Field evaluation of the new FITNESSGRAM® criterion-referenced standards

Changes in physical fitness in transgender adolescents receiving gender-affirming hormone therapy: protocol for a prospective cohort pilot study

There is very little data about the physical fitness of transgender and gender-diverse (TGD) youth. This protocol paper describes the methods for a pilot study that aims to measure changes in fitness levels in TGD adolescents undergoing gender-affirming hormone therapy (GAHT) using FitnessGram, a reliable, validated tool used to measure physical fitness. A secondary aim of the study is to compare the physical fitness of TGD adolescents with normative data for cisgender individuals. This will be a prospective cohort study. We will recruit 25 TGD participants who are 13-18 years old and patients in our organisation's Gender Development Clinic, planning to initiate GAHT. Participants will complete FitnessGram before starting GAHT and undergo repeat assessments 6 months and 12 months after GAHT initiation. Participants will also complete the Physical Activity Questionnaire for Adolescents. We plan to report changes in the participant's ability to achieve the FitnessGram standards over 12 months. Secondary outcomes will include a comparison of the achievement of the FitnessGram standards in the cohort with the reported achievement of standards for cisgender adolescents.

Longitudinal changes in Chinese minority college students' health-related fitness: A multilevel latent growth curve modeling approach

PURPOSE

The study aimed to test the overall changes of health-related fitness (HRF) in minority Chinese college students and to examine HRF differences in gender, race, and year in college. Method: Participants (n = 1320) were minority college students with more than two-thirds females (ie 76.1%), and Hui, Tibetan, and Mongolia consisted of 13.8%, 13.8%, and 11.2%, respectively. Student HRF was tracked for four years. Data were analyzed using multilevel latent growth curve modeling. Results: Muscular strength and endurance were the weakest component in minority college students' HRF, while body mass index was within the category of "excellent". Males outperformed female on all components of HRF. Conclusions: It is suggested that interventions concerning minority females' HRF and muscular strength and endurance for both genders be constructed and tested.

Healthy fitness zone prevalence and age-specific fitness profile of young people in seven European countries in 2022: The EUFITMOS project

BACKGROUND

Physical fitness is a health marker in youth and is associated with current and future health.

OBJECTIVE

Present the healthy fitness zone (HFZ) prevalence and age-specific fitness profile of young people from seven European countries.

METHODS

This study used data from the European Fitness Monitoring System project. The sample comprised 4965 (51.4% boys) youths aged 9 to 18 years. Fitness data were collected by physical education teachers using field-based tests. Raw data from the fitness tests were used to calculate the prevalence and 95% confidence intervals (CI) of participants in the HFZ.

RESULTS

The overall prevalence of boys and girls in the HFZ for all tests was 16.6% (95% CI = 14.7, 18.1) and 14.9% (95% CI = 13.2, 16.6), respectively. Boys have a mainly positive HFZ profiles, except for the 9-year-olds in the sit and reach (z-score difference = -1.20) and the 20 m run for boys 13-18-year-olds (z-score difference range: -0.09 to -0.01). Girls have worse HFZ profiles than boys, being out of the HFZ in several tests. Furthermore, a decreasing trend in z-score difference from the HFZ with age was observed in VO2 peak for boys and girls and sit and reach for girls. Notwithstanding, several country-related, sex and age differences were observed.

CONCLUSIONS

Boys presented mostly healthy age-specific fitness profiles in several fitness tests and ages. These differences should be considered when promoting youth's health through physical activity and fitness, as different fitness levels may require different approaches to implementing health-enhancing physical activity policies.

Dose-response associations of Monitor-Independent Movement Summary with health-related fitness in youth

The purpose of this study was to determine the dose-response associations between Monitor-Independent Movement Summary (MIMS) units and health-related fitness in youth. The sample comprised US children and adolescents who participated in the 2012 National Youth Fitness Survey (NNYFS; N = 1158, 48.9% female). Health-related fitness domains were assessed using tests of cardiorespiratory endurance (timed maximal and graded treadmill tests), muscular strength (modified pull-up and grip tests), and muscular endurance (plank test). Movement data were collected using wrist-worn ActiGraph accelerometers with raw data processed using MIMS and the calculated metrics of average MIMS/day, Peak 60-min MIMS, and Peak 30-min MIMS. Weighted regression models examined linear associations between MIMS metrics and fitness test scores. Nonlinear associations were examined using weighted spline models with knots placed at the 10th, 50th, and 90th percentiles. Models were adjusted for covariates and fit was examined using the coefficient of determination (R2 ). The strongest adjusted linear relationships included a positive association between MIMS/day (per every 1000 units) and maximal endurance times (b = 5.5 s, p < 0.001) and between Peak 60-min MIMS (per every 10 units) and estimated aerobic capacity (b = 1.7 mL/kg/min, p < 0.001), modified pull-ups (b = 0.7 reps, p < 0.001), and plank test scores (b = 5.0 s, p < 0.001). Linear spline models had slightly higher R2 values (R2 range = 16.9%-74.8%) compared to linear models (R2 range = 15.0%-74.5%). The relationship between MIMS metrics and fitness test scores was best modeled as piecewise linear functions. Although all MIMS metrics associated with cardiorespiratory endurance, Peak 60-min MIMS showed stronger associations with tests of muscular strength and endurance.

Activities of Daily Living, Physical Activity, Physical Fitness and Quality of Life in Children with Congenital Heart Disease: A Case-Control Study

BACKGROUND

Despite reports of reduced physical fitness in children with congenital heart disease (CHD), no specific performance evaluations for activities of daily living have been conducted.

OBJECTIVES

The aim was to compare the activities of daily living, quality of life, posture, physical fitness and physical activity levels of children with CHD with healthy controls (HC).

METHODS

The study included 30 children aged 6-14 diagnosed with moderate or severe CHD and 30 age-sex-matched HC. The sociodemographic and clinical data of the participants were recorded. All participants went through several tests, namely the TGlittre-P test for activities of daily living, the 6-minute walk test (6MWT) for functional capacity, the Fitnessgram test battery for physical fitness, the hand dynamometer for measuring grip strength, the pedometer for measuring physical activity, and both the child and parents reported the Pediatric Quality of Life Inventory (PedsQL) for evaluating the quality of life, in addition to posture analyses. Values of p < 0.05 were considered statistically significant.

RESULTS

Individuals with CHD had a longer TGlittre-P test completion time and a shorter 6MWT distance than HC (TGlittre-P: CHD 3.45 [3.24-4.02]min vs. HC 3.10 [2.57-3.23]min, 6MWT: CHD 514.00 [412.50-566.00]m vs. HC 591.50 [533.00-631.00]m). For the CHD group, sit-ups, push-ups, trunk lift, and sit-and-reach test scores within the Fitnessgram battery, grip strength, posture, and quality of life scores were lower than those for the HC group. Physical activity levels were similar in the groups.

