Approaches for development of criterion-referenced standards in health-related youth fitness tests

Influence of Physical Activity, Physical Fitness, Age, Biological Maturity and Anthropometric Variables on the Probability of Suffering Lumbar, Neck and Shoulder Pain in Spanish Adolescents from the Region of Murcia

Background: Back pain in adolescents is a common injury, mainly affecting the lumbar, cervical and sometimes shoulder region. This has been related to various factors, such as lifestyle habits or physical capacity, but no previous research has shown conclusive results. The aims of this study was to analyze the risk of suffering lumbar, neck and shoulder pain according to anthropometric and physical fitness variables, physical activity level, age and biological maturity in adolescents, as well as the influence of sex in the study results. Methods: A descriptive cross-sectional study was performed, including a sample of 2015 adolescents (boys: n = 1006, mean age = 14.41 ± 1.35 years-old; girls: n = 1009, mean age = 14.48 ± 1.41 years-old). The participants underwent an anthropometric evaluation and physical fitness tests were carried out, including a 20 m shuttle run, a counter movement jump, a horizontal jump, a 20 m sprint and push-up tests, followed by the completion of lumbar, neck and shoulder pain questionnaires. Results: Higher values in age and peak height velocity (PHV) showed an increase in the risk of suffering lumbar, neck and shoulder pain (OR = 0.79-1.55; p = 0.000-0.025). The anthropometric variables related to adiposity showed an increase in the risk of suffering back pain, with significant incidence in the lumbar region (OR = 1.32-1.60; p = 0.000); while muscle mass showed a protective effect (OR = 0.59; p = 0.000). Regarding the fitness tests, a better physical fitness seemed to protect adolescents from suffering from the analyzed back pains in the general sample and in the boys sample (OR = 0.56-1.60; p = 0.000), while in the girls sample the influence of the physical fitness was less relevant. Conclusions: Both anthropometry and physical fitness may influence the occurrence of back pain in adolescents, with some variations in their importance according to sex.

Functional fitness and physical independence in later years: cut-off values and validation

BACKGROUND

To establish and validate the criterion-referenced standards of functional fitness in predicting physical independence in 80 + years.

METHODS

A group of 2,749 older community dwellers (60-84 years) were recruited, and 2,050 were identified with moderate-to-high independent living ability according to the proposed minimum composite physical function score. The Senior Fitness Test battery was applied to measure functional fitness at five-year intervals. The declining rate for each fitness dimension was calculated based on the differences between any two adjacent age groups and was adjusted according to the reported degradation rate differences between the cross-sectional and longitudinal studies.

RESULTS

The age-and-sex-specific criterion-referenced standards were identified for muscle strength, cardiovascular endurance, and dynamic balance that older adults should possess at 60-79 to maintain independent living abilities. Moderate to high consistency (k = 0.622-0.650) and associations (φ = 0.641-0.694) were found between the predicted physical independence by criterion-referenced standards of functional fitness and the results from the composite physical function scale. Moreover, the predicted independent living abilities in later years from the criterion-referenced standards of functional fitness showed high test-retest reliability (Pa = 0.90-0.96).

CONCLUSION

The criterion-referenced standards for functional fitness are valid and reliable to predict independent living abilities in later years, and provide the threshold to identify the limitations in physical fitness and detect the risks of functional disabilities among older adults in an early stage.

Population-referenced percentiles for total movement and energetic play at early childhood education and care

OBJECTIVES

Childcare services such as preschools and long day care centres have been identified as a key setting to promote physical activity in early childhood as they provide access to large numbers of children for prolonged periods. Yet, specific standards for the type and amount of physical activity (PA) children accumulate whilst attending childcare are lacking. The purpose of this study was to derive population-referenced percentile values for children's total movement and energetic play whilst attending early childhood education and care services.

DESIGN

We analysed accelerometer data collected in four Australian studies involving over 150 long day care services and 3893 accelerometer records from 1945 children to derive population-referenced percentile values for total movement and energetic play whilst attending formal early childhood education and care.

METHODS

Accelerometer data were processed into time spent in total movement and energetic play using a random forest physical activity classification model. Total movement and energetic play estimates were transformed to a standard normal distribution and percentiles were calculated for a 4-, 6-, 8-, and 10-hour early childhood education and care day.

RESULTS

On an average 8-hour early childhood education and care day (50th percentile), Australian pre-schoolers spend between 269 and 292 min, or 60 % of their day in movement. In contrast, Australian pre-schoolers only accumulate between 15 and 29 min of energetic play.

CONCLUSIONS

The percentile reference values can be used to monitor young children's physical activity and energetic play levels whilst attending childcare. Educators can use the percentiles to assign norm-referenced ratings to identify children who could benefit from additional support for physical activity.

Development of a Fitness Surveillance System to Track and Evaluate Obesity in North Idaho

BACKGROUND

Internationally 18% of youth are obese. Fitness testing can be used to establish fitness surveillance, which can inform policy and targeted interventions aimed at addressing obesity. The purpose of this study was to estimate the prevalence of overweight, obesity, and low fitness in Idaho school-aged youth through a pilot study.

METHODS

A convenience sample of 13 teachers from 11 north Idaho rural schools collected FitnessGram fitness data: body composition (body mass index [BMI]), aerobic capacity (Progressive Aerobic Cardiovascular Endurance Run [PACER] test), muscular endurance (curl up), strength (pushup), and flexibility (sit and reach).

RESULTS

A total of 761 students (aged 9-18 years) from grades 3&5, 7, and 9 to 12 participated in the study. Approximately 24% of 3&5 and 22% of 7th, and 12% of 9 to 12th-grade students were categorized as Needs Improvement/Health Risk by FitnessGram standards for BMI. Similarly, approximately 25% of 3&5, and 22% of 7 and 9 to 12th-grade students were considered Needs Improvement/Health Risk for PACER.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Results from fitness testing can provide school and public health representatives with a "needs assessment" of student health that can be used to help develop policies and practices to improve student health and wellbeing.

