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
[en] 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).
Disciplines :
Human health sciences: Multidisciplinary, general & others
Author, co-author :
Ortega, Francisco
Leskosek, Bojan
Blagus, Rok
Gil-Cosano, José
Mäestu, Jarek
Tomkinson, Grant
Ruiz, Jonatan
Mäestu, Evelin
Starc, Gregor
Milanovic, Ivana
Tammelin, Tuija
Soric, Maroje
Scheuer, Claude ; University of Luxembourg > Faculty of Humanities, Education and Social Sciences (FHSE) > Department of Education and Social Work (DESW)
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
Ortega FB, Ruiz JR, Castillo MJ, et al. Physical ftness in childhood and adolescence: a powerful marker of health. Int J Obes 2008;32:1-11.
Ruiz JR, Castro-Piñero J, Artero EG, et al. Predictive validity of health-related ftness in youth: a systematic review. Br J Sports Med 2009;43:909-23.
García-Hermoso A, Ramírez-Campillo R, Izquierdo M. Is muscular ftness associated with future health benefts in children and adolescents? A systematic review and meta-analysis of longitudinal studies. Sports Med 2019;49:1079-94.
García-Hermoso A, Ramírez-Vélez R, García-Alonso Y, et al. Association of cardiorespiratory ftness levels during youth with health risk later in life: a systematic review and meta-analysis. JAMA Pediatr 2020;174:952-60.
Högström G, Ohlsson H, Crump C, et al. Aerobic ftness in late adolescence and the risk of cancer and cancer-associated mortality in adulthood: a prospective nationwide study of 1.2 million Swedish men. Cancer Epidemiol 2019;59:58-63.
Crump C, Sundquist J, Winkleby MA, et al. Interactive effects of aerobic ftness, strength, and obesity on mortality in men. Am J Prev Med 2017;52:353-61.
Ballin M, Nordström A, Nordström P. Cardiovascular disease and all-cause mortality in male twins with discordant cardiorespiratory ftness: a nationwide cohort study. Am J Epidemiol 2020;189:1114-23.
Ortega FB, Silventoinen K, Tynelius P, et al. Muscular strength in male adolescents and premature death: cohort study of one million participants. BMJ2012;345:e7279.
Henriksson P, Henriksson H, Tynelius P, et al. Fitness and body mass index during adolescence and disability later in life. Ann Intern Med 2019;170:230-9.
Henriksson H, Henriksson P, Tynelius P, et al. Muscular weakness in adolescence is associated with disability 30 years later: a population-based cohort study of 1.2 million men. Br J Sports Med 2019;53:1221-30.
Henriksson P, Shiroma EJ, Henriksson H, et al. Fit for life? Low cardiorespiratory ftness in adolescence is associated with a higher burden of future disability. Br J Sports Med 2021;55:128-9.
Henriksson H, Henriksson P, Tynelius P, et al. Cardiorespiratory ftness, muscular strength, and obesity in adolescence and later chronic disability due to cardiovascular disease: a cohort study of 1 million men. Eur Heart J 2020;41:1503-10.
Raghuveer G, Hartz J, Lubans DR, et al. Cardiorespiratory ftness in youth: an important marker of health: a scientifc statement from the American heart association. Circulation2020;142:E101-18.
Cadenas-Sanchez C, Mena-Molina A, Torres-Lopez LV, et al. Healthier minds in Fitter bodies: a systematic review and meta-analysis of the association between physical ftness and mental health in youth. Sports Med 2021;51:2571-605.
Chaddock-Heyman L, Erickson KI, Holtrop JL, et al. Aerobic ftness is associated with greater white matter integrity in children. Front Hum Neurosci 2014;8:1-7.
Raine LB, Lee HK, Saliba BJ, et al. The infuence of childhood aerobic ftness on learning and memory. PLoS One 2013;8:e72666.
Chaddock L, Erickson KI, Prakash RS, et al. A neuroimaging investigation of the association between aerobic ftness, hippocampal volume, and memory performance in preadolescent children. Brain Res 2010;1358:172-83.
Voss MW, Heo S, Prakash RS, et al. The infuence of aerobic ftness on cerebral white matter integrity and cognitive function in older adults: results of a one-year exercise intervention. Hum Brain Mapp 2013;34:2972-85.