CONCLUSIONS

The performance of activities of daily living, functional capacity, physical fitness, posture, and quality of life of children with moderate and severe CHD were affected compared to healthy peers.

Enhancing attention in children using an integrated cognitive-physical videogame: A pilot study

Inattention can negatively impact several aspects of a child's life, including at home and school. Cognitive and physical interventions are two promising non-pharmaceutical approaches used to enhance attention abilities, with combined approaches often being marketed to teachers, therapists, and parents typically without research validation. Here, we assessed the feasibility of incorporating an integrated, cognitive-physical, closed-loop video game (body-brain trainer or 'BBT') as an after-school program, and also evaluated if there were attention benefits following its use. Twenty-two children (7-12 years of age) with a range of attention abilities were recruited to participate in this proof of concept, single-arm, longitudinal study (24 sessions over 8 weeks, ~30 min/day). We interrogated attention abilities through a parent survey of their child's behaviors, in addition to objective performance-based and neural measures of attention. Here we observed 95% compliance as well as, significant improvements on the parent-based reports of inattention and on cognitive tests and neural measures of attention that were comparable in scale to previous work. Exploratory measures of other cognitive control abilities and physical fitness also showed similar improvement, with exploratory evaluation of retained benefits on the primary attention-related outcomes being present 1-year later. Lastly, there was no correlation between the baseline parent-rated inattention score and the improvement on the primary task-based measures of attention, suggesting that intervention-based benefits were not solely attained by those who stood the most to gain. These pilot findings warrant future research to replicate and extend these findings.

Longitudinal Associations of Cardiorespiratory Fitness and Poverty With Academic Performance Among Youth

BACKGROUND

Cardiorespiratory fitness (CRF) plays a significant role in health and academic performance in youth. The purpose of this study was to examine the longitudinal relationship between CRF and academic performance from fifth to eighth grade among a large, diverse, and state-wide cohort of students, and to determine the extent to which the relationship between change in CRF and academic performance is moderated by poverty status.

METHODS

CRF and academic performance data were obtained for a retrospective state-wide cohort of 11,013 students with baseline (fifth grade, school year 2015-2016) and follow-up (eighth grade, school year 2018-2019) data. Analysis of covariance was used to examine the association between changes in CRF over a 3-year follow-up period and eighth grade academic performance.

RESULTS

After adjusting for covariates, change in CRF and poverty status were positively and significantly associated with eighth grade academic performance. Poverty status did not significantly moderate the association between changes in CRF and academic performance.

CONCLUSIONS

Schools should prioritize evidence-based policies and programs that optimize students' access to high quantity and quality physical activity throughout the school day. Such efforts can improve and maintain student CRF and thus academic performance outcomes.

Longitudinal Changes of Cardiorespiratory Fitness Performance in High School: Association with Individual and School-Based Variables

This study aimed to model adolescents' cardiorespiratory fitness performance change trajectories longitudinally across high school years and its relation to school- and individual/student-level factors. We employed hierarchical linear modeling to examine longitudinal cardiorespiratory fitness performance changes, as measured by the progressive aerobic capacity endurance run (PACER), over the years, between sexes, and in association with the school-level variables. Participants were 76,227 adolescents from 80 high schools in the mid-Atlantic region of the United States. School-level academic performance (SAP), the percent of students eligible for free and reduced-price meals (FARM), and physical education student-faculty ratio were obtained with permission from the school districts. The number of laps completed in PACER test improved throughout the first three years of high school, however, proportions of those within the healthy fitness zone (HFZ) decreased overall from 9th to 11th grade. Furthermore, the number of laps completed by adolescents appeared to have plateaued at 11th grade, with a significant decline during the final year of high school. Sex-based discrepancies in performance in meeting HFZ were evident, where girls significantly outperformed boys during 9th and 10th grades, and boys significantly outperformed girls during 12th grade. Additionally, SAP and FARM were positively and negatively, respectively, significantly associated with PACER performance at the school level. The odds ratio of adolescents performing in the HFZ declined significantly over the years, even though the number of PACER laps improved in the first three years. Concerted efforts should be targeted at improving cardiorespiratory fitness in high school due to its positive relationship to academic achievement in schools, and negative association with cardiovascular disease, metabolic syndrome, obesity, and all-cause mortality in adulthood.

Potential Relevance of a Motor Skill “Proficiency Barrier” on Health-Related Fitness in Youth

This study investigated the potential impact of a motor skill proficiency barrier on measures of cardiorespiratory (CRF) and musculoskeletal (MSF) fitness in youth. A sample of 241 youth (114 girls) aged 10 - 18 years, completed the Motor Competence Assessment battery with composite scores indexed according to age- and gender-adjusted percentile scores. Motor competence (MC) levels were categorized as low (≤ 25%tile - proficiency barrier), moderate (≥ 26%tile to < 75%tile), and high (≥ 75%tile). CRF levels (Health Risk, Needs Improvement, and Healthy) were assessed using the Fitnessgram® 20 m PACER test. Low (≤ 20%tile), moderate (≥ 21%tile to ≤ 80%tile), and high (≥ 80%tile) MSF levels were assessed using grip strength normative data. Two 3 × 3 chi-square tests were conducted to determine the probability of MC level predicting CRF and MSF levels. Results demonstrated statistically significant models for performance on both the PACER (χ2[4, N = 241] = 22.65, p < .001) and grip strength (χ2[4, N = 241] = 23.95, p < .001). Strong evidence of a proficiency barrier impacting CRF was noted, as no low skilled youth met the "Healthy" fitness zone standards for PACER performance. Evidence supporting a barrier with grip strength was not as strong, as 20.8% of youth exhibiting low MC displayed high grip strength. However, all individuals with high levels of MC demonstrated at least moderate grip strength. Results emphasize the importance of developing MC during childhood as it may provide a protective effect against unhealthy CRF and MSF across youth.HighlightsThese data support the notion of Seefeldt's (1980) proficiency barrier as it relates to CRF, as no youth demonstrating low MC met the healthy fitness zone criteria for PACER performance. The development of MC may both directly and indirectly provide a protective effect against unhealthy CRF levels across childhood and adolescence.Evidence supporting a proficiency barrier with MSF as measured by grip strength was not as strong; however, all individuals with high levels of MC demonstrated at least moderate grip strength. Thus, the development of MC may be a protective factor to mitigate low levels of MSF via enhanced neuromuscular function.Promoting the development of MC in a variety of developmentally appropriate activities and settings (e.g. MC skills practice, structured and unstructured play, and performance contexts) is important to promote positive trajectories of CRF and MSF across childhood and adolescence.