CONCLUSIONS

This study provides a model for statewide annual fitness testing surveillance and reporting within K-12 public school physical education classrooms.

Strength versus aerobic program: effects on body composition and health-related physical fitness levels of youths with Down syndrome

Aims: To determine the effect of a 16-week fitness program (strength vs. aerobic) on different indicators of body composition and components of health-related physical fitness in youths with Down syndrome. Methods and procedures outcomes: Fifty adolescents (19 girls and 31 boys; average age, 18.33 ± 1.42 years) with Down syndrome were recruited and randomized to two groups (strength group vs. aerobic group). Adolescents allocated in the aerobic group carried out a physical activity program three times a week for 16 weeks meanwhile adolescents allocated in the strength group performed a fitness program three times a week for 16 weeks. Results: The exercise group had significant improvements in all health-related physical fitness variables (p < .05) but not on body composition. Conclusions and implications: A sixteen week fitness program consisting of three sessions of 60 min is able to increase levels of health-related physical fitness but not on body composition in youths with Down syndrome. The aerobic program does not seem to show significant differences.

Association between Physical Fitness and Low Back Pain: The Pepe Cross-Sectional Study

Background: Recent studies have shown that the lifetime prevalence of low back pain (LBP) in schoolchildren aged 10–12 years is 73.6%, and that it appears to have an impact on people’s quality of life. A wide range of risk factors associated with LBP have been studied. However, inconsistent results have been reported. In recent decades, the physical fitness level of children and adolescents has worsened, and the current data on the relationship between muscular fitness and musculoskeletal pain are ambiguous. The purpose of the present study was to analyze the relationship between physical fitness and the occurrence and intensity of LBP. Methods: This cross-sectional study assessed 849 students, aged 10–12 years, from 10 primary schools (fifth and sixth grades) from Majorca (Spain). It was based on two different structured and self-administered questionnaires and a fitness test battery validated for child populations. Results: The results showed that higher levels of VO2Max correspond to less LBP intensity. Additionally, LBP was less prevalent among participants who self-reported more physical activity, and higher VO2Max and higher levels of flexibility were associated with the absence of LBP in bed. Conclusion: These results are of particular importance, as cardiorespiratory fitness is the parameter most closely related to health, and it seems to also be related to LBP-prevention.

The association between student body mass index and tests of flexibility assessed by the FITNESSGRAM®: New York City public school students, 2017-18

FITNESSGRAM® is the most widely used criterion-referenced tool to assess/report on student health-related fitness across the US. Potential weight-related biases with the two most common tests of musculoskeletal fitness–the trunk extension and Back-Saver Sit-and-Reach (sit-and-reach)—have been hypothesized, though have not been studied. To determine the association between musculoskeletal fitness test performance and weight status, we use data from 571,133 New York City public school 4^th-12^th grade students (85% non-White; 75% qualified for free or reduced-price meals) with valid/complete 2017–18 FITNESSGRAM® data. Adjusted logistic mixed effects models with a random effect for school examined the association between weight status and whether a student was in the Healthy Fitness Zone (HFZ; met sex- and age-specific criterion-referenced standards) for the trunk extension and sit-and-reach. Compared to students with normal weight, the odds of being in the HFZ for trunk extension were lower for students with underweight (OR = 0.77; 95% CI: 0.741, 0.795) and higher for students with overweight (OR = 1.10; 95% CI: 1.081, 1.122) and obesity (OR = 1.11; 95% CI: 1.090, 1.13). The odds of being in the HFZ for sit-and-reach were lower for students with underweight OR = 0.85; 95% CI: 0.826, 0.878), overweight (OR = 0.83; 95% CI: 0.819, 0.844) and obesity (OR = 0.65; 95% CI: 0.641, 0.661). Students with overweight and obesity perform better on the trunk extension, yet worse on the sit-and-reach, compared to students with normal weight. Teachers, administrators, and researchers should be aware of the relationship of BMI with student performance in these assessments.

Health-Related Motor Testing of Children in Primary School: A Systematic Review of Criterion-Referenced Standards

Being physically fit in younger years prevents several diseases in the presence as well as in the life course. Therefore, monitoring physical fitness and motor competence through motor testing is essential for determining developmental status and identifying health-related risks. The main objectives of this systematic review were (1) to identify currently available health-related criterion-referenced standards and cut-off points for physical fitness and motor competence test items, (2) to frame the methodological background on setting health-related criterion-referenced standards and (3) to give implications for a health-related evaluation system for physical fitness and motor competence tests. The electronic data base search (PubMed, Web of Science and SURF) yielded 2062 records in total and identified six empirical studies reporting cut-off points of motor test items for children (7-10 years), as well as 30 methodological papers discussing determination approaches to health-related criterion-referenced standards. Data collection, selection and analyses followed the PRISMA guidelines. Health-related motor test standards need to be gender- and age-specific but should refer to an absolute cut-off point rather than to relative performance in the reference group. Due to the lack of data on health-related criterion referenced standards, receiver-operating-characteristic (ROC) curves provide a tool for the determination of cut-off points and criterion referenced standards for physical fitness and motor competence tests. A standardized approach forms the fundamental base for a globally applicable evaluation of health-related fitness tests.

The Cardiorespiratory fitness of children and adolescents in Tibet at altitudes over 3,500 meters

BACKGROUND

Cardiorespiratory fitness (CRF) is the core element of health-related physical fitness evaluation. High pressure and low oxygen in Tibet (over 3,500 m above sea level) may negatively impact the residents' CRF. The 20-m shuttle run test (20mSRT) is the most popular field-based assessment and estimate of CRF in children and adolescents worldwide. However, normative CRF data for the children and adolescents residing in China's plateau region are unavailable, which prevents comparability among those living at high-altitudes around the world.

PURPOSE

To measure the CRF of Chinese children and adolescents aged 9-18 years living in Tibet at altitudes exceeding 3,500 m, and to identify correlations between this metric and demographic characteristics (age, sex, and ethnicity). These data were then compared with those generated in the lowland (Shanghai, China) and various global regions.

