A tool to assess fitness among adults in public health studies - Predictive validity of the FFB-Mot questionnaire

BACKGROUND

Fitness has important implications for physical activity behavior and is associated with various health-related outcomes. It can be assessed through a test battery or a self-reported questionnaire. One example is the FFB-Mot (Funktionsfragebogen Motorik; engl. functional fitness questionnaire) which consist of 28 items to assess four components of fitness in adults: cardiorespiratory fitness/ endurance, muscular strength, gross motor coordination, and flexibility. The aims of this manuscript were to (1) provide an English-version of the FFB-Mot questionnaire (developed from the German-version using translation and back-translation) to the international community of researchers in the areas of physical activity, fitness and health in adults, and (2) examine the predictive validity of the FFB-Mot questionnaire in a large sample of community-dwelling adults.

METHODS

We used data from a longitudinal study in Germany with four measurement waves over a period of 18 years, with samples ranging between 310 and 437 participants (1572 adults in total, mean ages 46-58 years). To assess predictive validity, we calculated Pearson correlations between FFB-Mot data collected in 1997 and external health-related criteria (i.e., subjective health status, physician-rated health status, back pain, physical complaints and physical activity in minutes per week) collected in 2002, 2010, and 2015, and separately for males and females.

RESULTS

We observed correlations between higher FFB-Mot scores with better subjective health status (in 2002: males, r = 0.25; females, r = 0.18; in 2010: males, r = 0.29; females, r = 0.28; in 2015: males, r = 0.40), and higher physical activity (in 2002: males, r = 0.24; females, r = 0.25; in 2010: males, r = 0.30; females, r = 0.38; in 2015: females, r = 0.27). Higher FFB-Mot scores were also correlated with lower back pain (in 2002: males, r = -0.23; females, r = -0.25; in 2010: females, r = -0.22), less physical complaints (in 2002: males, r = -0.36; females, r = -0.24), and better physician-rated health status (in 2002: males, r = -0.41; females, r = -0.29, 2010: males, r = -0.38; females, r = -0.44; in 2015: males, r = -0.47).

CONCLUSIONS

Our results suggest that the FFB-Mot to assess fitness in adults has predictive validity for health-related outcomes as indicated by significant correlations, albeit some effect sizes are small. The FFB-Mot may be used as one-time assessment of self-reported fitness, or for repeated testing to assess change of self-reported fitness over time and in different settings (e.g., public health research).

Association between aerobic fitness and attentional functions in Egyptian preadolescent children

Growing evidence indicates that culture and education can influence cognitive constructs. Studies targeting Western and Asian populations have shown a positive relationship between aerobic fitness and cognitive control in children; however, this association has yet to be explored in the Arab world. The current study aimed to investigate the relationship between aerobic fitness and attentional networks in Egyptian preadolescent children. In total, 103 preadolescent children (9.76 ± 0.11) completed an assessment of aerobic fitness using a 6-min running test and a computerized attention network test that allowed for assessing alerting, orienting, and executive networks. The results revealed that higher aerobic fitness was associated with shorter response time and higher response accuracy in a more cognitively demanding task condition (i.e., incongruent trials). Furthermore, higher aerobic fitness was associated with a more efficient executive network. No associations were observed for alerting and orienting networks. These findings corroborate growing evidence indicating the importance of aerobic fitness for cognitive development and extend the literature by suggesting that the positive association between aerobic fitness and cognitive control might be generalized to the Arab population and not significantly change across cultures.

Longitudinal associations between physical activity and five risk factors of metabolic syndrome in middle-aged adults in Germany

BACKGROUND

We examined the longitudinal association between (change in) physical activity (PA) with new onset of five risk factors of metabolic syndrome among 657 middle-aged adults (mean age 44.1 (standard deviation (SD) 8.6) years) who were free of the respective outcome at baseline, in a longitudinal cohort study spanning over 29 years.

METHODS

Levels of habitual PA and sports-related PA were assessed by a self-reported questionnaire. Incident elevated waist circumference (WC), elevated triglycerides (TG), reduced high-density lipoprotein cholesterols (HDL), elevated blood pressure (BP), and elevated blood-glucose (BG) were assessed by physicians and by self-reported questionnaires. We calculated Cox proportional hazard ratio regressions and 95% confidence intervals.

RESULTS

Over time, participants developed (cases of incident risk factor; mean (SD) follow-up time) elevated WC (234 cases; 12.3 (8.2) years), elevated TG (292 cases; 11.1 (7.8) years), reduced HDL (139 cases; 12.4 (8.1) years), elevated BP (185 cases; 11.4 (7.5) years), or elevated BG (47 cases; 14.2 (8.5) years). For PA variables at baseline, risk reductions ranging between 37 and 42% for reduced HDL levels were detected. Furthermore, higher levels of PA (≥ 16.6 METh per week) were associated with a 49% elevated risk for incident elevated BP. Participants who increased PA levels over time, had risk reductions ranging between 38 and 57% for elevated WC, elevated TG and reduced HDL. Participants with stable high amounts of PA from baseline to follow-up had risk reductions ranging between 45 and 87% for incident reduced HDL and elevated BG.

CONCLUSIONS

PA at baseline, starting PA engagement, maintaining and increasing PA level over time are associated with favorable metabolic health outcomes.

Analysis and evaluation of developed and used health scores

This systematic review provides an overview of existing multidimensional health scores, including an assessment of their holistic value (coverage of all determinants and dimensions of health), and a systematic comparison of their properties. The review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Literature searches were conducted in English (PubMed, Scopus, Web of Sciences) and German databases (BISp-Surf, BIBNET). All scores that considered health multidimensional on an individual level were included. Two independent reviewers screened and identified articles. The Quality assessment tool for studies with diverse design was used to assess study quality. Scores were recorded in a criteria grid to make their properties comparable, and the multidimensionality of the individual scores was evaluated using radar chart visualizations. Twenty-six studies met the inclusion criteria. Study quality was strong in eight, fair in twelve, and weak in six studies. Among the 26 studies, 21 different questionnaire-based scores were included, which all covered at least three of the five health dimensions (Five dimensions have been identified in a former literature research). Three scores covered all dimensions, but none covered all of the previously defined determinants. Thus, according to this works created definition (holistic = cover all dimensions with all determinants), no holistic health score exists, only multidimensional scores covering different dimensions and determinants. This review offers good comparability, as all the instruments were questionnaires, and could be used as a basis for future research. A universal (holistic) health construct should be defined and developed to improve the quantification of health.