Cardiorespiratory Fitness Growth in Middle School: Socio-Demographic Factor Associations

Purpose: The purposes of this study were to (a) examine the three-year longitudinal growth trends of cardiorespiratory fitness among middle school students, and (b) examine the associations between individual and school-level socio-demographic variables and middle school student cardiorespiratory fitness performance. Methods: A longitudinal multilevel analysis design was used. Participants were adolescents (N = 44,801; 48.1% girls) from 33 middle schools in an Eastern U.S. state. The grand mean age for the participants was 12.42 ± 0.98 years old. Individual-level variables included grade (testing year), sex, and the 15-m Progressive Aerobic Cardiovascular Endurance Run (PACER) performance, which was measured annually for 3 years. School-level variables included the percentage of students receiving a free and reduced-price meal, student-faculty ratio for physical education, and school-level academic performance. Results: A three-level hierarchical linear model was used to model the longitudinal performance change across 3 years accounting for individual and school-level factors. A quadratic growth curve was identified in PACER performance changes, with a positive first-order coefficient (β = 3.05) and a negative second-order coefficient (β =-0.82) overall. Sex was significantly associated with PACER changes (p < .01), with boys and girls having divergent longitudinal growth curves. School-level academic performance was positively associated with PACER performance; however, the association was not statistically significant. Conclusion: Results indicate that although cardiorespiratory fitness improved across years, on average, performance did not keep up with healthy fitness zone recommendations. In addition, sex-based discrepancies were evident as boys and girls demonstrated different quadratic growth curves in cardiorespiratory fitness.

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.

A Mediation Analysis of the Association between Fundamental Motor Skills and Physical Activity during Middle Childhood

The purposes of the study were: (1) to investigate the associations between fundamental motor skills (FMS), health-related fitness (HRF) and physical activity (PA) during middle childhood; and (2) to examine whether HRF serves as a mediator in these pathways. The participants were 342 children (156 girls; Mage = 8.40, SD = 0.50) recruited in Texas. Children’s FMS (locomotor and ball skills) were assessed. School-based PA that included light, moderate, and vigorous PA was captured by accelerometers. The FITNESSGRAM battery was used to measure children’s HRF, including body composition, cardiorespiratory fitness, and muscular fitness. Structural equation models were used to evaluate two proposed models (model-1 = FMS»HRF»PA; model-2 = PA»HRF»FMS). Both locomotor and ball skills were associated with all components of HRF (p < 0.01), but not PA. The SEM analyses supported associations between FMS, HRF and PA, with sound goodness-of-fit indices: (1) model-1: CFI = 0.95; RMSEA = 0.072; and (2) model-2: CFI = 0.95; RMSEA = 0.071, respectively. The relationship between FMS and PA was fully mediated by the HRF in both directions. The behavioral mechanism (e.g., maintaining appropriate levels of HRF) provides meaningful insights to understand the obesity trajectory during middle childhood.

Cardiorespiratory Fitness in Youth: An Important Marker of Health: A Scientific Statement From the American Heart Association

Cardiorespiratory fitness (CRF) refers to the capacity of the circulatory and respiratory systems to supply oxygen to skeletal muscle mitochondria for energy production needed during physical activity. CRF is an important marker of physical and mental health and academic achievement in youth. However, only 40% of US youth are currently believed to have healthy CRF. In this statement, we review the physiological principles that determine CRF, the tools that are available to assess CRF, the modifiable and nonmodifiable factors influencing CRF, the association of CRF with markers of health in otherwise healthy youth, and the temporal trends in CRF both in the United States and internationally. Development of a cost-effective CRF measurement process that could readily be incorporated into office visits and in field settings to screen all youth periodically could help identify those at increased risk.

Testing validity of FitnessGram in two samples of US adolescents (12-15 years)

Background

This study examined the validity of the FitnessGram® criterion-reference cut-points for cardiorespiratory fitness (CRF) based on two samples of US adolescents (aged 12–15 years). This study also established the CRF cut-points for metabolically healthy weight status based on a recent national fitness survey for the purposes of cross-validating with pre-existing cut-points including FitnessGram.

Methods

Two cross-sectional data from the 2003–2004 National Health and Nutrition Examination Survey (NHANES) (n = 378) and 2012 NHANES National Youth Fitness Survey (NNYFS) (n = 451) were used. CRF (estimated V˙O_2max in mL/kg/min) was estimated from a submaximal exercise test. CRF categories based on FitnessGram cut-points, a clustered cardiometabolic risk factors score and weight status were used. A series of Receiver Operating Characteristic (ROC) curve analyses were conducted to identify age- and sex-specific CRF cut-points that were optimal for metabolically healthy weight status.

Results

Based on FitnessGram cut-points, having high risk CRF, but not low risk CRF, was associated with high cardiometabolic risk (OR = 3.17, 95% CI = 1.14–8.79) and unhealthy weight status (OR = 5.81, 95% CI = 3.49–9.68). The optimal CRF cut-points for 12-13-year-olds and 14-15-year-olds were 40 and 43 mL/kg/min in males and 39 and 34 mL/kg/min in females, respectively. Compared to meeting new CRF cut-points, not meeting new CRF cut-points was associated with higher odds of showing high cardiometabolic risk (OR = 2.91, 95% CI = 1.47–5.77) and metabolically unhealthy weight status (OR = 4.47, 95% CI = 2.83–7.05).

Conclusion

FitnessGram CRF cut-point itself has rarely been scrutinized in previous literature. Our findings provide partial support for FitnessGram based on two samples of US adolescents. CRF cut-points established in this study supports international criterion-referenced cut-points as well as FitnessGram cut-points only for males. FitnessGram should be continuously monitored and scrutinized using different samples.

Physical Fitness with Regular Lifestyle Is Positively Related to Academic Performance among Chinese Medical and Dental Students

Objective

The purpose of this study was to examine the relationship between physical fitness, lifestyle, and academic performance of Chinese college students and investigate the differences among medical and dental students on their lifestyle.

Methods

This study was conducted with 316 students enrolled from 2012 to 2014 at Tongji University. Scores from the college physical test were used to represent the students' physical fitness condition. Lifestyle was measured by some variables extracted from the students' behavior data provided by the university's information center. Academic performance was measured by the average score of basic courses and the average score of professional courses. Demographic information, including age, gender, nation, and family background, was also obtained. Separate multiple linear regression analysis was performed for modeling academic performance and physical fitness with a p value threshold of 0.05.