METHODS

20mSRT performance (number of completed laps) and predicted peak oxygen consumption (VO2peak) were used as indicators of CRF. We measured the CRF of 1,717 healthy children and adolescents aged 9-18 years living in Tibet. The CRF data from school-age subjects in Shanghai (2,437 boys and 2,396 girls) and worldwide (1,142,026 students from 50 countries/regions in Africa, Asia, Europe, Latin America, North America, and Oceania) were collated from published papers.

RESULTS

The average CRF of the participants from Tibet was 39.8 mL/kg/min. The male subjects (n = 876; 41.1 ± 4.42 mL/kg/min) had a higher average CRF than their female counterparts (n = 841; 37.8 ± 5.40 mL/kg/min). CRF decreased with age in both sexes at statistical significance (F = 1249.9, p for trend 0.05). The indigenous Tibetans (n = 1289; 40.1 ± 3.71 mL/kg/min) had a significant higher average CRF than those of Han descent (n = 394; 38.9 ± 4.70 mL/kg/min) (p < 0.05).

CONCLUSIONS

Children and adolescents aged 7-18 years residing above 3,500 m in Tibet displayed lower CRF traits compared with their counterparts from the plains area and other high altitude places. CRF varied according to age, sex, and ethnic group. Given the importance of CRF in children and adolescents, effective intervention strategies should be implemented to improve CRF in children and adolescents on the plateau.

A comparison of the utility of different step-indices to translate the physical activity recommendation in adolescents

Previous studies translating the daily moderate-to-vigorous physical activity (MVPA) recommendation of total steps/day among adolescents are inconsistent, and those with cadence-based steps are scarce. The main purpose was to compare the accuracy of different daily steps index-based cut-points related to the daily 60 minutes of MVPA recommendation measured by a waist-worn accelerometer for adolescents. Following a cross-sectional design, 428 Spanish adolescents (final sample 351, 50.4% males), aged 13-16 years old, wore an ActiGraph GT3X/+ accelerometer (reference standard = MVPA; index tests = total steps/day, average steps/min and peak 1-min cadence) on the right hip for eight consecutive days. 32.5% of the adolescents met the daily MVPA recommendation. The multiple ROC curve comparisons showed that the accuracy of the daily total step-based recommendation (AUC = 0.97) was statistically higher than for those with the steps/min (AUC = 0.90) and peak 1-min cadence (AUC = 0.58) (p < 0.001). The 10,000-step-per-day cut-point (k= 0.59-0.83) showed highest accuracy values than the 12,000 steps/day (k= 0.20-0.32). Daily total step-based recommendations are more accurate than those with steps/min and peak 1-min cadence for classifying adolescents as being physically active or inactive. A 10,000-step-per-day target is simple and accurate for both male and female adolescents.

Muscular fitness is associated with spinal pain among young people: A cross-sectional exploratory study

PURPOSE

the aim of this study was to analyze the association between upper limb muscular fitness and spinal pain in the cervical, thoracic, and lumbar regions among young people.

METHODS

Cross-sectional study involving a probabilistic sample of 1054 participants (547 female) with ages ranging from 10 to 17 years, from Brazil. The dependent variable was pain in the cervical, thoracic, and lumbar regions of the spine, assessed by a self-report instrument. The independent variable was muscular fitness, verified using the 90° push-up test with the cut-offs proposed by FITNESSGRAM. The covariates were age, sex, socioeconomic status, physical activity, and body mass index. Ordinal logistic regression was adopted to conduct the multivariate association and estimate the Odds Ratios (OR). Two separate analyses were conducted: one with the whole sample and the other with only participants who reported pain.

RESULTS

The prevalences of spine pain in the cervical, thoracic, and lumbar regions were 24.4, 28.3, and 31.0%. In the whole sample, young people who achieved the criterion-referenced standard for muscular fitness were less likely to present high intensity pain in the thoracic region (OR = 0.67, 0.50-0.90). The same occurred when analyzing only those who reported pain for cervical region (OR = 0.48, 0.29-0.79). No association was found between muscular fitness and lumbar pain.

CONCLUSIONS

Upper limb muscular fitness can be used as an additional tool to prevent high levels of spine pain in the thoracic region among young people as well as the severity of cervical pain in those who report pain.

Profiling the health-related physical fitness of Irish adolescents: A school-level sociodemographic divide

Background and aims

Examining factors that may explain disparities in fitness levels among youth is a critical step in youth fitness promotion. The purpose of this study was twofold; 1) to examine the influence of school-level characteristics on fitness test performance; 2) to compare Irish adolescents’ physical fitness to European norms.

Methods

Adolescents (n = 1215, girls = 609) aged 13.4 years (SD .41) from a randomised sample of 20 secondary schools, stratified for gender, location and educational (dis)advantage, completed a series of field-based tests to measure the components of health-related physical fitness. Tests included: body mass index; 20 metre shuttle run test (20 m SRT); handgrip strength; standing broad jump (SBJ); 4 x 10 metre shuttle run; and back-saver sit-and-reach (BSR).

Results

Overall, boys outperformed girls in all tests, aside from the BSR (p < 0.005, t-test, Bonferroni correction). Participants in designated disadvantaged schools had significantly higher body mass index levels (p < 0.001), and significantly lower cardiorespiratory endurance (20 m SRT) (p < 0.001) and muscular strength (handgrip strength) (p = 0.018) levels compared to participants in non-disadvantaged schools. When compared to European norms, girls in this study scored significantly higher in the 20 m SRT, 4 x 10 metre shuttle run and SBJ tests, while boys scored significantly higher in the BSR test (Cohen’s d 0.2 to 0.6, p < 0.001). However, European adolescents had significantly higher handgrip strength scores (Cohen’s d 0.6 to 0.8, p < 0.001).

Conclusion

Irish adolescents compared favourably to European normative values across most components of HRPF, with the exception of muscular strength. School socioeconomic status was a strong determinant of performance among Irish adolescents. The contrasting findings for different fitness components reiterate the need for multi-component testing batteries for monitoring fitness in youth.