European fitness landscape for children and adolescents: updated reference values, fitness maps and country rankings based on nearly 8 million test results from 34 countries gathered by the FitBack network

OBJECTIVES

(1) To develop reference values for health-related fitness in European children and adolescents aged 6-18 years that are the foundation for the web-based, open-access and multilanguage fitness platform (FitBack); (2) to provide comparisons across European countries.

METHODS

This study builds on a previous large fitness reference study in European youth by (1) widening the age demographic, (2) identifying the most recent and representative country-level data and (3) including national data from existing fitness surveillance and monitoring systems. We used the Assessing Levels of PHysical Activity and fitness at population level (ALPHA) test battery as it comprises tests with the highest test-retest reliability, criterion/construct validity and health-related predictive validity: the 20 m shuttle run (cardiorespiratory fitness); handgrip strength and standing long jump (muscular strength); and body height, body mass, body mass index and waist circumference (anthropometry). Percentile values were obtained using the generalised additive models for location, scale and shape method.

RESULTS

A total of 7 966 693 test results from 34 countries (106 datasets) were used to develop sex-specific and age-specific percentile values. In addition, country-level rankings based on mean percentiles are provided for each fitness test, as well as an overall fitness ranking. Finally, an interactive fitness platform, including individual and group reporting and European fitness maps, is provided and freely available online (www.fitbackeurope.eu).

CONCLUSION

This study discusses the major implications of fitness assessment in youth from health, educational and sport perspectives, and how the FitBack reference values and interactive web-based platform contribute to it. Fitness testing can be conducted in school and/or sport settings, and the interpreted results be integrated in the healthcare systems across Europe.

Longitudinal association between physical activity and the risk of incident metabolic syndrome in middle-aged adults in Germany

We examined the longitudinal association between physical activity (PA) and the risk of incident metabolic syndrome (MetS) among middle-aged, community-dwelling adults, including 591 individuals (314 females; mean (SD) age, 43.8 (8.5) years) who were free of MetS at baseline. Habitual and sports-related PA was assessed by a self-reported questionnaire. MetS was defined based on HDL-cholesterols, triglycerides, glucose or HbA1c, blood pressure, and waist circumference. We calculated Cox proportional hazard ratios (HR) and 95% confidence intervals (CI) using regression analyses. Over a mean follow-up of 12.5 years, 205 participants developed incident MetS. Four different sports-related PA measures were associated with a decreased risk of incident MetS: (1) Engaging in ≥ 75 min/week (HR 0.71, 95% CI 0.53-0.94), (2) maintaining a continuously high amount from baseline to follow-up of ≥ 75 min/week (HR 0.66, 95% CI 0.46-0.94), (3) starting from < 150 min/week at baseline to ≥ 150 min/week at follow-up (HR 0.65, 95% CI 0.45-0.94), and (4) increasing from < 16.6 MET-hours/week at baseline to ≥ 16.6 MET-hours/week at follow-up (HR 0.47, 95% CI 0.31-0.71). Thus, maintaining, starting or increasing sports-related PA is associated with a lower risk of incident MetS.

Association Between Sense of Coherence and Health Outcomes at 10 and 20 Years Follow-Up: A Population-Based Longitudinal Study in Germany

Background: The sense of coherence (SOC) is reported to influence health, but health may also have an impact on SOC. The objective of this study was to examine the longitudinal associations between SOC and selected self-reported and physician-assessed health outcomes over a period of 10 and 20 years and to determine the predominant direction of the associations.

Methods: We conducted a population-based, longitudinal study, involving 392 participants (188 females and 204 males; mean age 43.01 years) who were followed for a median of 10 and 18 years. Analyses of variance were carried out to examine the longitudinal associations between SOC at baseline and health outcomes (i.e., self-rated health status, SHS; physical health status assessed by a physician, PHS; self-reported satisfaction with life, SWL) at follow-ups. The direction of associations was examined using a cross-lagged model on correlation coefficients.

Results: There were significant group effects for SOC at baseline on SHS at 20-year follow-up (F = 4.09, p = 0.018, ηp² = 0.041), as well as on SWL at 10-year (F = 12.67, p < 0.01, ηp² = 0.072) and at 20-year follow-up (F = 8.09, p < 0.1, ηp² = 0.069). SHS (r = 0.238, p < 0.01), PHS (r = −0.140, p < 0.05) and SWL (r = 0.400, p < 0.01) predicted SOC at 10-year follow-up stronger than vice versa. The direction of associations between SOC and health parameters at 20-year follow-up was less consistent.

Conclusions: The long-term associations between SOC and self-reported and physician-assessed health may be reciprocal in community-dwelling adults. More research is needed to examine the predictive power of health on SOC and whether interventions targeted at improving health parameters, may impact SOC.

The Fitness Barometer: A Best Practice Example for Monitoring Motor Performance With Pooled Data Collected From Practitioners

Introduction: Motor Performance (MP) in children is an important resource for their future active lifestyle and health. Monitoring of MP is crucial to derive information of trends and to implement specific programs on the base of current MP levels. A variety of MP assessment tools exist, making it difficult to determine a “gold-standard” for assessment and to compare the findings. In Germany, the German Motor Test 6–18 (GMT 6–18) and Kinderturntest Plus 3–10 (KITT+ 3–10) are widely used MP assessment tools. The aim of this paper is to show which key questions can be answered within the context of a best practice example of a MP assessment tool and what can be derived from this for a practical application (the Fitness Barometer).

Methods: The raw data of the Fitness Barometer was collected with the MP assessment tools GMT 6–18 and KITT+ 3–10 from 2012 through 2020. Data was pooled anonymously with the e-Research infrastructure MO|REdata and categorized into percentiles for MP and BMI. Overall, we included data of 23,864 children for the statistical analyses. T-tests for independent samples, percentage frequency analysis, descriptive statistics (chi- square-test) and single analysis of variance were conducted.