Results

A total of 212 (45.97% females) medical students and 104 (58.65% females) dental students participated in this study. Physical fitness score (medical: r = 0.34, p value threshold of 0.05. r = 0.34, p value threshold of 0.05. r = 0.34, p value threshold of 0.05. r = 0.34, p value threshold of 0.05. r = 0.34, p value threshold of 0.05. r = 0.34, p value threshold of 0.05. r = 0.34, p value threshold of 0.05. r = 0.34, p value threshold of 0.05. r = 0.34, p value threshold of 0.05. r = 0.34, p value threshold of 0.05. r = 0.34, p value threshold of 0.05. r = 0.34, p value threshold of 0.05. r = 0.34, p value threshold of 0.05. r = 0.34, p value threshold of 0.05.

Conclusion

Physical fitness, library usage, and the regularity of lifestyle are significant contributors to academic performance among Chinese medical and dental students. Moreover, medical students are shown to have less rest time compared to dental students.

Body Mass Index, Age, Sexual Maturation and Incidence of Hyperlordosis in Children and Adolescents

Abstract Introduction: Hyperlordosis can cause several degenerative spinal pathologies in children and adolescents. Objective: Determine whether body mass index, age and sexual maturation predict the occurrence of hyperlordosis in children and adolescents. Method: The study analyzed 380 students aged between 10 and 18 years. Body mass index was evaluated using the reference values suggested by the Fitnessgram test battery, and sexual maturation through Tanner’s scale of self-assessed pubic hair growth. Postural assessment was conducted using the DIPA photogrammetry method, version 3.1. (Digital Image Based Postural Assessment) The SPSS 24.0 program was used to analyze the data, and the following statistical tests were applied: chi-squared, Mann-Whitney, Fisher’s exact and binary logistic regression. Results: There was statistical significance between hyperlordosis, girls’ age and puberty in boys (p <0.05). The adjusted binary logistic regression for the girls (OR = 0.656) indicated that this disorder declined by 34% with advancing age and for stage P2 of puberty in boys (OR = 4.292), and the likelihood of boys’ presenting with hyperlordosis at this stage is approximately 4-fold higher. There was no statistical significance between body mass index and hyperlordosis (p> 0.05). Conclusion: The girls’ age and boys’ stage of puberty were associated with the occurrence of hyperlordosis.

Physical fitness of children and adolescents with moderate to severe intellectual disabilities

Background: Low levels of physical fitness are associated with low physical and mental health. The aims of this study were to assess the health-related physical fitness of children with intellectual disability (ID), and study the association of physical activity and motor development with physical fitness.Methods: One hundred and twenty-eight children with moderate to severe ID (83 boys; age 2-18 years) visiting specialised day programme centres engaged in field-based physical fitness tests (body composition, muscular strength, muscular endurance, and cardiorespiratory fitness). Scores were compared to reference values, and with linear regression analysis the association between the fitness outcomes and physical activity and motor development was studied.Results: High rates of overweight (23-25%) and obesity (10-15%) were found. A majority of the participants (71-91%) scored below reference values for muscular strength, endurance, and cardiorespiratory fitness tests. Physical activity and motor development were positively associated with scores on several fitness test (β = 0.27-0.44; p < 0.05).Conclusions: Children with moderate to severe ID visiting specialised day programme centres have strikingly low physical fitness levels. Policies and interventions to increase the physical fitness for this specific group of children are urgently needed, in which increasing physical activity and motor skills are expected to be effective components.Implications for rehabilitationStrikingly low levels of physical fitness were seen in children and adolescents with moderate to severe intellectual disabilities.This vulnerable group is in need of appropriate interventions to increase their physical fitness levels.Increasing the physical activity is a potential component in these interventions.Improving motor development will most likely lead to improved physical fitness as well.

Measurement agreement in percent body fat estimates among laboratory and field assessments in college students: Use of equivalence testing

The purpose of this study was to examine the agreement in percent body fat estimates among 7 laboratory and field assessments against dual-emission x-ray absorptiometry using equivalence testing. Participants were 437 college students (mean age = 19.2±0.6 years). Dual-emission x-ray absorptiometry was used as the criterion with hydrostatic weighing, skinfold thickness, air displacement plethysmography, near infrared reactance, and three methods of bioelectrical impedance analysis examined as surrogate assessments. Relative agreement was examined using intraclass correlation coefficients. Group level agreement was examined using equivalence testing. Individual-level agreement was assessed using Mean Absolute Percent Error and Bland-Altman Plots. Single measure intraclass correlation coefficient scores ranged from 0.71-0.80. Hydrostatic weighing, skinfold thickness, air displacement plethysmography, and 4-electrode bioelectrical impedance analysis showed statistical equivalence with the criterion using a 10% Equivalence Interval with absolute mean differences ranging from 1.0%-4.9% body fat. Mean Absolute Percent Error ranged from 11.7% using skinfold thickness to 21.9% using Omron (hand-held) bioelectrical impedance analysis. Limits of Agreement were heteroscedastic across the range of mean scores compared to dual-emission x-ray absorptiometry, with greater mean differences observed at higher levels of percent body fat. Hydrostatic weighing, skinfold thickness, air displacement plethysmography, and 4-electrode bioelectrical impedance analysis showed strong evidence for statistical equivalence with dual-emission x-ray absorptiometry in a sample of college students.

CDC childhood physical activity strategies fail to show sustained fitness impact in middle school children

An increasing number of children are now obese and fail to meet minimum recommendations for physical activity (PA). Schools play a critical role in impacting children's activity behaviors, including PA. Our objective was to assess whether CDC-based school-centered strategies to promote PA increase long-term cardiovascular fitness (CVF) levels in students in schools. A prospective observational trial was conducted in 26 middle schools to implement CDC school-based strategies to increase PA for 3 years. Students had CVF assessed by Fitnessgram (PACER), a 20-meter shuttle run, at the start and end of each school year. A post-study questionnaire was administered to assess each school's strategy adherence. At baseline, 2402 students with a mean age 12.2 ± 1.1 years showed a mean CVF measured by PACER of 33.2 ± 19.0 laps (estimated VO2max 44.3 ± 5.3 ml/kg/min). During the first year, there was a significant increase in the mean PACER score (Δ = 3, 95% CI: 2-4.1 laps, p < 0.001) and PACER z-score (Δ = 0.09, 95% CI: 0.04-0.14, p = 0.001). Subsequently, however, a significant negative trend in PACER z-scores occurred (β = -0.02, p < 0.0001) so that over the 3-year study period, the intervention did not increase overall CVF. This effort to implement CDC school-based PA strategies in middle schools did not result in sustained increase in CVF over 3 years. It remains to be clarified whether this limited efficacy indicates that CDC physical activity strategies are not sufficiently robust to meaningfully impact health outcomes and/or additional support is needed in schools to improve fidelity of implementation.