Evidence-Based Optimal Cutoff Values with the Validation of Criterion-Referenced Standards for Sarcopenic Elderly Fitness Improvement

This study provides a newly updated perspective of information on severely screened 21 previous studies of the various measurement methods for improving physical fitness and providing determined cutoff values from our reserved elderly human database. We aimed to provide scientific evidence-based information regarding physical fitness standards for developing useful prognostics, promoting and maintaining health programs for sarcopenic elderly. 21 previous studies emphasizing criterion referenced standards and receiver operator characteristic (ROC) curve analyses for improving physical fitness were screened. For predicting the prevalence of sarcopenia, the t-test, logistic regression, linear regression, ROC curve analyses, and voluntary categorizations such as the twentieth or sixtieth percentile classification were used. Based on these scientific evidences, we determined cutoff values from our reserved DB and realized that 75 years for men and 70 years for women are the transitional period during which there are large declines in muscle and fat mass (p < 0.01), which reflects physical function tests (p < 0.01) in both genders. Using the six factors with ideal cutoff thresholds, an individual exercise program can be designed for alleviating symptoms of frailty caused by sarcopenia for the elderly.

Evidence‐Based Optimal Cutoff Values with the Validation of Criterion‐Referenced Standards for Sarcopenic Elderly Fitness Improvement

This study provides a newly updated perspective of information on severely screened 21 previous studies of the various measurement methods for improving physical fitness and providing determined cutoff values from our reserved elderly human database. We aimed to provide scientific evidence‐based information regarding physical fitness standards for developing useful prognostics, promoting and maintaining health programs for sarcopenic elderly. 21 previous studies emphasizing criterion referenced standards and receiver operator characteristic (ROC) curve analyses for improving physical fitness were screened. For predicting the prevalence of sarcopenia, the t‐test, logistic regression, linear regression, ROC curve analyses, and voluntary categorizations such as the twentieth or sixtieth percentile classification were used. Based on these scientific evidences, we determined cutoff values from our reserved DB and realized that 75 years for men and 70 years for women are the transitional period during which there are large declines in muscle and fat mass (p < 0.01), which reflects physical function tests (p < 0.01) in both genders. Using the six factors with ideal cutoff thresholds, an individual exercise program can be designed for alleviating symptoms of frailty caused by sarcopenia for the elderly.

Physical Fitness and Metabolic Syndrome in Brazilian Adolescents: Validity of Diagnostic Health Criteria

We tested health criteria cutoff points from physical fitness variables proposed by the Fitnessgram program for detecting metabolic syndrome ( MetS) in a representative sample of 1,035 Brazilian adolescents (565 girls and 470 boys) aged 12-20 years. We studied five fitness tests: (a) back-saver sit and reach, (b) trunk lift, (c) curl-up, (d) push-up, and (e) progressive aerobic cardiovascular endurance run ( PACER), and we defined MetS through the criteria of the International Diabetes Federation. We described the predictive performance of each fitness test in terms of sensitivity, specificity, and area under the curve ( AUC) estimates of the receiver operating characteristic method. The AUCs for four tests ( back-saver sit and reach, trunk lift, curl-up, and push-up) revealed low accuracy for identifying MetS in both sexes (0.50 ≥ AUC ≤ 0.60), but AUCs for the PACER test demonstrated good accuracy values between 0.72 (0.68-0.76) and 0.83 (0.78-0.89). Thus, cutoff points proposed in the Fitnessgram program for the PACER test offer an effective means of screening adolescents at higher cardiometabolic risk, which, for the age-group used in this study, should be from 40.3-44.3 ml/kg/min for boys and 38.6-40.1 ml/kg/min for girls.

The Intersections of Science and Practice: Examples From FitnessGram® Programming

The FitnessGram® program has provided teachers with practical tools to enhance physical education programming. A key to the success of the program has been the systematic application of science to practice. Strong research methods have been used to develop assessments and standards for use in physical education, but consideration has also been given to ensure that programming meets the needs of teachers, students, parents, and other stakeholders. This essay summarizes some of these complex and nuanced intersections between science and practice with the FitnessGram® program. The commentaries are organized into 5 brief themes: science informing practice; practice informing science; balancing science and practice; promoting evidence-based practice; and the integration of science and practice. The article draws on personal experiences with the FitnessGram® program and is prepared based on comments shared during the 37th Annual C. H. McCloy Research Lecture at the 2017 SHAPE America - Society of Health and Physical Educators Convention.

Multivariate Associations Among Health-Related Fitness, Physical Activity, and TGMD-3 Test Items in Disadvantaged Children From Low-Income Families

Motor skills are needed for physical development and may be linked to health-related fitness and physical activity levels. No studies have examined the relationships among these constructs in large samples of disadvantaged children from low-income families using the Test for Gross Motor Development-3rd Edition (TGMD-3). The purpose of this study was to examine the multivariate associations among health-related fitness, physical activity, and motor skills assessed using the TGMD-3. Participants included 1460 school-aged children (730 boys, 730 girls; M age = 8.4 years, SD = 1.8 years) recruited from the K to sixth grades from three low-income schools. Health-related fitness was assessed using the FITNESSGRAM battery, physical activity was assessed using accelerometers and pedometers, and motor skills were assessed using the TGMD-3. Canonical correlations revealed statistically significant correlations between the Ball Skills and health-related fitness variates (R_c = 0.43, R_c²= 17%, p < 0.001). Significant canonical coefficients in the Ball Skills variate included two-handed striking, dribbling, and catching, and significant canonical coefficients in the health-related fitness variate included body mass index and the progressive aerobic cardiovascular endurance run ( p < 0.01). Locomotor skills did not significantly correlate with health-related fitness or physical activity. Ball skills are related to health-related fitness in disadvantaged children from low-income families.

