The main findings from this study indicate that adolescents who are more active (≥9423 steps/day) and those who achieve the HZ in five tests have lower odds for having one or more MRF. Other important findings of the study indicate that 59% of the participants showed at least one MRF and 57.6% were UHZ in the 20mSRT.
In this study, the mean daily step counts were 7427 for girls and 7916 for boys. These results are below the ranges of steps/day reported for adolescents by previous authors [6, 26]. A three-year follow-up study of adolescents in Sweden showed that the daily mean step for boys was 11,892 and for girls 12,271 , while US children took between 11,000 and 13,000 steps/day . The Canadian Physical Activity Levels Among Youth Study reported that Canadian children and youth (aged 5 to 19) take an average of 11,356 steps/day . The ranges of steps/day reported in these studies are much higher than those found for the Azorean adolescents. Some explanations of these differences could be environmental, such as community design as well as other cultural differences.
Given the lack of recommended step counts for the adolescent population, we decided to divide the mean step counts/day into quartiles adjusted to the adolescent's age. In this study, it was observed that the value of the 4th quartile was 9423 steps/day, which is close to the step count cut-off of 10,000 proposed for adults,  and as adolescents reach adulthood, they begin to approximate adults in PA patterns.
Though this study has not examined PA intensity, Wild et al.  showed that adolescents who reported meeting the recommendations for both moderate and vigorous PA accumulated the most steps/day. Moreover, the highest levels of PA were associated with healthy outcomes. In this study, the finding of very low PA patterns suggests that Azorean adolescents may be at an increased risk for obesity, hypertension, type II diabetes, and coronary heart disease . We found no significant sex differences in PA, although Azorean boys have slightly higher levels of PA compared to girls, which is consistent with the findings reported by Hardman et al. .
Reduction in PA is linked to increases in childhood/adolescent obesity  and MetS . In the EYHS using a cross-sectional multicenter study of 1732 children and adolescents, Andersen et al.  showed that the risk of having clustered risk factors decreased in a dose-gradient manner with increased moderate-to-vigorous PA. In another study with the Danish cohort of 9- to 10-year-old children, PA was also shown to be inversely associated with clustered metabolic risk . However, the total volume of PA necessary for preventing cardiovascular disease risk in adolescents is not clear, and no pedometer guidelines have been set for adolescents.
The lack of PF has also been associated with the development of cardiovascular disease risk factors in youth, such as lipid disorders, high BP and insulin resistance, among others . Our results showed a positive influence of overall PF levels on MRF. Adolescents who are in the HZ in five tests had lower odds of having MRF than those who were UHZ. Some studies have shown that PF levels track from adolescence to adulthood,  with moderate to strong coefficients for CRF and strength, respectively .
Ruiz et al. have also shown an inverse association between CRF and clustered MRF in 9-10-year-old Swedish and Estonian children . Reinforcing this idea, Ortega et al.  reported that children and adolescents with higher levels of CRF also have a more favorable cardiovascular profile compared to their unfit counterparts. Conversely, some studies have shown that high levels of CRF and PA are associated with a favorable metabolic risk profile . Similarly, Ekelund et al.  found independent inverse associations of PA and CRF with clustered metabolic risk. However, direct comparisons with our study are difficult because in this study PF was evaluated using five tests from the Fitnessgram Test Battery, while in other studies PF was measured using only the CRF level [8, 23, 24].
Regarding the relationship between PA and CRF levels with MRF, our study indicated that although Azorean adolescent girls had similar step counts to boys, they had lower CRF levels and had more prevalence of MRF. A partial explanation for these differences could be the fact that boys, in general, are more vigorous in PA [35, 36]; therefore, this may to lead to higher CRF levels compared to girls. With this in mind, boys may be more protected in relation to MRS than girls. Although in our study we did not assess PA intensity, it is possible that boys engaged in more vigorous PA than girls, leading to high CRF levels.
The main strength of the current study is that PA was assessed objectively by pedometers, which are a valid and reliable measure. Moreover, walking is one of the most common forms of PA and is easily captured by a pedometer. Their relatively low cost and ease of administration make them attractive for use in field-based PA studies. The use of field tests for PF assessment, which can be administered in school settings where a large number of participants can be tested simultaneously, enhances participant motivation, making it a valuable tool for studying PF in youth. Another aspect to note is the specificity of the place of the study, which was conducted in the Azores Islands. Some studies have been published on Azorean adults [37–39], but in adolescence, the information is scarce . This study is limited because it consisted of a cross-sectional analysis, which limits inferences about causality and its direction. Another limitation of the pedometer it is that it does not provide information about PA intensity, nor does it record activities such as bicycling, swimming and climbing. Moreover, in this study a four sex-and-age-specific BMI categories (thinness, normal weight, overweight and obese) were not analyzed since there were fewer adolescents in the limit categories (thinness and obese), however, in the thinness category none of the adolescents had one or more MRF or had low fitness levels. As evidenced by Bovet et al. , there was a trend toward lower performance in lean students, as compared to students with normal weight for all fitness tests.