Physical Literacy Knowledge Questionnaire: feasibility, validity, and reliability for Canadian children aged 8 to 12 years

BACKGROUND

Physical literacy is defined as the motivation, confidence, physical competence, and knowledge and understanding to engage in physical activity for life. Physical literacy knowledge and understanding encompasses movement (how to move), performance (evaluation of movement), and health and fitness (value of exercise, need for relaxation and sleep, etc.). This paper describes the development and evaluation of a standardized assessment of physical literacy knowledge and understanding for Canadian children in grades 4, 5, and 6.

METHODS

Proposed Physical Literacy Knowledge Questionnaire (PLKQ) content was identified through expert consultation and a review of provincial/territorial physical education curricula for grades 4 to 6. Open-ended questions verified language and generated response options. Feasibility was assessed via completion time and error frequency. Item validity assessed scores by age, gender, and teacher ratings of student knowledge. Test-retest reliability was assessed over short (2-day) and long (7-day) intervals.

RESULTS

Subsets of 678 children (54% girls, 10.1 ± 1.0 years of age) completed the feasibility and validity assessments. Response errors (missing or duplicate responses, etc.) were minimal (2% or less) except for one question (7% error) about the use of safety gear during physical activity. A Delphi process among experts in children's physical activity and fitness achieved consensus on the core content and supported an item analysis to finalize item selection. As expected, knowledge scores increased with age (partial eta² = 0.07) but were not related to gender (p = 0.63). Teacher ratings of children's knowledge of physical activity behaviour (r = 0.13, p = 0.01) and fitness (r = 0.12, p = 0.03), but not movement skill (r = 0.07, p = 0.19) were associated with PLKQ scores. Test-retest reliability for PLKQ score and individual questions was substantial to excellent for 71% of comparisons over a 2-day interval, but lower over a 7-day interval (53% substantial or excellent). Items with low reliability had high or low proportions of correct responses.

CONCLUSIONS

This study provides feasibility and validity evidence for the Physical Literacy Knowledge Questionnaire as an assessment of physical literacy knowledge for Canadian children in grades 4, 5, and 6. Completion rates were high and knowledge scores increased with age. Streamlining of the content in accordance with Delphi panel recommendations would further enhance feasibility, but would also focus the content on items with limited reliability. Future studies of alternative item wording and responses are recommended to enhance test-retest reliability.

Effects of cardiorespiratory fitness and weight status on knowledge of physical activity and fitness, attitude toward physical education, and physical activity

Background

The purpose of this study was to examine the effects of cardiorespiratory fitness and weight status on knowledge of physical activity and fitness (PAF knowledge), attitude toward physical education (PE), and physical activity.

Methods

A total of 343 middle school students participated in the study (Age: M/SD = 12.76/.94, ranging from 11 to 14 years old). PE Metrics™ was used to measure PAF knowledge, and Attitude toward Physical Education Questionnaire and Youth Activity Profile were used to measure attitude, physical activity and sedentary behavior. Fitness and weight status were assessed using FitnessGram and converted to in Healthy Fitness Zone (HFZ) or Not in HFZ.

Results

Two-way multivariate analyses of covariance (MANCOVA; gender and grade as covariates) showed a significant group effect for cardiorespiratory fitness (Λ_Pilla = .07, F_4,255 = 5.03, p = .001, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\eta}_p^2 $$\end{document}ηp2 = .07) but not for weight status (p = .57). PAF knowledge (F_1,258 = 9.49, p < .01, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\eta}_p^2 $$\end{document}ηp2= .04), attitude (F_1,258 = 4.45, p < .05, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\eta}_p^2 $$\end{document}ηp2= .02) and sedentary behavior (F_1,258 = 6.89, p < .01, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\eta}_p^2 $$\end{document}ηp2= .03) all favored the HFZ group.

Conclusions

The findings reinforce the importance of promoting cardiorespiratory fitness in middle school PE as students acquire attitude, knowledge, and behaviors needed for active-living.

Independent and Combined Effects of Weight Status and Maturation on Aerobic Fitness in Adolescent School-Aged Males

Batista, MB, Valente-dos-Santos, J, Duarte, JP, Sousa-e-Silva, P, Coelho-e-Silva, MJ, Werneck, AO, Ohara, D, Cyrino, ES, and Ronque, ERV. Independent and combined effects of weight status and maturation on aerobic fitness in adolescent school-aged males. J Strength Cond Res 34(9): 2663-2671, 2020-This study aimed to examine the independent and combined effects of pubertal and weight status on concurrent measurements of peak oxygen (V[Combining Dot Above]O2peak) in school-aged adolescent males. The final sample included 49 boys (12.3 ± 0.8 years). V[Combining Dot Above]O2peak was derived from an incremental progressive maximal protocol using a motorized treadmill. In addition, maximal oxygen uptake was estimated from a 20-m shuttle run test. Static allometric models were obtained as an alternative to performance output per unit of size descriptors. Weight status had a significant effect on V[Combining Dot Above]O2peak using simple ratio standards per unit of body mass (BM) with adolescents classified as overweight and obese (OWOB) attaining lower values of V[Combining Dot Above]O2peak. A similar trend was noted for the allometric models adopting body mass (ml·kgBM·min), stature (L·m·min), and fat-free mass (FFM; ml·kgFFM·min). Findings also suggest the influence and interaction of pubertal and weight status on absolute values of V[Combining Dot Above]O2peak. Considering the data obtained, linear equations to estimate V[Combining Dot Above]O2peak from the 20-m shuttle run test should not be applied to boys who are OWOB because it will produce inaccurate assessments of cardiorespiratory fitness and penalize those who are heavier. Equations for V[Combining Dot Above]O2peak prediction need to be specific for pubertal status and preferably consider FFM as a body size descriptor.

Impact of NFL PLAY 60 Programming on Elementary School Children's Body Mass Index and Aerobic Capacity: The NFL PLAY 60 FitnessGram Partnership Project

BACKGROUND

We examined the impact of the Fuel Up to Play 60 (FUTP60) program on children's body mass index (BMI) and aerobic capacity (AC).

METHODS

Participation in the FUTP60 and both BMI and AC profiles were collected through the NFL PLAY 60 FitnessGram Partnership Project involving over 100 schools from 22 US states. We specifically examined the distributions of BMI and AC among participating versus nonparticipating schools in the 2012-2013 school year. Hierarchical linear models tested the impact of participation and availability of additional funding for program implementation on the proportions of youth meeting FitnessGram health-related fitness standards (ie, Needs Improvement-Health Risk [NIHR] and Healthy Fitness Zone [HFZ] categories).