Establishing Waist-to-Height Ratio Standards from Criterion-Referenced BMI Using ROC Curves in Low-Income Children

The purpose of this study was to establish health-related waist-to-height ratio (WHtR) cut-points associating with FITNESSGRAM's body mass index (BMI) criterion-referenced standards in low-income children. A secondary aim was to examine the classification agreement between the derived WHtR cut-points and various cardiometabolic blood markers using current recommendations. Participants were 219 children from low-income schools (mean age = 10.5 ± 0.6 years). Waist circumference, height, weight, and cardiometabolic blood markers were collected in a fasting state before school hours. Receiver operating characteristic (ROC) curves were used to determine WHtR cut-points that associated with a child meeting FITNESSGRAM's age- and sex-specific criterion-referenced standards for BMI. The derived WHtR cut-point was 0.50 (AUC = 0.89, p < 0.001; sensitivity = 0.86, specificity = 0.82, and accuracy = 84.3%). Classification agreement using the derived WHtR cut-point with various blood marker standards was statistically significant but considered weak to fair (kappa 0.14-0.34, agreement = 59%-67%, and p < 0.01). The WHtR cut-point of 0.50 can be used with strong accuracy to distinguish low-income children who met FITNESSGRAM's criterion-referenced standards for body composition; however, the evidence was weaker for its use in distinguishing low-income children meeting specific cardiometabolic blood marker recommendations.

Contextual factors related to physical activity during daily middle school physical education

OBJECTIVES

Given the importance of optimizing physical activity in adolescents, the purpose of this study was to examine the effect of activity mode, environment, and semester on step counts/minute and MVPA during daily middle-school physical education (PE).

DESIGN

A prospective and observational research design.

METHODS

Participants included 232 students (Mean age=13.3±0.4 years) recruited from the seventh and eighth grades from one public middle-school in the U.S. Activity modes were employed across the school year including motor skills, games, and fitness activities located in indoor and outdoor environments. Step counts/minute and MVPA were monitored across 132 PE lessons during Fall and Spring semesters using NL-1000 piezoelectric pedometers. A three-way Multivariate Analysis of Covariance (MANCOVA) was employed to examine the effect of activity mode (skill games vs. fitness), environment (indoors vs. outdoors), and semester (Fall vs. Spring) on student step counts/minute and MVPA. MANCOVA was followed by separate ANCOVA tests.

RESULTS

MANCOVA yielded a statistically significant three-way interaction (Wilks' Λ=0.98 F(2, 1153)=8.9, P<0.001). Follow-up tests supported that physical activity was higher during outdoor fitness activities in the Fall compared to indoor motor skills in the Spring for step counts/minute (Mean difference=27.0 steps/minute, P<0.001, Cohen's d=1.6) and MVPA (Mean difference=7.8min, P<0.001, Cohen's d=2.0).

CONCLUSIONS

Daily middle-school physical activity was the highest during outdoor fitness activities in the Fall and the lowest during indoor motor skill games in the Spring.

Overview of the Hungarian National Youth Fitness Study

The 2012 Public Act on Education in Hungary made daily physical education (PE) a mandatory part of the school day starting in the 2012-2013 school year. This directive was linked to a significant reorganization of the Hungarian education system including a new National Core Curriculum that regulates the objectives and contents of PE. The Hungarian School Sport Federation (HSSF) recognized the opportunity and created the Strategic Actions for Health-Enhancing Physical Education or Testnevelés az Egészségfejlesztésben Stratégiai Intézkedések (TESI) project. Physical fitness assessments have been a traditional part of the Hungarian PE program; however, the TESI plan called for the use of a new health-related battery and assessment system to usher in a new era of fitness education in the country. The HSSF enlisted the Cooper Institute to assist in building an infrastructure for full deployment of a national student fitness assessment program based on the FITNESSGRAM® in Hungarian schools. The result is a new software-supported test battery, namely the Hungarian National Student Fitness Test (NETFIT), which uses health-related, criterion-referenced youth fitness standards. The NETFIT system now serves as a compulsory fitness assessment for all Hungarian schools. This article details the development process for the test battery and summarizes the aims and methods of the Hungarian National Youth Fitness Study.

Establishing Normative Reference Values for Standing Broad Jump Among Hungarian Youth

PURPOSE

The purpose of this study was to examine age and sex trends in anaerobic power assessed by a standing broad jump and to determine norm-referenced values for youth in Hungary.

METHOD

A sample of 2,427 Hungarian youth (1,360 boys and 1,067 girls) completed the standing broad jump twice, and the highest distance score was recorded. Quantile regression was used to fit standing broad jump trends across linear and quadratic functions of age. Statistical significance was determined with bootstrap confidence intervals and the Wald test with p < .05. Age-by-sex specific centiles were generated and the 50th percentile was used to describe the overall patterns.

RESULTS

Standing broad jump scores increased steadily in boys from age 11 through 18 years with a discrete plateau at the end of adolescence. Girls' standing broad jump scores of those who performed above the median increased with age and plateaued later in the adolescence. Both linear and quadratic age terms were statistically significant predictors of standing broad jump trends across age (p < .05), but the relations varied depending on the percentile. The 50th percentile values resulted in 147.0 cm, 162.0 cm, 175.0 cm, 186.0 cm, 195.0 cm, 202.0 cm, 207.0 cm, and 210.0 cm for boys aged 11 to 18 years old, respectively, and 140.0 cm, 143.9 cm, 147.3 cm, 150.0 cm, 152.1 cm, 153.7 cm, 154.6 cm, and 155.0 cm for girls aged 11 to 18 years old, respectively.

CONCLUSIONS

This study provides normative reference charts that take into account age and sex differences in standing broad jump performance. The proposed reference values can be used to interpret standing broad jump scores in Hungarian youth.

Cross-Validation of FITNESSGRAM® Health-Related Fitness Standards in Hungarian Youth

PURPOSE

The purpose of this study was to cross-validate FITNESSGRAM® aerobic and body composition standards in a representative sample of Hungarian youth.