Results and Discussion: Children tested reached a mean value of 57.03 (SD = 18.85). Of the sample, 12.7% children were overweight or obese and there is a significant difference between age groups [χ(4)2 = 178.62, p < 0.001, Cramer V = 0.09; n = 23.656]. The relationship between BMI category and mean value of MP was significant [F_(4,19,523) = 224.81, p < 0.001]. During 2020, the year of the COVID-19 pandemic, mean value of endurance and speed decreased [Welch's F_(1,573) = 8.08, p = 0.005; Welch's F_(1,610) = 35.92, p < 0.001]. The GMT 6–18 and KITT+ 3–10 are valid, objective, reliable, and economic MP assessment tools for monitoring MP levels and derive added practical value. Specific programs and interventions should focus on the findings of these. The Fitness Barometer is a best practice example how a standardized assessment tool of monitoring MP point to trends on which practical evidence-based suggestions can be derived with many various partners and expertise.

Examination of Construct Validity and Criterion-Related Validity of the German Motor Test in Egyptian Schoolchildren

Physical fitness is an indicator for children’s public health status. Therefore, the aim of this study was to examine the construct validity and the criterion-related validity of the German motor test (GMT) in Egyptian schoolchildren. A cross-sectional study was conducted with a total of 931 children aged 6 to 11 years (age: 9.1 ± 1.7 years) with 484 (52%) males and 447 (48%) females in grades one to five in Assiut city. The children’s physical fitness data were collected using GMT. GMT is designed to measure five health-related physical fitness components including speed, strength, coordination, endurance, and flexibility of children aged 6 to 18 years. The anthropometric data were collected based on three indicators: body height, body weight, and BMI. A confirmatory factor analysis was conducted with IBM SPSS AMOS 26.0 using full-information maximum likelihood. The results indicated an adequate fit (χ² = 112.3, df = 20; p < 0.01; CFI = 0.956; RMSEA = 0.07). The χ²-statistic showed significant results, and the values for CFI and RMSEA showed a good fit. All loadings of the manifest variables on the first-order latent factors as well as loadings of the first-order latent factors on the second-order superordinate factor were significant. The results also showed strong construct validity in the components of conditioning abilities and moderate construct validity in the components of coordinative abilities. GMT proved to be a valid method and could be widely used on large-scale studies for health-related fitness monitoring in the Egyptian population.

Representative Percentile Curves of Physical Fitness From Early Childhood to Early Adulthood: The MoMo Study

Introduction: Monitoring of physical fitness in youth is important because physical fitness is a summative indicator of health. From a developmental and preventive perspective, physical fitness levels are relatively stable from childhood to early adulthood. Thus, it is important to monitor physical fitness on a population based level being able to intervene at early stages (1). In order to reliably assess and evaluate the physical fitness of youth, a reliable system of standard values based on representative data is required. The aim of this analysis is to report sex- and age-specific physical fitness percentile curves from childhood to early adulthood in a nationwide sample in Germany. Methods: We use data from the nationwide representative Motorik Modul (MoMo) Study in Germany (data collection wave 1: 2009-2012; age: 4-23 years; n = 3,742; 50.1% female). Physical fitness was assessed by means of the MoMo test profile covering four dimensions of physical fitness (strength, endurance, coordination, and flexibility) and including eight physical fitness items. Percentile curves were fitted using the LMS transformation method of Cole and Green. Results: Standardized age- and sex-specific physical fitness percentiles were calculated for eight items: ergometric endurance testing, standing long jump, push-ups, sit-ups, jumping side-ways, balancing backwards, static stand, and stand and reach test. The physical fitness curves differ according to gender and the fitness dimension. Physical fitness improvements with age are linear (e.g., max. strength) or curvilinear (e.g., coordination) and have their stagnation points at different times over the course of adolescence. Discussion: Our results provide for the first time sex- and age-specific physical fitness percentile curves for Germany from 4 to 17 years. Differences in curve-shapes indicating a timed and capacity-specific physical fitness development. Nationwide German physical fitness percentiles can be useful in comparing different populations (e.g., cross-country), reporting secular trends, comparing special groups, and to evaluate physical fitness interventions.

[Control group formation using propensity score matching: The role of primary and secondary data - Results of prevention studies]

BACKGROUND

The creation of control groups in the evaluation of statutory health insurances is a key issue. Randomization represents both an ethical and a legal problem with legally guaranteed services. Matching procedures are relevant alternatives in the construction of control groups. Matchings are mostly based on secondary data from statutory health insurances (for example age, gender, cost of illness, days of incapacity to work). In this study, we examined whether matching based on secondary data alone can cause selection bias.

METHODS

We used data from three large prevention studies and applied sensitivity analyses to compare the results of propensity score matchings used to create control groups on the basis of secondary data, with those obtained on the basis of both primary and secondary data. Analysis of covariance was used to investigate the impact of potential selection bias on cost effects.

RESULTS

Matchings based on secondary data alone lead to control groups with similar characteristics captured by secondary data. However, the control group participants are significantly healthier (they have, for example, lower levels of pain, lower levels of psychological stress, a higher degree of quality of life) than the patients in intervention groups. This selection bias would lead to a systematic underestimation of the cost reduction produced by preventive interventions.

DISCUSSION

Prevention course participants seem to have characteristics that differ from the average population (higher health orientation level, preference for prevention over medical treatment services, etc.) and cannot be captured by secondary data; therefore, matchings based on secondary data alone cause selection bias.

CONCLUSIONS

Including both primary and secondary data reduces the risk of selection bias in matching procedures for prevention studies. The E-value can be used to evaluate the robustness of results with regard to selection bias.

