.D., associate professor of kinesiology in the UND College of Education and Human Development, in a press release. “This study is the largest of its kind so it’s exciting to have this evidence at hand.”

Of course, a score on a running test is about more than just bragging rights. “Kids who are aerobically fit tend to be healthy; and kids who are healthy are apt to be healthy adults,” said lead author Justin Lang, a PhD student at the University of Ottawa. “It’s important to know how kids in Canada or America fare on the world stage, for example, because we can always learn from other countries with fitter kids.”

Interestingly, the study found that children from countries with high levels of income inequality—larger gaps between the rich and the poor—fared worse in the rankings. One possible reason for this could be because such countries often have high numbers of extremely poor people.

“Poverty is linked to bad health outcomes—one of which being aerobic fitness—including lower physical activity, higher adiposity and higher psychological/physical health symptoms,” Tomkinson told

So why did our neighbor to the north come out so far ahead of us? “Certainly, Canada is a more income-equal country than the U.S.,” says Tomkinson. Childhood obesity is also a bigger problem in the United States, he adds, which could lead to lower test scores either directly (it’s harder for larger bodies to move quickly) or indirectly (overweight people get less moderate-to-vigorous physical activity).

“We also know that a higher proportion of Canadian children participate in regular organized sport and active transportation—the human powered transportation such as walking, cycling, scooting and skateboarding—to and from school relative to their American peers,” he says.

Tomkinson says the study results should be a message to doctors, policy makers, school and community leaders, parents, and youth. “We need to work together as a nation if we want to see real improvement in the physical fitness and activity levels of young Americans,” he says.

Government policies aimed at getting kids moving will certainly help, he says, but more action is needed to get people involved at the community and personal levels. For example, he says, tax credits could be offered to families who participate in physical activity by joining a gym, sports team, or dance club.

“We also need to increase public awareness, through national messaging campaigns, of the U.S. guidelines for physical activity and sedentary behavior,” he says. “My bet is that most American kids would not be able to describe these guidelines.”

Finally, he says, a new nationally representative fitness survey of American kids is needed. (The last one was in 1985.)

But most importantly, America needs to get kids moving. “Increasing levels of vigorous physical activity will really benefit aerobic fitness levels, he says. “I also think improving physical literacy—the physical, cognitive, emotional and social capabilities an individual needs to be physically active for life—will help tremendously.”

That means teaching kids skills like catching, throwing, jumping, and riding a bike; helping them understand the benefits of being physically active; and giving them the confidence and motivation to enjoy and try new movements—all of which enable people to be physically active for life, Tomkinson says.

“A child’s physical literacy ‘toolkit’ does not comprise pens and computers, but instead skipping ropes, bicycles, open spaces and encouragement and guidance from loved ones, coaches and teachers,” he says. “These ‘tools’ are developed through the learning that takes place not only in homes and schools, but also on playing fields, beaches and walking trails.”