Hot Topic: Youth Fitness Testing in Schools
New study proposes Youth Fitness International Test (YFIT)
The Annual Check-up
Open up and say …ahh. We all probably remember the annual check-up with the pediatrician as a kid. Or if you are a parent, have experienced it more recently.
During the visit, several routine health measures and vitals are taken.
The child steps onto the old rickety medical scale to measure height and weight, which are then plotted on the growth chart. (Later that week, the parents comment to friends or associates on how lil’ Jimmy is in the 75th percentile for height.) Height and weight are then used to compute the BMI (body mass index, kg/m2) which is used as a proxy of ‘body fatness’ and weight status. Those with BMI between the 85th and 95th percentile for age- and sex-specific values of the BMI growth chart are classified as overweight and those with BMI >95th percentile are considered obese. [In general, there is a pretty good correlation between BMI and body fatness … but it also reflects fat-free mass as well.]
Temperature and resting pulse rate are taken. The blood pressure cuff is wrapped around the upper arm and inflated and blood pressure is checked and compared against reference values.
The physician (or physician assistant) enters the room and reviews the chart and the current vital signs. They take the stethoscope from around their neck and ask the child to take a deep breath in ….and out … while listening to the lungs. The abdominal cavity is checked as are reflexes with the little rubber mallet.
Maybe a blood draw is scheduled to determine biomarkers.
Essentially, all major organ systems are checked to ensure normal structure and function ….. at rest. And, perhaps the physician asks about lifestyle behaviours like regular activity or exercise, seatbelt use, wearing a helmet while biking, etc.
What about the Annual Youth Fitness ‘Check-up’ in Schools?
This routine medical check-up provides an assessment of general health and well-being of the child, and includes an indicator of body composition (BMI) and some aspects of cardio-pulmonary ‘fitness’ (resting heart rate and blood pressure). But what about muscle strength? and aerobic exercise capacity? These are two key components of physical fitness that have been shown to reduce the risk of several chronic diseases in adults and also the current and future health of children and adolescents.
As a parent, don’t you want to know that your child is healthy and physically fit?
Several months ago, I posted a poll on Twitter asking ‘How important is it to conduct health-related fitness testing in schools?’ The results: quite equivalent across the four choices. Some may interpret as about 3 of 4 saying fitness testing is ‘important’ whether that be slightly (24%), moderately (22%) or important (31%). Others may interest the opposite way with only 31% being convinced enough that it is Important. And yet, there could be those who interpret as a toss-up. In any case, there are certainly detractors.
Where do you stand? Would love to hear your thoughts on the topic, please comment below.
Hot Off the Press: The Youth Fitness International Test (YFIT)
If fitness testing is to be conducted in schools, what tests should be used?
Across the years, several fitness testing batteries have been used throughout the world.
In the United States, FITNESSGRAM is widely-used. For several years, I sat on the scientific advisory board of FITNESSGRAM and along with colleagues (Drs. Greg Welk, Kelly Laurson and Pedro Saint-Maurice) developed the reference values or benchmarks for evaluating the data obtained from fitness testing.
In Europe, the ALPHA-Fit (Assessing the Levels of Physical Activity and Fitness) test battery was developed from funding from the Directorate General for Health and Consumers Affairs of the EU to assess the health-related fitness status in children and adolescents of the European Union.
Recently, an international group of scholars conducted a Delphi study to identify a core set of fitness tests for monitoring and surveillance internationally, and to standardize the protocols for each test. The Delphi approach is a procedure or research method to attain expert consensus by gathering the most reliable opinions from a group (ideally large and diverse) of independent experts who cannot meet in real-time for logistic or economic reasons and with the ultimate goal of attaining consensus.
The details of the study and Delphi approach can be found here but let’s get to the main findings.
The YFIT battery includes:
Body size/composition: height and weight to compute BMI
Cardiorespiratory fitness: 20-m shuttle run
Muscular fitness: handgrip strength and standing long jump
Details of the test protocol can be found in Table 3 of the paper and include a video link as well.
Overall, there was a high agreement (≥85 %) from the experts for all tests and protocols. The overall consensus on the use of the 20-m shuttle run, handgrip strength, and standing long jump tests was very high (>90 % agreement). Although the agreement for using BMI as a measure of body composition was still high, it was the lowest among the proposed measures (87 %). Of note, only 68 % of North American participants agreed with the BMI.
What about reference values or benchmarks for fitness testing for YFIT?
Conducting youth fitness testing is one thing but what does a BMI of 17.6 kg/m2 mean for a 12-year old girl? Or a 30-kg handgrip mean for a 10-year old boy?
The answer to this question is somewhat complex and calls for another blog. In essence, this was the entire work that we undertook developing the FITNESSGRAM benchmarks that are age- and sex-specific and tied to health-related outcomes.
It is the longer-term goal of the authors of the YFIT to begin using the standardized test battery to collect and pool data to develop international and regional sex- and age-specific reference values.
In addition, it is the hope of YFIT to ultimately provide global data that can inform surveillance and guide public health policies to ensure the development of health-related fitness in youth.
For those interested in the papers that led to the FITNESSGRAM reference values see below. (P.S. This probably warrants a blog or video lecture on ‘Developing Reference Values for Youth Fitness and Athleticism’)