Population-based trends in physical fitness of children and adolescents in Germany, 2003-2017

Physical fitness is an important health resource. From 2003 onwards, the MoMo study, a part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), has investigated physical fitness on the basis of nationally representative data. The objective of this paper was to analyse trends in physical fitness of three cohorts at the ages of 4-17 years. Changes within 10 test items of the MoMo-test profile are reported. The mean values of physical fitness and the relevant influencing factors were directly compared across cohorts (in the total group and in age-and sex-subgroups). Statistical significance of differences was examined by calculating the confidence intervals (95% CI) for complex samples; effect sizes were determined using Cohen's d. The results indicated that physical fitness levels of German children and adolescents initially slightly increased between MoMo baseline (2003-2006) and wave 1 (2009-2012). This could partly be attributed to increased physical activity in sports clubs and in extracurricular sports at school. Then, between MoMo wave 1 and MoMo wave 2 (2014-2017) the physical fitness of children and adolescents in Germany remained the same, as did all influencing factors with the exception of extracurricular sport. From a public health perspective, programmes and measures that can increase the chances for all children and adolescents to strive for greater physical fitness should be of the highest priority.

[Reference Values for Cardiorespiratory Fitness of the General Population: The German National Health Interview and Examination Survey for Adults (DEGS1) 2008-2011]

AIM OF STUDY

This study aims to provide population-based reference values for heart rate-based indicators of cardiorespiratory fitness for adults with physical activity readiness aged 18 to 64 years living in Germany.

METHODS

Based on data on 2,826 individuals who participated in a submaximal cycle ergometer exercise test as part of the German National Health Interview and Examination Survey for Adults (DEGS1) between 2008 and 2011, we calculated the following indicators: physical working capacity at 150 and 130 beats/min and at 75% of estimated maximum heart rate (PWC150, PWC130 and PWC75%) as well as heart rate-based estimated maximum oxygen uptake (VO₂max). We used the LMS method by Cole & Green 1992 to calculate reference values.

RESULTS

25^th, 50^th and 75^th percentiles of PWC150 were 1.5, 1.77 and 2.08 watts/kg among men and 1.18, 1.44 and 1.69 among women. 25^th, 50^th and 75^th percentiles of PWC130 were 1.16, 1.41 and 1.68 watts/kg among men and 0.81, 1.05 and 1.29 among women. Age-dependent median PWC75% values among men and women were 1.87 - age in years× 0.01 and 1.31 - (age in years/100)²× 0.98, respectively, and VO₂max among men is 41.7 - age× 0.15.

CONCLUSIONS

The references values presented can be used for individual rating of cardiorespiratory fitness among adults living in Germany. Furthermore, they can serve as a basis for regular monitoring purposes.

Recommendations for assessing motor performance in individuals with dementia: suggestions of an expert panel - a qualitative approach

Background

Recommendations for assessing motor performance in individuals with dementia (IWD) are rare, and most existing assessment tools previously applied in IWD were initially developed for healthy older adults. However, IWD and their healthy counterparts differ in motor and cognitive capabilities, which needs to be considered when designing studies for this population. This article aims to give recommendations for motor assessments for IWD and to promote standardisation based on a structured discussion of identified assessment tools used in previous trials.

Methods

Appropriateness and standardisation of previously applied motor assessments for IWD were intensively discussed using a qualitative approach during an expert panel. Furthermore, the use of external cues and walking aids, as well as psychometric properties were considered. Starting with a comprehensive overview of current research practice, the discussion was gradually specified and resulted in the elaboration of specific recommendations.

Results

The superior discussion emphasised the need for tailoring motor assessments to specific characteristics of IWD and attaching importance to standardised assessment procedures. Specific recommendations include the use of sequential approaches, which incorporate a gradual increase of complexity from simple to more difficult tasks, a selection of motor assessments showing sufficient relative reliability and appropriateness for IWD, as well as allowing external cues and walking aids when restricted to repeated instructions and commonly used devices, respectively.

Conclusions

These are the first recommendations for assessing motor performance in IWD based on a comprehensive qualitative approach. Due to limited evidence, it was not possible to address all existing questions. It is therefore important to evaluate these recommendations in studies with IWD. Besides tailoring and evaluating available assessments, future research should focus on developing specific tools for IWD. Moreover, further progress in standardisation is necessary to enhance comparability between different trials. This article provides initial approaches for overcoming existing limitations in trials with IWD by giving recommendations and identifying future research questions, and therefore contributes to enhancing evidence regarding efficacy and effectiveness of physical activity interventions.

Physical activity during work and leisure show contrasting associations with fear-avoidance beliefs: cross-sectional study among more than 10,000 wage earners of the general working population

BACKGROUND AND AIMS

The association between different types of physical activity and fear-avoidance beliefs remains unclear. This study investigates the association between work-related and leisure-time physical activity with fear-avoidance beliefs in the general working population.

METHODS

Currently employed wage earners (n=10,427) from the 2010 round of the Danish Work Environment Cohort Study replied to questions about work, lifestyle and health. General linear models controlling for lifestyle, psychosocial work factors, education, pain, medication-use and chronic diseases tested associations of work-related and leisure-time physical activity (explanatory variables) with fear-avoidance beliefs (outcome variable, scale 0-100).

RESULTS

The level of fear-avoidance was 41.7 (SD 27.3), 38.0 (SD 26.9) and 54.3 (SD 27.7) among the general working population, a subgroup of pain-free individuals, and a subgroup with back disease, respectively. In the general working population, the level of fear-avoidance among those with low, moderate and high physical activity during leisure were 47 [95% confidence intervals (CI) 45-49], 44 (95% CI 42-46) and 43 (95% CI 41-45), and physical activity at work were 40 (95% CI 39-42), 44 (95% CI 42-46) and 49 (95% CI 48-51), respectively. Individuals with back disease and a high level of physical activity at work showed the overall highest level of fear-avoidance whereas pain-free individuals with a low level of physical activity at work showed the overall lowest level of fear-avoidance.

CONCLUSIONS

Physical activity during work and leisure shows contrasting associations with fear-avoidance beliefs. While high physical activity during leisure is associated with lower levels, high physical activity at work is associated with higher levels of fear-avoidance.

IMPLICATIONS

The present results may reflect some deeply rooted negative beliefs about pain and work in the population. On the societal level, campaigns may be a possible way forward as these have shown to improve beliefs about musculoskeletal pain and work.