RESULTS

After 1 year implementing the program, participating schools had lower proportions of boys (-4.1 ± 2.0%, p = .04) and girls (-4.5 ± 2.0%, p = .03) in the NIHR for BMI, and lower proportion of girls (-9.7 ± 4.0%, p = .02) in the NIHR for AC. There were no differences in the distributions for the HFZ and the availability of additional funding did not alter the relationships (p > .05).

CONCLUSIONS

This study provides preliminary evidence that participation in the FUTP60 is associated with improved profiles of health-related fitness.

Relationship between Recreational Resources in the School Neighborhood and Changes in Fitness in New York City Public School Students

Physical fitness in children has many beneficial effects, including the maintenance of a healthy weight. The built environment may influence youths' physical fitness by encouraging physical activity. This paper assessed whether higher density of parks, playgrounds, and sports facilities around a school is related to improvements in fitness in middle school boys and girls. Fitness scores and other student covariates collected as part of NYC FITNESSGRAM between the 2006-2007 and 2010-2011 school years were linked with school neighborhood data on characteristics of the built environment for NYC public school students in grades 6-8. Data were analyzed in 2015. Medium, but not high, density of recreational resources in the area surrounding a school was associated with greater annual improvements in fitness for both boys and girls. This association appeared to be driven mainly by the presence of parks. Findings for sports facilities and playgrounds were inconsistent. Overall, few associations were observed between recreational resources near a school and changes in student fitness. Future studies of school influences on student fitness should consider the influence of school resources and the home neighborhood.

International variability in 20 m shuttle run performance in children and youth: who are the fittest from a 50-country comparison? A systematic literature review with pooling of aggregate results

OBJECTIVES

To describe and compare 20 m shuttle run test (20mSRT) performance among children and youth across 50 countries; to explore broad socioeconomic indicators that correlate with 20mSRT performance in children and youth across countries and to evaluate the utility of the 20mSRT as an international population health indicator for children and youth.

METHODS

A systematic review was undertaken to identify papers that explicitly reported descriptive 20mSRT (with 1-min stages) data on apparently healthy 9-17 year-olds. Descriptive data were standardised to running speed (km/h) at the last completed stage. Country-specific 20mSRT performance indices were calculated as population-weighted mean z-scores relative to all children of the same age and sex from all countries. Countries were categorised into developed and developing groups based on the Human Development Index, and a correlational analysis was performed to describe the association between country-specific performance indices and broad socioeconomic indicators using Spearman's rank correlation coefficient.

RESULTS

Performance indices were calculated for 50 countries using collated data on 1 142 026 children and youth aged 9-17 years. The best performing countries were from Africa and Central-Northern Europe. Countries from South America were consistently among the worst performing countries. Country-specific income inequality (Gini index) was a strong negative correlate of the performance index across all 50 countries.

CONCLUSIONS

The pattern of variability in the performance index broadly supports the theory of a physical activity transition and income inequality as the strongest structural determinant of health in children and youth. This simple and cost-effective assessment would be a powerful tool for international population health surveillance.

International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries

OBJECTIVE

To develop sex-specific and age-specific international norms for the 20 m shuttle run test (20mSRT) in children and youth (aged 9-17 years), and to estimate the prevalence meeting the FITNESSGRAM criterion-referenced standards for healthy cardiorespiratory endurance (CRE).

METHODS

A systematic review was undertaken to identify papers explicitly reporting descriptive 20mSRT (with 1 min stages) data on children and youth since 1981. Data were included on apparently healthy (free from known disease/injury) 9-17 years old. Following standardisation to a common metric and for protocol differences, pseudo data were generated using Monte Carlo simulation, with population-weighted sex-specific and age-specific normative centiles generated using the Lambda Mu and Sigma (LMS) method. Sex-related and age-related differences were expressed as per cent and standardised differences in means. The prevalence with healthy CRE was estimated using the sex-specific and age-specific FITNESSGRAM criterion-referenced standards for [Formula: see text].

RESULTS

Norms were displayed as tabulated centiles and as smoothed centile curves for the 20mSRT using 4 common metrics (speed at the last completed stage, completed stages/minutes, laps and relative [Formula: see text]). The final data set included 1 142 026 children and youth from 50 countries, extracted from 177 studies. Boys consistently outperformed girls at each age group (mean difference±95% CI: 0.86±0.28 km/h or 0.79±0.20 standardised units), with the magnitude of age-related increase larger for boys than for girls. A higher proportion of boys (mean±95% CI: 67±14%) had healthy CRE than girls (mean±95% CI: 54±17%), with the prevalence of healthy CRE decreasing systematically with age.

CONCLUSIONS

This study provides the most comprehensive and up-to-date set of international sex-specific and age-specific 20mSRT norms for children and youth, which have utility for health and fitness screening, profiling, monitoring and surveillance.

Predictors and grade level trends of school day physical activity achievement in low-income children from the U.S

The achievement of recommended levels (≥ 30 min/day) of school moderate-to-vigorous physical activity (MVPA) is paramount to decrease risk of chronic disease in children from low-income families. The purpose of this study was to examine the predictors and grade-level trends of school day MVPA achievement in low-income children. Data were collected during the Fall of 2014 on 1232 children (Mean age = 8.8 ± 1.6 years; 625 girls, 607 boys) recruited from three low-income schools from the state of Utah in the U.S. Children wore pedometers for one school week and a stratified random subsample (n = 533) also wore accelerometers to record sedentary time and MVPA. Generalized linear mixed models were employed to calculate odds ratios for achieving school MVPA standards (≥ 30 min/day) from various predictors and to determine odds of achievement across grade levels, accounting for school and classroom clustering. Odds of meeting MVPA standards were 3 times greater if a student achieved at least 6000 steps during the school day (p < 0.01), and were 55% lower for every 1% increase in sedentary time (p < 0.001). Older children had 26% lower odds of meeting the recommended levels of MVPA compared to children in an immediately younger grade level (p < 0.05). A significant proportion of MVPA variance was explained by classroom and school affiliation (Rho = 0.09 to 0.54, p < 0.001). Daily steps, sedentary times, grade level, and classroom and school affiliation associate with school MVPA achievement in low-income children.

A lower cardiorespiratory fitness is associated to an unhealthy status among children and adolescents from Bogotá, Colombia

OBJECTIVE

Several studies have shown that low cardiorespiratory fitness (CRF) is a significant independent risk factor for future cardiometabolic disease in adult life. The aim of this study was to examine the relationship between CRF and health status in children and adolescents in Bogotá, Colombia.

METHODS

A cross-sectional study was conducted in 921 children and adolescents aged 9-17 years living in the metropolitan area of the District of Bogotá, Colombia (2,480m asl). CRF was assessed with the 20m shuttle run test (Course-Navette) according to ALPHA-FITNESS and FITNESSGRAM standards. Blood pressure, waist circumference, hip circumference, body composition (body fat percentage, fat body mass, and fat-free mass by bioimpedance), skin fold calipers, body mass index, and sexual maturity (Tanner) were used as indicators of physical health.