METHOD

A nationally representative sample (N = 405) of Hungarian adolescents from the Hungarian National Youth Fitness Study (ages 12-18.9 years) participated in an aerobic capacity assessment via treadmill test to maximum to determine peak oxygen consumption (VO2peak) and a bioelectrical impedance assessment to estimate percent body fat (%BF). Additionally, metabolic syndrome status was assessed via finger-stick blood sample. Youth were categorized into Healthy Fitness Zone (HFZ) and Needs Improvement (NI) groups based on Fitnessgram standards. Prevalence of metabolic syndrome was calculated and logistic regression was used to estimate odds of metabolic syndrome.

RESULTS

Hungarian youth were generally fit with a low prevalence of metabolic syndrome. Approximately 69% to 77% of boys and 55% to 57% of girls were classified into the HFZ based on %BF and VO2peak. Youth in the NI health risk zones for VO2peak and %BF were 4 times to 5 and 2 times to 3 times more likely to have metabolic syndrome than children in the lower-risk groups, respectively.

CONCLUSIONS

Fitnessgram standards for aerobic capacity and body composition were associated with metabolic syndrome status, though odds ratios were larger for VO2peak than for %BF and varied by sex. Even though these standards were developed in U.S. youth, they can be applied in Hungary and still provide a criterion-referenced indication of fitness.

Development of an aerobic capacity prediction model from one-mile run/walk performance in adolescents aged 13-16 years

A popular algorithm to predict VO2Peak from the one-mile run/walk test (1MRW) includes body mass index (BMI), which manifests practical issues in school settings. The purpose of this study was to develop an aerobic capacity model from 1MRW in adolescents independent of BMI. Cardiorespiratory endurance data were collected on 90 adolescents aged 13-16 years. The 1MRW was administered on an outside track and a laboratory VO2Peak test was conducted using a maximal treadmill protocol. Multiple linear regression was employed to develop the prediction model. Results yielded the following algorithm: VO2Peak = 7.34 × (1MRW speed in m s(-1)) + 0.23 × (age × sex) + 17.75. The New Model displayed a multiple correlation and prediction error of R = 0.81, standard error of the estimate = 4.78 ml kg(-1) · min(-1), with measured VO2Peak and good criterion-referenced (CR) agreement into FITNESSGRAM's Healthy Fitness Zone (Kappa = 0.62; percentage agreement = 84.4%; Φ = 0.62). The New Model was validated using k-fold cross-validation and showed homoscedastic residuals across the range of predicted scores. The omission of BMI did not compromise accuracy of the model. In conclusion, the New Model displayed good predictive accuracy and good CR agreement with measured VO2Peak in adolescents aged 13-16 years.

Comparisons of sarcopenia prevalence based on different diagnostic criteria in Chinese older adults

The study aimed to describe the prevalence of sarcopenia and discussed the applicability of different diagnostic criteria in Chinese older adults. 286 Chinese adults (136 men and 150 women) aged 60-88 were recruited. The prevalence of sarcopenia were calculated using different diagnostic criteria. Physical functioning was compared in sarcopenic and non-sarcopenic older adults. Compared with the standard of EWGSOP (European Working Group on Sarcopenia in Older People), the prevalence of sarcopenia was higher when the IWGS (International Working Group on Sarcopenia) standard was applied (Men: 7.4% vs. 0.8%; Women: 4.7% vs. 0%). If the AWGS (Aisa Working Group on Sarcopenia) standard was applied, the prevalence was 5.9% in men and 0.7% in women. In conclusion, the prevalence of sarcopenia in Chinese older adults ranged from 0% to around 10% when the diagnostic criteria of IGWS, EWGSOP and AGWS were applied. Further studies are still needed to investigate appropriate diagnostic criterion of sarcopenia for Chinese population.

[Low agreement between the fitnessgram criterion references for adolescents]

OBJECTIVE:

To analyze the association and agreement of fitnessgram reference criteria (RC) for cardiorespiratory fitness, body mass index (BMI) and strength in youth.

METHODS:

The study included 781 youth, 386 females, aged 10 to 18 years of Londrina-PR. It were performed cardiorespiratory fitness and muscular strength tests and was calculated body mass index. The association between the tests was analyzed using Poisson regression to obtain prevalence ratio (PR) and confidence intervals of 95%, while agreement of the reference criteria was tested by Kappa index.

RESULTS:

Significant associations were found between cardiorespiratory fitness and BMI (PR=1,49, 1,27-1,75), muscle strength and BMI (PR=1,55, 1,17-2,08), cardiorespiratory fitness and muscle strength (PR=1,81, 1,47-2,24). The agreement between reference criteria ranged from weak to fair, 48.8% (k=0.05, p=0.10) for cardiorespiratory fitness and BMI, 52.9% (k=0.09, p=0.001) for muscle strength and BMI and 38.4% (k=0.22, p<0.001) for cardiorespiratory fitness and muscle strength.

CONCLUSIONS:

Although RC for cardiorespiratory fitness, muscle strength and BMI are associated, the agreement between them ranged from weak to fair. To evaluate health related physical fitness it is suggest the execution of all tests, since each test has specific characteristics.

GPS suggests low physical activity in urban Hispanic school children: a proof of concept study

Background

Urban environments can increase risk for development of obesity, insulin resistance (IR), and type 2 diabetes mellitus (T2DM) by limiting physical activity. This study examined, in a cohort of urban Hispanic youth, the relationship between daily physical activity (PA) measured by GPS, insulin resistance and cardiovascular fitness.

Methods

Hispanic middle school children (n = 141) were assessed for body mass index (BMI), IR (homeostasis model [HOMA-IR]), cardiovascular fitness (progressive aerobic cardiovascular endurance run [PACER]). PA was measured (GPS-PA) and energy expenditure estimated (GPS-EE) utilizing a global positioning mapping device worn for up to 7 days.

Results

Students (mean age 12.7 ± 1.2 years, 52% female) spent 98% of waking time in sedentary activities, 1.7% in moderate intensity PA, and 0.3% in vigorous intensity. GPS analysis revealed extremely low amounts of physical movement during waking hours. The degree of low PA confounded correlation analysis with PACER or HOMA-IR.