The relationship between physical activity, fitness, physical complaints and BMI in German adults - results of a longitudinal study

OBJECTIVES

This study's aims were to describe the development of physical activity, physical fitness (PF), subjective (physical complaints (PC)) and objective (Body mass index (BMI)) health measures and to examine the relationship between the development trajectories. In addition, the study also aimed to assess the influence of sociodemographic determinants (age, sex, socioeconomic status (SES)) in German adults over a period of 18 years.

METHODS

The longitudinal study population comprises of 721 men and women, aged 33-76 years over the study period. There was self-report of physical activity and PC and testing of physical fitness and BMI in each study year (1992, 1997, 2002 and 2010). Latent growth curve models were used to analyse the development.

RESULTS

Physical activity slightly increased while fitness, PC and BMI worsened over the course of 18 years. Sex, age and SES play important roles concerning physical activity, fitness and health. Several integrative associations could be detected between physical activity, fitness, PC and BMI as well as their trajectories. In particular, high initial levels of physical activity and fitness protect from high PC and BMI.The slope of physical activity was not significantly associated with slopes of fitness, PC and BMI. However, increase of fitness resulted in decrease of PC.

CONCLUSIONS

A general positive development regarding the amount of physical activity could be detected. However, if it is only an unsystematic increase of physical activity, this is not in itself enough to achieve health benefits. The strengthening of fitness should be focused when increasing physical activity, since only then a health benefit is possible.

The kinetics of blood lactate in boys during and following a single and repeated all-out sprints of cycling are different than in men

This study characterized the impact of high-intensity interval training on the kinetics of blood lactate and performance in trained boys and men. Twenty-one boys (11.4 ± 0.8 years) and 19 men (29.4 ± 5.0 years) performed a set of four 30-s sprints with 2-min of rest and a single 30-s sprint on 2 separate occasions (randomized order) with assessment of performance. Blood lactate was assayed after each sprint and during 30 min of recovery from both tests. The individual time-curves of blood lactate concentration were fitted to the biexponential function as follows: [Formula: see text], where the velocity parameters γ1 and γ2 reflect the capacity to release lactate from the previously active muscle into the blood and to subsequently eliminate lactate from the organism, respectively. In both tests, peak blood lactate concentration was significantly lower in the boys (four 30-s sprints: 12.2 ± 3.6 mmol·L(-1); single 30-s sprint: 8.7 ± 1.8 mmol·L(-1)) than men (four 30-s sprints: 16.1 ± 3.3 mmol·L(-1); single 30-s sprint: 11.5 ± 2.1; p < 0.001). The boys exhibited faster γ1 (1.4531 ± 0.65 min; p < 0.001) and γ2 (0.059 ± 0.023 min; p = 0.01) in the single 30-s sprint and faster γ2 (0.049 ± 0.016 min; p = 0.01) in the four 30-s sprints. The worsening of performance from the first to the last of the four 30-s sprints was less pronounced in boys (9.2% ± 13.9%) than men (19.2% ± 11.5%; p = 0.01). In the present study boys, when compared with men, exhibited lower Peak blood lactate concentration; less pronounced decline in performance during the sprints concomitantly with more rapid release and elimination during the single 30-s sprint; and faster elimination of lactate following the four 30-s sprints.

[The influence of Nintendo-Wii® bowling upon residents of retirement homes]

The few studies dealing with the positive effects of health and well-being of older people are only one-sided. The aim of the study therefore was to analyze the effects of Nintendo-Wii® bowling on daily function, state of dementia, quality of life, cognition and motor skills in retirement home inhabitants. The study was performed with 27 study participants (13 women, 14 men) between the ages of 49 and 95 years (mean = 71, SD = 14). They were randomly assigned to a control group (KG) and an intervention group (IG). Between pre- and posttest, the IG played 60 min/twice a week Nintendo-Wii® Bowling over 6 weeks. The improvement of IG was significant in the analysis of variance concerning strength (arm curls: F df = 2 = 7.199; p = 0,013; η(2) = 0,231) and showed a significant trend concerning coordination (tracking lines: F df = 2 = 3.99; p = 0,058; η(2) = 0,154) compared with KG. The area of rapidity (catching bars: F df = 2 = 28.511; p = 0,008; η(2) = 0,279) showed a significant decline in the IG compared with the KG. However, closer examination shows that the short time of intervention and the wide age range could have affected the results. Thus, further studies should take these critical aspects into consideration.

A half-marathon and a marathon run induce oxidative DNA damage, reduce antioxidant capacity to protect DNA against damage and modify immune function in hobby runners

This study investigated whether a 21.1 km (half-marathon) or a 42.195 km (marathon) run modulates DNA damage, antioxidant capacity in lymphocytes and plasma, and the immune system in healthy hobby runners. Ten and 12 volunteers who completed the Baden-Marathon race in Karlsruhe with a running distance of 21.1 km and 41.195 km, respectively, were assessed 10 days before and immediately after the finish. There was no increase in the levels of endogenous DNA strand breaks immediately after half-marathon or marathon races. A statistically significant increase in the levels of oxidative DNA damage in lymphocytes was found using endonuclease III but not formamidopyrimidine glycolase (Fpg). The resistance of DNA to oxidative damage induced by hydrogen peroxide in isolated lymphocytes was significantly decreased after both races. The levels of plasma antioxidants such as alpha-tocopherol, beta-carotene and lycopene were close to, or higher than, those considered optimal for reducing the risk of cardiovascular diseases and there were no significant changes after the races in antioxidant capacity of LDL (lag-time test) or plasma in ORAC, TEAC or paraoxonase assays. The number and percentage of granulocytes and monocytes able to generate oxidative burst were significantly increased after both races, but the lytic activity of NK cells was significantly increased at the end of the half-marathon; no effect was observed in the marathon runners. Thus, oxidative DNA damage in lymphocytes, decreased the antioxidant capacity to protect lymphocytes against DNA strand breaks and increased the formation of reactive species by phagocytes in well-nourished hobby runners indicating moderate oxidative damage during such high-intensity exercise.