RESULTS

After adjusting for sex, age, and sexual maturity, significant inverse relationships were seen between CRF and body mass index (r=-0.107), body fat percentage (r=-0.197), fat body mass (r=-0.159), skin fold (r=-0.246), and waist circumference (r=-0.169); P<.001. Schoolchildren with low CRF levels showed OR 6.06 (95% CI 3.98-9.24) increase in body fat by bioimpedance; OR 4.04 (95% CI 1.83-9.11) risk of overweight/obese by body mass index and OR 2.47 (95% CI 1.14-5.37) abdominal obesity due to increased waist circumference.

CONCLUSION

Approximately two thirds of participants had a CRF level suggesting future cardiovascular disease. Early identification of children and adolescents with low CRF levels will allow for implementing interventions to prevent cardiometabolic disease in adulthood.

Health-Related Physical Fitness in Hungarian Youth: Age, Sex, and Regional Profiles

PURPOSE

The purpose of this study was to examine region, age, and sex profiles of physical fitness in Hungarian youth.

METHOD

A sample of 2,602 Hungarian youth aged 10 to 18 years old completed a series of physical fitness field tests: the Progressive Aerobic Cardiorespiratory Endurance Run (PACER) fitness test, body mass index (BMI), percent body fat (%BF), waist circumference (WC), curl-ups (CU), pushups (PU), trunk extension (TE), back-saver sit-and-reach (SR), handgrip (HG), and standing broad jump. Physical fitness scores were classified using FITNESSGRAM® standards, and trends for region, age, and sex were examined using logistic regression. The outcome variable represented the likelihood that a child would meet the recommended levels of fitness for health.

RESULTS

Achievement rates varied considerably by region, age, and sex. The likelihood of achieving the Healthy Fitness Zone (HFZ) varied among Hungarian regions and on all the assessments (p <  .05) with exception of the CU, PU, and HG tests (p > .05). The likelihood of achieving the HFZ was linearly related with age based on PACER, BMI, WC, %BF, CU, and SR scores (p <  .05). There were statistically significant gender differences and boys were more likely to achieve the HFZ based on PACER, WC, CU, PU, TE, and SR scores (p <  .05).

CONCLUSIONS

The likelihood of achieving the recommended levels of fitness for youth varies between regions in Hungary, in most cases decreases with age, and tends to be higher in boys. This study is one of the few that provides evidence of regional, age, and sex patterns of health-related fitness using a representative sample of youth.

Comparison of height, weight, and body mass index data from state-mandated school physical fitness testing and a districtwide surveillance project

BACKGROUND

Approximately one third of California school-age children are overweight or obese. Legislative approaches to assessing obesity have focused on school-based data collection. During 2010-2011, the Chula Vista Elementary School District conducted districtwide surveillance and state-mandated physical fitness testing (PFT) among fifth grade students. We compared height, weight, and body mass index (BMI) to examine measurement differences between the projects.

METHODS

We assessed demographic characteristics and BMI category frequencies. We used paired t-tests to test continuous variables. κ statistics were used to assess categorical agreement.

RESULTS

Of 3549 children assessed, 69% were Hispanic. Fifty-one percent were boys. Mean heights, weights, and BMIs were significantly different for each project (p < .0001). Surveillance height (106.7-165.1 cm) and weight (21.6-90.8 kg) ranges were lesser than PFT ranges (109.2-180.3 cm and 22.7-98.4 kg). The overall BMI category agreement was good (weighted κ = 0.77). Categorical percentage agreement was highest among normal weight children (94.9%) and lowest among underweight children (56.6%).

CONCLUSIONS

Methodological differences might have resulted in the observed height, weight, and BMI differences. As school-based interventions become common, districts should carefully consider measurement reliability, training, and data-handling protocols to have confidence in their findings.

Physical fitness in Spanish schoolchildren aged 6-12 years: reference values of the battery EUROFIT and associated cardiovascular risk

BACKGROUND

Physical fitness is considered an important indicator of health in children. The aims of this study were to (1) provide sex- and age-specific EUROFIT battery levels of fitness in Spanish children; (2) compare Spanish children's fitness levels with those of children from other countries; and (3) determine the percentage of Spanish children with cardiovascular risk associated with low cardiorespiratory fitness (CRF).

METHODS

Physical fitness was assessed using the EUROFIT tests in 1725 children, aged 6 to 12, from Castilla-La Mancha, Spain. We derived specific values for physical fitness using LMS method. FITNESSGRAM 2010 criteria were used to estimate the percentage of children with cardiovascular risk associated with low CRF.

RESULTS

Boys scored higher in all the physical fitness tests, except for the flexibility test. Physical fitness improved as age increased, except for flexibility, which worsened in boys, and VO2max, which decreased in both sexes. The prevalence of boys and girls with cardiovascular risk associated to low CRF was 13% and 26%, respectively.

CONCLUSIONS

Specific fitness test scores for children and adolescents can represent the fitness status of schoolchildren accurately. Schools need to make efforts to improve the fitness level of the schoolchildren to prevent cardiovascular risk.

Geographical variation in health-related physical fitness and body composition among Chilean 8th graders: a nationally representative cross-sectional study

PURPOSE

In addition to excess adiposity, low cardiorespiratory fitness (CRF) and low musculoskeletal fitness (MSF) are important independent risk factors for future cardio-metabolic disease in adolescents, yet global fitness surveillance in adolescents is poor. The objective of this study was to describe and investigate geographical variation in levels of health-related physical fitness, including CRF, MSF, body mass index (BMI), and waist circumference (WC) in Chilean 8th graders.

METHODS

This cross-sectional study was based on a population-based, representative sample of 19,929 8th graders (median age = 14 years) in the 2011 National Physical Education Survey from Chile. CRF was assessed with the 20-meter shuttle run test, MSF with standing broad jump, and body composition with BMI and WC. Data were classified according to health-related standards. Prevalence of levels of health-related physical fitness was mapped for each of the four variables, and geographical variation was explored at the country level by region and in the Santiago Metropolitan Area by municipality.

RESULTS

Girls had significantly higher prevalence of unhealthy CRF, MSF, and BMI than boys (p<0.05). Overall, 26% of boys and 55% of girls had unhealthy CRF, 29% of boys and 35% of girls had unhealthy MSF, 29% of boys and 44% of girls had unhealthy BMI, and 31% of adolescents had unhealthy WC. High prevalence of unhealthy fitness levels concentrates in the northern and middle regions of the country and in the North and Southwest sectors for the Santiago Metropolitan Area.