Conclusions

Levels of moderate and vigorous intensity PA, measured by GPS, were extremely low in these urban Hispanic youth, possibly contributing to high rates of obesity and IR. Physical movement patterns suggest barriers to PA in play options near home, transportation to school, and in school recess time. GPS technology can objectively and accurately evaluate initiatives designed to reduce obesity and its morbidities by increasing PA.

Top 10 research questions related to musculoskeletal physical fitness testing in children and adolescents

The purpose of this article is to bring attention to the 10 most pressing questions relevant to musculoskeletal physical fitness testing in children and adolescents. The goal is to stimulate research to answer these questions. The most pressing needs include establishing definitive links between valid, reliable, and feasible field test measures of muscular strength, endurance, power, and flexibility and health risk factors/markers in children and adolescents; determining the effects of exercise training on these relationships; and documenting the tracking of these relationships. The role of flexibility in health-related physical fitness (HRPF) needs to be carefully and specifically examined. Although body weight/composition is a separate component of health-related fitness, it is also a factor that can influence the performance of musculoskeletal test items. The role of body weight, body fat, and central adiposity and the possibility of adjustment of tests results are important research questions. Several questions relate to which field tests are best for use in schools. Finally, actual health-related criterion-referenced cutoff values need to be developed. In conclusion, more quality research is needed to firmly establish the musculoskeletal area for HRPF in youth.

Physical fitness percentiles for Portuguese children and adolescents aged 10-18 years

This study aimed to produce age- and sex-specific physical fitness reference data for Portuguese youth; to report the prevalence of youth in the healthy zone of physical fitness according to the FITNESSGRAM(®) criteria; to verify the agreement between the Portuguese physical fitness percentiles and the FITNESSGRAM(®) healthy zones. In 2008, 22,048 Portuguese children and adolescents (10-18 years) were evaluated. Physical fitness (curl-ups, push-ups, 20-m shuttle run and modified-back-saver-sit-and-reach tests) was evaluated using the FITNESSGRAM(®) Test Battery 8.0. Smoothed percentile curves were estimated using Cole's LMS method. Boys consistently outperformed girls in every physical fitness test, except for the modified-back-saver-sit-and-reach tests. In both sexes and for all physical fitness tests, higher percentile values were observed at older ages. The 50th percentile of all physical fitness tests had the highest accuracy to discriminate between under healthy zone and healthy zone of the FITNESSGRAM(®). Portuguese schools and physical education teachers may considerer the 50th percentile for age and sex or the FITNESSGRAM(®) criteria for classifying participants in the healthy zone as acceptable cut-offs, above which youth should be considered fit. These reference values can be used as normative data and for baseline values for subsequent surveillance of the physical fitness of Portuguese youth.

Hospital for Special Surgery Pediatric Functional Activity Brief Scale predicts physical fitness testing performance

BACKGROUND

An eight-item activity scale was recently developed and validated for use as a prognostic tool in clinical research in children and adolescents. It is unclear, however, if this brief questionnaire is predictive of quantitative metrics of physical activity and fitness.

QUESTIONS/PURPOSES

The purposes of this study were to prospectively administer the Hospital for Special Surgery Pediatric Functional Activity Brief Scale to a large cohort of healthy adolescents to determine (1) if the activity scale exhibits any floor or ceiling effects; (2) if scores on the activity scale are correlated with standardized physical fitness metrics; and if so, (3) to determine the discrimination ability of the activity scale to differentiate between adolescents with healthy or unhealthy levels of aerobic capacity and calculate an appropriate cutoff value for its use as a screening tool.

METHODS

One hundred eighty-two adolescents (mean, 15.3 years old) prospectively completed the activity scale and four standardized metrics of physical fitness: pushups, sit-ups, shuttle run exercise (Progressive Aerobic Cardiovascular Endurance Run), and calculated VO2-max. Age, sex, and body mass index were also recorded. Pearson correlations, regression analyses, and receiver operating characteristic analyses were used to evaluate activity scale performance.

RESULTS

The activity scale did not exhibit any floor or ceiling effects. Pushups (ρ = 0.28), sit-ups (ρ = 0.23), performance on the Progressive Aerobic Cardiovascular Endurance Run (ρ = 0.44), and VO2-max (ρ = 0.43) were all positively correlated with the activity scale score (Pearson correlations, all p < 0.001). Receiver operating characteristic analysis revealed that those with an activity score of ≤ 14 were at higher risk of having low levels of aerobic capacity.

CONCLUSIONS

In the current study, activity score was free of floor and ceiling effects and predictive of all four physical fitness metrics. An activity score of ≤ 14 was associated with at-risk aerobic capacity previously shown to be associated with an increased risk of metabolic syndrome. This study is the first to prospectively validate an activity questionnaire against quantitative physical fitness assessments and provides further evidence substantiating its use in outcomes research and screening for healthy levels of childhood activity and fitness.

LEVEL OF EVIDENCE

Level I, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Measuring advanced motor skills in children with cerebral palsy: further development of the Challenge module

PURPOSE

Since previous testing of the Challenge Module revealed that response scales should assess performance speed as well as skill accomplishment, this study sought to develop empirically based dual-criterion (accomplishment and time) response options.

METHODS

Challenge items were tested with a convenience sample of 34 children who were typically developing (4-10 years) to obtain time cut-points that could be applied to children/youth with cerebral palsy. Median/lower quartile item performance times were calculated within younger (<7.5 years) and older child (≥7.5 years) groups, and used as benchmarks for response option cut-points. Children's scores were recalculated using these cut-points to verify that differences in younger and older children's abilities and times were captured.

RESULTS

Mean scores were 48.9% and 87.2% for younger and older groups, reflecting expected developmental progression. Further response revision captured high-level movement control older children exhibited.

CONCLUSION

The revised Challenge measures skill accomplishment, speed, and quality.