Distal and proximal factors of health behaviors and their associations with health in children and adolescents

OBJECTIVE

The aim of the present paper was to analyze factors affecting distal and proximal health behavior within a biopsychosocial model for examining their interactions and associations with respect to health.

METHODS

Path analysis was based on the nationwide, cross-sectional German Health Interview and Examination Survey for Children and Adolescents (2003 to 2006). The data was collected from 4,529 participants with an average age of 9.45 years (SD = 4.01). Socio-demographic data, psychosocial factors and health behavior were assessed via questionnaire. Participants also underwent physical fitness tests and a medical examination.

RESULTS

Over the five levels of the model analyzed with socioeconomic status, immigration background, and rural-urban differences on the first level; physical activity of relatives and peers, intrinsic motivation, and quality of life on the second level; eating patterns, sedentary behavior, and physical activity on the third level; physical fitness and objective health on the fourth level; and health complaints and subjective health on the fifth level; direct, moderation, and mediation effects could be shown.

CONCLUSIONS

Several distal and proximal factors are needed to take account of the multivariate complexity of health: e.g., immigration background affected health behaviors only indirectly and the effect of physical activity on objective health was mediated by physical fitness.

Cohort profile: the Motorik-Modul Longitudinal Study: physical fitness and physical activity as determinants of health development in German children and adolescents

The Motorik-Modul (MoMo) Longitudinal Study aims to contribute to long-term improvement in the health of German children and adolescents by focusing on: (i) the development of physical fitness and physical activity (including period effects); (ii) the individual and physical/social environmental determinants of the development of physical fitness and physical activity; and (iii) the impact of physical fitness and physical activity on the development of physical and mental health. The MoMo Longitudinal Study began with a nationwide representative sample of 4529 children and adolescents who ranged in age from 4-17 years at the study baseline (2003-2006). The first survey wave of the MoMo Longitudinal Study was conducted between 2009 and 2012, with two subsequent survey waves to be conducted between 2014 and 2016 and 2018 and 2020, respectively. The MoMo Longitudinal Study includes a physical fitness test profile, a physical activity questionnaire, and subjective and objective measures of health from the German Health Interview and Examination Survey (KiGGS). Data access is provided on request (alexander.woll@kit.edu). For further information, including a complete list of publications please visit www.motorik-modul.de.

Acute and medium term effects of a 10-week running intervention on mood state in apprentices

Exercise and physical activity have proven benefits for physical and psychological well-being. However, it is not clear if healthy young adults can enhance mood in everyday life through regular exercise. Earlier studies mainly showed positive effects of acute exercise and exercise programs on psychological well-being in children, older people and in clinical populations. Few studies controlled participants' physical activity in daily life, performed besides the exercise program, which can impact results. In addition the transition from mood enhancement induced by acute exercise to medium or long-term effects due to regular exercise is not yet determined. The purpose of this pilot study was to examine the acute effects of an aerobic running training on mood and trends in medium term changes of mood in everyday life of young adults. We conducted a 10-week aerobic endurance training with frequent mood assessments and continuous activity monitoring. 23 apprentices, separated into experimental and control group, were monitored over 12 weeks. To control the effectiveness of the aerobic exercise program, participants completed a progressive treadmill test pre and post the intervention period. The three basic mood dimensions energetic arousal, valence and calmness were assessed via electronic diaries. Participants had to rate their mood state frequently on 3 days a week at five times of measurement within 12 weeks. Participants' physical activity was assessed with accelerometers. All mood dimensions increased immediately after acute endurance exercise but results were not significant. The highest acute mood change could be observed in valence (p = 0.07; η(2) = 0.27). However, no medium term effects in mood states could be observed after a few weeks of endurance training. Future studies should focus on the interaction between acute and medium term effects of exercise training on mood. The decreasing compliance over the course of the study requires the development of strategies to maintain compliance over longer periods.

MOON-test - determination of motor performance in the pediatric oncology

BACKGROUND

Pediatric cancer patients suffer from various negative consequences due to the disease, the medical therapy and the inactivity during the intensive treatment. Only few studies have systematically identified the adverse effects of cancer on motor performance in childhood.

METHODS

To determine the motor performance of pediatric cancer patients, a motor performance test was developed which is applicable for this specific patient group. Eight test items with reference values for healthy children were merged to the MOON-test (test for motor performance in the oncology).

RESULTS

MOON was tested for feasibility and acceptance in 33 patients aged 4-18 years. Feasibility was confirmed for children with different types of cancer (hematological malignancies and solid tumors) and with amputation, endoprosthesis, during aplasia as well as reduced general condition. Furthermore the patients showed a broad acceptance.

CONCLUSION

Based on the study findings, the use of MOON-test as a standardized motor performance diagnostic tool in clinical routine of oncological acute clinics as well as rehabilitation clinics can be recommended.·

Age- and sex-dependent disparity in physical fitness between obese and normal weight children and adolescents

AIM

Aim of the present study was to determine whether the association between obesity and physical fitness in children and adolescents is age- and sex-specific.

METHODS

A total of 4519 children and adolescents aged 4-17 years grouped by age (4-5, 6-10, 11-13 and 14-17 years), sex and BMI (normal-weight: BMI≤90th percentile; overweight: BMI>90th percentile; adipose: BMI>97th percentile) participated in this large-scale representative cross-sectional study. Endurance, strength, flexibility and fine and gross motor coordination was measured using the following physical fitness tests: PWC170, push-ups test, standing long-jumps, side-to-side jumps, one-minute single leg stance on the dominant leg, balancing backwards on three beams of different width, lowest point reached by the fingertips while standing on a box with legs extended, reaction to colour changes of traffic light, tracing lines without touching the rim and sorting 25 pens.

RESULTS

Overweight and obese boys and girls had lower physical fitness values describing endurance, strength and gross motor coordination than normal-weight boys and girls, respectively (P<0.001 for all; boys: -12% and -19%, respectively; girls: -9% and -19%, respectively). Differences in physical fitness between weight groups were greater in older groups (P<0.001). Fine motor skills and flexibility values did not differ between weight groups.