Chaddock L, Erickson KI, Prakash RS, et al. Basal ganglia volume is associated with aerobic ftness in preadolescent children. Dev Neurosci 2010;32:249-56.
Chaddock L, Pontifex MB, Hillman CH, et al. A review of the relation of aerobic ftness and physical activity to brain structure and function in children. J Int Neuropsychol Soc 2011;17:975-85.
Chaddock L, Hillman CH, Pontifex MB, et al. Childhood aerobic ftness predicts cognitive performance one year later. J Sports Sci 2012;30:421-30.
Chaddock-Heyman L, Erickson KI, Kienzler C, et al. The role of aerobic ftness in cortical thickness and mathematics achievement in preadolescent children. PLoS One 2015;10:e0134115.
Mora-Gonzalez J, Esteban-Cornejo I, Cadenas-Sanchez C, et al. Fitness, physical activity, working memory, and neuroelectric activity in children with overweight/obesity. Scand J Med Sci Sports 2019;29:1352-63.
Valkenborghs SR, Noetel M, Hillman CH, et al. The impact of physical activity on brain structure and function in youth: a systematic review. Pediatrics2019;144.
Ortega FB, Campos D, Cadenas-Sanchez C, et al. Physical ftness and shapes of subcortical brain structures in children. Br J Nutr 2019;122:S49-58.
Esteban-Cornejo I, Stillman CM, Rodriguez-Ayllon M, et al. Physical ftness, hippocampal functional connectivity and academic performance in children with overweight/obesity: the ActiveBrains project. Brain Behav Immun 2021;91:284-95.
Esteban-Cornejo I, Cadenas-Sánchez C, Contreras-Rodriguez O, et al. A whole brain volumetric approach in overweight/obese children: examining the association with different physical ftness components and academic performance. The ActiveBrains project. Neuroimage 2017;159:346-54.
Esteban-Cornejo I, Mora-Gonzalez J, Cadenas-Sanchez C, et al. Fitness, cortical thickness and surface area in overweight/obese children: the mediating role of body composition and relationship with intelligence. Neuroimage 2019;186:771-81.
Rodriguez-Ayllon M, Esteban-Cornejo I,Verdejo-Román J, et al. Physical ftness and white matter microstructure in children with overweight or obesity: the ActiveBrains project. Sci Rep 2020;10:12469.
Cadenas-Sanchez C, Migueles JH, Erickson KI, et al. Do ftter kids have bigger brains? Scand J Med Sci Sports 2020;30:2498-502.
Pietschnig J, Penke L, Wicherts JM, et al. Meta-Analysis of associations between human brain volume and intelligence differences: how strong are they and what do they mean? Neurosci Biobehav Rev 2015;57:411-32.
Castro-Piñero J, Artero EG, España-Romero V, et al. Criterion-related validity of feld-based ftness tests in youth: a systematic review. Br J Sports Med 2010;44:934-43.
Artero EG, España-Romero V, Castro-Piñero J, et al. Reliability of feld-based ftness tests in youth. Int J Sports Med 2011;32:159-69.
Ruiz JR, Castro-Piñero J, España-Romero V, et al. Field-based ftness assessment in young people: the alpha health-related ftness test battery for children and adolescents. Br J Sports Med 2011;45:518-24.
Ortega FB, Ruiz JR. Fitness in youth: methodological issues and understanding of its clinical value. Am J Lifestyle Med 2015;9:403-8.
IOM (Institute of Medicine). Fitness measures and health outcomes in youth. Washington, DC: The National Academies Press, 2012.
Whitehead M. The concept of physical literacy. European Journal of Physical Education 2001;6:127-38.
De Miguel-Etayo P, Gracia-Marco L, Ortega FB, et al. Physical ftness reference standards in European children: the IDEFICS study. Int J Obes 2014;38:S57-66.
Ortega FB, Artero EG, Ruiz JR, et al. Physical ftness levels among European adolescents: the Helena study. Br J Sports Med 2011;45:20-9.
Tomkinson GR, Carver KD, Atkinson F, et al. European normative values for physical ftness in children and adolescents aged 9-17 years: results from 2 779 165 Euroft performances representing 30 countries. Br J Sports Med 2018;52:1445-56.
Jurak G, Leskoŝek B, Kovac M, et al. SLOft surveillance system of somatic and motor development of children and adolescents: upgrading the Slovenian sports educational chart. Auc Kinanthropologica 2020;56:28-40.