Science and art of setting performance standards and cutoff scores in kinesiology

Setting standards and cutoff scores is essential to any measurement and evaluation practice. Two evaluation frameworks, norm-referenced (NR) and criterion-referenced (CR), have often been used for setting standards. Although setting fitness standards based on the NR evaluation is relatively easy as long as a nationally representative sample can be obtained and regularly updated, it has several limitations-namely, time dependency, population dependence, discouraging low-level performers, and favoring advantaged or punishing disadvantaged individuals. Fortunately, these limitations can be significantly eliminated by employing the CR evaluation, which was introduced to kinesiology by Safrit and colleagues in the 1980s and has been successfully applied to some practical problems (e.g., set health-related fitness standards for FITNESSGRAM). Yet, the CR evaluation has its own challenges, e.g., selecting an appropriate measure for a criterion behavior, when the expected relationship between the criterion behavior and a predictive measure is not clear, and when standards are not consistent among multiple field measures. Some of these challenges can be addressed by employing the latest statistical methods (e.g., test equating). This article provides a comprehensive review of the science and art of setting standards and cutoff scores in kinesiology. After a brief historical overview of the standard-setting practice in kinesiology is presented, a case analysis of a successful CR evaluation, along with related challenges, is described. Lessons learned from past and current practice as well as how to develop a defendable standard are described. Finally, future research needs and directions are outlined.

Standardized childhood fitness percentiles derived from school-based testing

OBJECTIVE

To develop a statewide school-based program of measuring and reporting cardiovascular fitness levels in children, and to create age- and sex-specific cardiovascular fitness percentile-based distribution curves.

STUDY DESIGN

A pilot study validated cardiovascular fitness assessment with Progressive Aerobic Cardiovascular Endurance Run (PACER) testing as an accurate predictor of cardiovascular fitness measured by maximal oxygen consumption treadmill testing. Schools throughout the state were then recruited to perform PACER and body mass index (BMI) measurement and report de-identified data to a centralized database.

RESULTS

Data on 20 631 individual students with a mean age 12.1 ± 2.0 years, BMI of 21.4 ± 5.1, and a cardiovascular fitness measured with PACER of 29.7 ± 18.2 laps (estimated maximal oxygen consumption of 36.5 mL/kg/min) were submitted for analysis. Standardized fitness percentiles were calculated for age and sex.

CONCLUSIONS

This study demonstrates the feasibility of performing, reporting, and recording annual school-based assessments of cardiovascular fitness to develop standardized childhood fitness percentiles on the basis of age and sex. Such data can be useful in comparing populations and assessing initiatives that aim to improve childhood fitness. Because health consequences of obesity result from both adiposity and physical inactivity, supplementation of BMI measurement with tracking of cardiovascular fitness adds a valuable tool for large-scale health assessment.

Development of youth percent body fat standards using receiver operating characteristic curves

BACKGROUND

Few studies have identified health-related criterion standards of percent body fat (%BF) in U.S. youth. Further, existing standards are static thresholds (e.g., 25%, 30%) and do not account for normal growth and maturation.

PURPOSE

The purpose of this study was to identify thresholds of %BF in youth linked to metabolic syndrome in a large sample of U.S. children and adolescents.

METHODS

Percent fat was derived from the skinfold thicknesses of those aged 12-18 years, from the National Health and Nutrition Examination Survey (NHANES [1999-2004, N=1966]). Metabolic syndrome was classified using previously published standards based on the National Cholesterol Education Program/Adult Treatment Panel III adult values at age 20 years. Using %BF z-scores as the test and metabolic syndrome as the criterion, receiver operating characteristic (ROC) curve analysis was used to identify %BF thresholds.

RESULTS

ROC analysis indicated that %BF can be used with moderate accuracy to identify metabolic syndrome in adolescents. %BF thresholds of 22.3% and 35.1% in boys and 31.4% and 38.6% in girls (at age 18 years) were found to be indicative of "low" and "high" metabolic syndrome risk.

CONCLUSIONS

Age- and gender-specific %BF thresholds for creating separate risk groups were identified in relation to metabolic syndrome status. The selected thresholds identify adolescents with unfavorable metabolic profiles. These values could be extrapolated to younger children using previously created %BF centiles, which potentially allows for earlier identification and intervention of at-risk youth if tracking of current %BF was maintained.

Development of youth aerobic-capacity standards using receiver operating characteristic curves

BACKGROUND

Cardiovascular fitness has important implications for current and future health in children.

PURPOSE

In this paper, criterion-referenced standards are developed for aerobic capacity (an indicator of cardiovascular fitness) based on receiver operating characteristic (ROC) curves.

METHODS

The sample was drawn from participants aged 12-18 years in the National Health and Nutrition Examination Survey (1999-2002, N=1966). Subjects completed a treadmill exercise test from which maximal oxygen uptake (VO(2)max) was estimated from heart rate response. Metabolic syndrome was classified using previously published standards based on the National Cholesterol Education Program/Adult Treatment Panel III adult values at age 20 years. Using aerobic fitness z-scores as the test and metabolic syndrome as the criterion, ROC curve analysis was used to identify aerobic-capacity thresholds.

RESULTS

The area under the curve (AUC) value for boys (83.1%) was high, indicating good utility for detecting risk of metabolic syndrome with aerobic fitness values. The AUC for girls (77.2%) was slightly below the recommended value of 80%. Although the ROC plots identified a defensible point for classifying levels of fitness, the approach in the present study was to establish two independent thresholds, one aimed at high specificity and one aimed at high sensitivity. The resulting z values for the low- and higher-risk threshold lines were then converted back to VO(2)max estimates using published LMS (L=skewness, M=median, and S=coefficient of variation) parameters. Values at the low-risk threshold ranged from 40 to 44 mL/kg/min for boys and from 38 to 40 mL/kg/min for girls.

CONCLUSIONS

In summary, aerobic fitness can be used with moderate accuracy to differentiate between adolescents with and without metabolic syndrome. Age- and gender-specific aerobic-capacity thresholds for creating separate risk groups were identified using nationally representative growth percentiles.