CONCLUSION

The disparity in physical fitness, in particular in endurance, strength and gross motor coordination, between obese and normalweight is greater in adolescents than in children. Physical fitness programs are warranted for all overweight and obese children and adolescents but especially for overweight and obese adolescents.

Peer problems mediate the relationship between developmental coordination disorder and behavioral problems in school-aged children

The aim of this study was to gain insights into the relationship between developmental coordination disorder, peer problems, and behavioral problems in school-aged children where both internalizing and externalizing behavioral problems were considered. We assumed that the relationship between developmental coordination disorder and internalizing/externalizing problems in school-aged children is mediated by peer problems and tested the hypothesis that a greater degree of motor impairment causes a greater degree of peer problems and thus a greater degree of internalizing or externalizing problems. Seventy boys and girls aged between 5 and 11 years were examined using the Movement Assessment Battery for Children 2 and the Intelligence and Developmental Scales. The results of path analysis showed that the relationship between developmental coordination disorder and internalizing/externalizing problems in school-aged children is mediated at least in part by peer problems. However, the cross-sectional design of the study does not provide conclusive evidence for a cause-effect relationship and only allows for the conservative prognosis that a greater degree of motor impairment may cause a greater degree of peer problems and thus a greater degree of internalizing/externalizing problems. Nevertheless, the results of this study emphasize the importance of being well-integrated in their peer group especially for children with developmental coordination disorder.

Socio-demographic correlates of physical activity and physical fitness in German children and adolescents

AIM

Identifying factors that influence children's and adolescents' participation in physical activity (PA), as well as their physical fitness (PF), is essential for the development of effective intervention strategies. The aim of this study was to investigate and compare influential socio-demographic factors that affect PA such as socio-economic status (SES), rural-urban differences, immigration and age, as well as the effects of age and PA on PF as differentiated by gender. Subjects and

METHODS

German children between 6 and 9 years and adolescents between 10 and 17 years of age (n = 2574) participated in the representative, nationwide, cross-sectional 'Motorik'-Module study between 2003 and 2006.

RESULTS

Results revealed that immigrant children and children with a lower SES background were less physically active and that this inactivity subsequently resulted in lower levels of PF as compared with non-immigrant children and children with a higher SES background. PA was further positively associated with age for children. All of these three socio-demographic factors were comparably meaningful for PA. In adolescents, the only PA-relevant socio-demographic parameter was SES with lower PA again resulting in lower PF levels observed in adolescents from lower income families. PF in childhood as well as adolescence was mostly positively affected by age, followed by PA, except for in female adolescents for whom PA and age were nearly equally significant.

CONCLUSIONS

An intervention aiming to improve PA levels, and consequently PF levels, must, with respect to age and gender, refer to SES, as well as immigration background, but not to rural-urban differences.

[Daily ailments among healthy, middle-aged adults--situation report and explanatory approaches]

BACKGROUND

Physical performance steadily declines with increasing age even among healthy adults.

METHODS

A sport scientific screening-battery was used to determine the relationship between physical performance--that is endurance, strength, coordination, flexibility--and typical daily ailments as measured by a questionnaire among 222 healthy, middle-aged women and men. Cardiopulmonary performance was estimated by a 2-km walking test.

RESULTS

Cardiopulmonary performance declined significantly as a result of increasing age and increasing body-mass index. 44% of men and 29% of women reached substandard values when compared to norm tables. Daily ailments such as "Problems while climbing stairs" or "Breathing difficulty" showed a strong correlation to the estimated cardiopulmonary performance. In contrast, they were less influenced by strength or flexibility. The subjects were oblivious of the relationship between the decreased performance of the cardiovascular system and daily ailments.

CONCLUSION

Performing a simple screening-battery may be a good chance to promote the participation of middle-aged and non-athletic people in an adequate and health oriented sports program.

Frühdiagnostik motorischer Funktionen

Zusammenfassung. Der motorischen Entwicklung kommt in der frühen Kindheit eine zentrale Bedeutung zu. Ziel des vorliegenden Beitrages ist die Kennzeichnung wissenschaftlich abgesicherter Instrumente zur Diagnose des frühkindlichen motorischen Entwicklungsstandes. Hierzu werden gängige motorische Entwicklungstests anhand ausgewählter Testgütekriterien diskutiert. Am Ende des Beitrages steht eine Entscheidungshilfe für die Testauswahl.

[Daily ailments among healthy, middle-aged adults - Situation report and explanatory approaches]

HEADING

Background: Physical performance steadily declines with increasing age even among healthy adults.

METHODS

A sport scientific screening-battery was used to determine the relationship between physical performance - that is endurance, strength, coordination, flexibility - and typical daily ailments as measured by a questionnaire among 222 healthy, middle-aged women and men. Cardiopulmonary performance was estimated by a 2-km walking test.

RESULTS

Cardiopulmonary performance declined significantly as a result of increasing age and increasing body-mass index. 44% of men and 29% of women reached substandard values when compared to norm tables. Daily ailments such as "Problems while climbing stairs" or "Breathing difficulty" showed a strong correlation to the estimated cardiopulmonary performance. In contrast, they were less influenced by strength or flexibility. The subjects were oblivious of the relationship between the decreased performance of the cardiovascular system and daily ailments.

CONCLUSION

Performing a simple screening-battery may be a good chance to promote the participation of middle-aged and non-athletic people in an adequate and health oriented sports program.

The impact of obesity on developmental coordination disorder in adolescence

Developmental coordination disorder (DCD) as well as overweight and obesity are of increasing importance in the study of human development. Data on the relation between DCD and obesity in adolescence are of particular interest because both phenomena are unlikely to disappear with age. The objective of this study was to determine the impact of obesity on severe DCD in adolescence. A total of 99 obese adolescents aged between 11 and 16 years and 99 normal-weight controls matched for age and gender were included in this cross-sectional study. The Movement Assessment Battery for Children 2 (age band 3) was used to determine subjects' stage of motor development. Results made clear that (i) obese show a higher severe DCD-risk in comparison to normal-weight adolescents (p<.01) which is (ii) most pronounced in balance (p<.01), and (iii) thereby rather appears in boys (p≤.10). Thus, our results at least do not exclude the possibility that obesity might have a detrimental effect on the etiopathology of DCD beyond childhood. Therefore, primary obesity prevention measures may additionally contribute to the prevention of a possible consolidation of severe DCD.