Csányi T, Finn KJ, Welk GJ, et al. Overview of the Hungarian national youth ftness study. Res Q Exerc Sport 2015;86 Suppl 1:S3-12.
Henriques-Neto D, Hetherington-Rauth M, Magalhães J P, et al. Physical ftness tests as an indicator of potential athletes in a large sample of youth. Clin Physiol Funct Imaging 2022;42:88-95.
Léger LA, Mercier D, Gadoury C, et al. The multistage 20 metre shuttle run test for aerobic ftness. J Sports Sci 1988;6:93-101.
Tomkinson GR, Lang JJ, Tremblay MS, et al. International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries. Br J Sports Med 2017;51:1545-54.
Esteban-Cornejo I,Tejero-González CM, Martinez-Gomez D, et al. Independent and combined infuence of the components of physical ftness on academic performance in youth. J Pediatr 2014;165:306-12.
Lumley T. Complex surveys: a guide to analysis using R. John Wiley & Sons, Inc, 2010.
Rigby RA, Stasinopoulos DM. Generalized additive models for location, scale and shape (with discussion). J Royal Statistical Soc C 2005;54:507-54.
Cole TJ, Green PJ. Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 1992;11:1305-19.
R Core Team. R: a language and environment for statistical computing. R Found. Stat. Comput 2019 https://www.r-project.org/
Stasinopoulos DM, Rigby RA. Generalized Additive Models for Location Scale and Shape (GAMLSS) in R. J Stat Softw 2007;23:1-46.
Lang JJ, Wolfe Phillips E, Orpana HM, et al. Field-based measurement of cardiorespiratory ftness to evaluate physical activity interventions. Bull World Health Organ 2018;96:794-6.
Iglesias-Soler E, Rúa-Alonso M, Rial-Vázquez J, et al. Percentiles and principal component analysis of physical ftness from a big sample of children and adolescents aged 6-18 years: the DAFIS project. Front Psychol 2021;12:627834.
The Finnish National Board of Education. Move!-monitoring system for physical functional capacity, 2021. Available: www.oph.f/en/move [Accessed 12 May 2022].
Lang JJ, Zhang K, Agostinis-Sobrinho C, et al. Top 10 international priorities for physical ftness research and surveillance among children and adolescents: a Twin-Panel Delphi study. Sports Med 2022:1-16.
Jurak G, Morrison SA, Kovac M, et al. A COVID-19 crisis in child physical ftness: creating a barometric tool of public health engagement for the Republic of Slovenia. Front Public Health 2021;9:1-7.
Jarnig G, Jaunig J, van Poppel MNM. Association of COVID-19 mitigation measures with changes in cardiorespiratory ftness and body mass index among children aged 7 to 10 years in Austria. JAMA Netw Open 2021;4:e2121675-12.
Association International Physical Literacy. What is physical literacy, 2014. Available: https://physicalliteracy.ca/physical-literacy/
Jean de Dieu H, Zhou K. Physical literacy assessment tools: a systematic literature review for why, what, who, and how. Int J Environ Res Public Health 2021;18:7954.
Rongen F, McKenna J, Cobley S, et al. Are youth sport talent identifcation and development systems necessary and healthy? Sports Med Open 2018;4:2-5.
Tambalis KD, Panagiotakos DB, Psarra G, et al. Physical ftness normative values for 6-18-year-old Greek boys and girls, using the empirical distribution and the lambda, mu, and sigma statistical method. Eur J Sport Sci 2016;16:736-46.
Dobosz J, Mayorga-Vega D, Viciana J. Percentile Values of Physical Fitness Levels among Polish Children Aged 7 to 19 Years-a Population-Based Study. Cent Eur J Public Health 2015;23:340-51.
Ortega FB, Ruiz JR, Labayen I, et al. Health inequalities in urban adolescents: role of physical activity, diet, and genetics. Pediatrics 2014;133:e884-95.
Tomkinson GR, Olds TS, Borms J. Who are the Eurofttest? Med Sport Sci 2007;50:104-28.
Lang JJ, Tremblay MS, Léger L, et al. International variability in 20 m shuttle run performance in children and youth: who are the fttest from a 50-country comparison? A systematic literature review with pooling of aggregate results. Br J Sports Med 2018;52:276.