CONCLUSION

Prevalence of unhealthy CRF, MSF, and BMI is relatively high among Chilean 8th graders, especially in girls, when compared with global estimates. Identification of geographical regions and municipalities with high prevalence of unhealthy physical fitness presents opportunity for targeted intervention.

A holistic school-based intervention for improving health-related knowledge, body composition, and fitness in elementary school students: an evaluation of the HealthMPowers program

Background

Over the past 30 years, obesity in the United States has increased twofold in children and threefold in adolescents. In Georgia, nearly 17% of children aged 10 – 17 are obese. In response to the high prevalence of child obesity in Georgia and the potential deleterious consequences that this can have, HealthMPowers was founded in 1999 with the goal of preventing childhood obesity by improving health-enhancing behaviors in elementary schools, utilizing a holistic three-year program. This study measures the effectiveness of the HealthMPowers program in improving the school environment, student knowledge, behavior, cardiovascular fitness levels, and Body Mass Index (BMI).

Methods

The present analysis utilizes data from 40 schools that worked with HealthMPowers over the course of the 2012 – 2013 school year (including schools at each of the three years of the intervention period) and provided information on demographics, student knowledge and behaviors, BMI, performance on the PACER test of aerobic capacity, and school practices and policies (measured via school self-assessment with the HealthMPowers-developed instrument “Continuous Improvement Tracking Tool” or CITT), measured at the beginning and end of each school year. Paired two-sample T tests were used to compare continuous variables (e.g., student knowledge scores, BMI-for-age Z scores), while chi-squared tests were used to assess categorical variables (e.g., trichotomized PACER performance).

Results

Students across all grades and cohorts demonstrated improvements in knowledge and self-reported behaviors, with particularly significant improvements for third-graders in schools in the second year of the HealthMPowers program (p < 0.0001). Similarly, decreases were observed in BMI-for-Age Z scores for this cohort (and others) across grades and gender, with the most significant decreases for students overweight or obese at baseline (p < 0.0005). Students also showed significant increases in performance on the PACER test across grades and cohorts (p < 0.0001). Lastly, schools tended to improve their practices over time, as measured via the CITT instrument.

Conclusions

The present report demonstrates the effectiveness of the HealthMPowers program in producing positive change in school policies and practices, student knowledge and behaviors, and student fitness and BMI, supporting the use of holistic interventions to address childhood obesity.

Critical measurement issues/challenges in assessing aerobic capacity in youth

We discuss current measurement issues related to tests of aerobic capacity in the FITNESSGRAM. Interpretation of tests of aerobic capacity is difficult because the criterion measure of aerobic capacity, maximal rate of oxygen uptake (VO2(max)) expressed relative to body weight, is inversely related to body fatness and body mass index (BMI). This association cannot be easily be eliminated in a way that maintains the units commonly used to express aerobic capacity (i.e., mL x kg(-1) x min(-1)) and is understandable to typical test users. Requiring the measurement of BMI to predict VO2(max) creates practical problems for users by: (a) uncoupling the relation of predicted VO2(max) to physical performance on the 1-mile run/walk (MRW) and the Progressive Aerobic Cardiovascular Endurance Run (PACER) tests, (b) making explicit the influence of body composition on the ability of children to achieve the aerobic capacity healthy fitness zone, and (c) creating a barrier for users who cannot measure height and weight. The use of test equating improved classification agreement between the MRW and PACER tests but required measurement of BMI to estimate aerobic capacity from the PACER. A new equation to predict aerobic capacity that does not require BMI was recently introduced to address user concerns. This change will improve ease of use of the Fitnessgram with little effect on prediction accuracy but will likely result in poorer classification agreement between the MRW and PACER tests. Although considerable progress has been made in addressing issues related to assessment of aerobic capacity in youth, future work is needed to carefully balance the issues of prediction accuracy, test feasibility, and test agreement.

Top 10 research questions related to growth and maturation of relevance to physical activity, performance, and fitness

Growth, maturation, and development dominate the daily lives of children and adolescents for approximately the first 2 decades of life. Growth and maturation are biological processes, while development is largely a behavioral process. The 3 processes occur simultaneously and interact. They can be influenced by physical activity and also can influence activity, performance, and fitness. Allowing for these potential interactions, 10 questions on growth and maturation that have relevance to physical activity, performance, and fitness are presented. The questions are not mutually exclusive and address several broadly defined topical areas: exercise and growth, body weight status (body mass index, adiposity rebound, "unhealthy weight gain"), movement proficiency (hypothesized barrier, role in obesity), individual differences, tracking, maturity-associated variation in performance, and corresponding variation in physical activity. Central to the discussion of each is the need for a biocultural approach recognizing the interactions of biology and behavior as potential influences on the variables of interest.

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.

Measurement agreement between estimates of aerobic fitness in youth: the impact of body mass index

PURPOSE

The purpose of this study was to examine the impact of body mass index (BMI) on the agreement between aerobic capacity estimates from different Progressive Aerobic Cardiorespiratory Endurance Run (PACER) equations and the Mile Run Test.

METHOD

The agreement between 2 different tests of aerobic capacity was examined on a large data set from 2 suburban school districts (n = 1,686 youth in Grades 3-10). Difference estimates between the Mile Run Test and several PACER equations were computed, and residuals were examined using cluster analysis. The implication of the discrepancy between these tests was also examined using FITNESSGRAM health-related standards for BMI. Comparisons were made against corresponding estimates of peak oxygen consumption from the Mile run because this equation is more established.

RESULTS

Results supported a 2-cluster solution. The discrepancy between tests was higher in participants with higher BMI scores (Z scores for residuals in this group ranged from -0.07 to 1.57). BMI was able to explain 30% to 34% of the disagreement between the Mile and different PACER equations of aerobic fitness. Classification analyses revealed that kappa scores were lower among PACER equations that do not include a BMI term (kappa = .12-.34 vs. .59-.81). Overall, the test-equating approach used in the Fitnessgram program to process PACER data had better agreement than alternative PACER equations that included BMI.

CONCLUSION

The results support the inclusion of BMI in prediction equations used to estimate aerobic capacity from the PACER.

Field assessments for obesity prevention in children and adults: physical activity, fitness, and body composition

Nutrition and health educators work in community settings implementing lifestyle programs focused on obesity prevention and chronic disease risk reduction. These programs typically focus on improving diet and physical activity (PA) behaviors. Many nutrition educators may not be confident in their ability to select, administer, and interpret PA assessments to effectively evaluate their PA or lifestyle programs. This report will assist educators in identifying and selecting appropriate field-based assessments for measurement of PA, physical fitness, and body composition for children and adults. Specific guidelines, references, and resources are given for selecting assessment methods and test within these 3 areas.

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.