Factorial validity of the Movement Assessment Battery for Children-2 (age band 2)

The Movement Assessment Battery for Children-2 (M-ABC-2) is one of the most commonly used tests for the diagnosis of specific developmental disorders of motor function (F82). The M-ABC-2 comprises eight subtests per age band (AB) that are assigned to three dimensions: manual dexterity, aiming and catching, and balance. However, while previous exploratory findings suggested the correctness of the assumption of factorial validity, there is no empirical evidence that the M-ABC-2 subtests allow for a valid reproduction of the postulated factorial structure. The purpose of this study was to empirically confirm the factorial validity of the M-ABC-2. The German normative sample of AB2 (7-10 years; N=323) was used as the study sample for the empirical analyses. Confirmatory factor analysis was used to verify the factorial validity of the M-ABC-2 (AB2). The incremental fit indices (χ2=28.675; df=17; Bollen-Stine p value=0.318; RMSEA=0.046 [0.011-0.075]; SRMR=0.038; CFI=0.960) provided evidence for the factorial validity of the M-ABC-2 (AB2). However, because of a lack of empirical verification for convergent and discriminant validity, there is still no evidence that F82 can be diagnosed using M-ABC-2 (AB2).

A biopsychosocial process model of health and complaints in children and adolescents

The purpose of the study was to test a biopsychosocial process model based on theoretically and empirically supported factors previously found to influence health and complaints in children and adolescents. Participants (N = 823) of the ages of nine, 14 or 18 were administered parts of the Health Behaviour in School-Aged Children Questionnaire and a physical activity questionnaire. They subsequently underwent physical fitness tests and a medical examination. For complaints, direct and indirect influences over four levels (socioeconomic status, physical activity of relatives and peers, physical activity and physical fitness) were shown, but the findings did not hold for health. The interpretation of expected and unexpected results is discussed.

Motor abilities and aerobic fitness of obese children

Obesity is considered to be epidemic worldwide. Stopping further progression interdisciplinary, outpatient intervention therapy programs for obese children have become increasingly important. FITOC (Freiburg Intervention Trial for Obese Children) consists of a combination of organized sports, behavioral therapy and nutritional advice. The effectiveness of the therapy is determined on the basis of anthropometrical and physical performance data. The purpose of this report is to give a differentiated view of the motor abilities of obese children and to describe changes in the course of the therapy program FITOC. Data were collected on n = 49 obese children (BMI > 97th percentile) aged 8 - 12 in a pretest at the beginning and posttest at the end of the intensive phase of the therapy. These data were compared with an age-matched German reference group. Besides the General Sports-Motor Test (Allgemeiner Sportmotorischer Test [AST]), the BMI-SDS values, the body fat mass (FM %) and the aerobic capacity (Watt/kg body weight) were recorded. In the pretest, the running exercise results and the aerobic capacity checked ranged significantly below the values of the reference group. The performance in the coordinative tests of the AST was differentiated. The medicine-ball toss was significantly above average of the reference group. In the posttest, the BMI-SDS values and the body fat mass (% FM) decreased (p < 0.001) and the aerobic capacity improved (p < 0.001). Performance in all motor abilities tests improved and the difference between the strength of the obese children and the strength of the reference group decreased. This study demonstrates that in obese children weight-bearing activities are below average but not all motor abilities.

Motorik-Modul (MoMo) im Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS)

Motor fitness and physical activity are important aspects of a healthy development in childhood and adolescence. However, the assessment of motor fitness and physical activity is not subject to standardized criteria; furthermore, the samples investigated do not provide a representative image of the whole population. Therefore, the existing data only allow very limited statements on the state and development of motor fitness and physical activity. The "Motorik" module, as part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), offers nationwide representative data on the motor fitness and physical activity of children and adolescents for the first time. Besides the baseline-analysis, another aim is to analyse the complex relationship between motor fitness, physical activity and health. Motor fitness, based on the systematisation of motor abilities, was assessed using a test profile. The test profile consists of 11 items measuring cardiorespiratory fitness, strength, coordination and mobility. Physical activity was assessed using a questionnaire containing 51 items on the duration, intensity and frequency of physical activity in everyday life, during leisure time, at school and in sports clubs. The above-mentioned questionnaire subtopics were supplemented by questions on the weekly prevalence of at least 60 minutes of daily physical activity, on material and local conditions, as well as on cognition and motivation for physical activity. In the years 2004 to 2006, the motor fitness and physical activity of 4,529 children and young people between the ages of 4 and 17 years was investigated on 168 sample points in the context of the "Motorik" module. Half of the children and adolescents investigated belong to the middle class, approximately 15% have a background of migration. The majority of the subjects come from small towns, about a quarter live in the city, less than 20% are settled in rural areas.

Motorische Leistungsfähigkeit

Motor fitness was investigated in children and adolescents aged 4-17 using specific short tests. These tested the motor abilities: co-ordination, strength, cardiorespiratory fitness and flexibility. Among the 4-10 year olds, the focus of the investigation was on recording coordination, strength and flexibility; in the age group of the 11-17 year olds it was on recording cardiorespiratory fitness. The current investigation describes motor fitness based on the tested abilities according to age, sex and sociodemographic aspects. In all the test tasks, as expected, there are better results from older children and adolescents than from younger ones. Among the 4-10 year olds, girls display a slightly higher motor fitness in five out of the six tasks. In cardiorespiratory fitness, the cycle ergometer test for the 11-17 year olds shows better results for boys. The results indicate that there is a correlation between migrant status, social status and motor fitness. The shown differences point out that possible intervention programmes should be specifically attuned to age and sex as well as to the concerns of children and families with a migrant background and those of low social status. These collected data on motor fitness produced a database, representative of Germany. This will enable statements on state and development of motor fitness in children and adolescents in the future.