How to design and establish a national school-based physical fitness monitoring and surveillance system for children and adolescents: A 10-step approach recommended by the FitBack network.

BACKGROUND: Providing individual- and population-level data on children's physical fitness (PF) is a crucial public health and education priority. However, few national fitness monitoring or surveillance systems are currently in practice internationally. We aim to summarize the current European PF monitoring and surveillance systems for school-aged children and to provide experience-based guidelines on how to design such systems. METHODS: The FitBack network consists of experts from diverse backgrounds with the common interest to improve the accessibility of PF monitoring for young people globally. Through FitBack network, we identified and compared the national or regional PF monitoring and surveillance systems currently in operation across Europe. We formulated a 10-step approach for designing and establishing one's own system, based on analysis of experienced strengths, weaknesses, opportunities, and threats to monitoring childhood fitness. RESULTS: We identified a total of eight PF monitoring systems in Finland, France, Galicia of Spain, Hungary, Lithuania, Portugal, Serbia, and Slovenia. The FitBack network recommends the following steps for designing and establishing one's own system: (1) set up mission statements and aims, (2) involve stakeholders, (3) utilize scientific background, (4) governance structure, (5) ensure sufficient funding, (6) data management planning, (7) provide meaningful feedback, (8) conduct pilot testing, (9) plan implementation process, and (10) invest in communication with stakeholders. CONCLUSIONS: This study provides an updated overview of the best practices for school-aged children's fitness monitoring and surveillance in Europe. Additionally, it offers a 10-step approach to assist in the creation of similar systems in Europe or globally.

The Prevalence of Educational Neuromyths among Hungarian Pre-Service Teachers.

Teachers with poor neuroliteracy fail to distinguish scientific evidence from neuromyths (NM), which might lead to the implementation of pseudoscientific educational methods. The prevalence of NM and general knowledge about the brain (GKAB) among in-service and pre-service teachers has been assessed in multiple countries, but no such study has been performed in Hungary. The aims of this study were to (1) assess the neuroliteracy of pre-service teachers, (2) compare the results with those of previous studies and (3) analyze the factors influencing neuroliteracy. Our sample included 822 pre-service teachers from 12 Hungarian universities. We developed a survey including 10 NM and 13 GKAB statements, adapted from a widely used questionnaire. The average rate of incorrect answers to NM was 56.9%, whereas the average rate of correct answers to GKAB was 70.9%. Male gender and frequency of using Facebook as the primary information source about neuroscience were the only predictors of NM acceptance. In comparison with other studies, the Hungarian pre-service teachers had the second highest endorsement of NM. The most prevalent NM were linked to motor functions, which might be related to the widespread use and promotion of motor therapies in Hungary.

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.

Top 10 International Priorities for Physical Fitness Research and Surveillance Among Children and Adolescents: A Twin-Panel Delphi Study.

BACKGROUND: The measurement of physical fitness has a history that dates back nearly 200 years. Recently, there has been an increase in international research and surveillance on physical fitness creating a need for setting international priorities that could help guide future efforts. OBJECTIVE: This study aimed to produce a list of the top 10 international priorities for research and surveillance on physical fitness among children and adolescents. METHODS: Using a twin-panel Delphi method, two independent panels consisting of 46 international experts were identified (panel 1 = 28, panel 2 = 18). The panel participants were asked to list up to five priorities for research or surveillance (round 1), and then rated the items from their own panel on a 5-point Likert scale of importance (round 2). In round 3, experts were asked to rate the priorities identified by the other panel. RESULTS: There was strong between-panel agreement (panel 1: rs = 0.76, p < 0.01; panel 2: rs = 0.77, p < 0.01) in the priorities identified. The list of the final top 10 priorities included (i) "conduct longitudinal studies to assess changes in fitness and associations with health". This was followed by (ii) "use fitness surveillance to inform decision making", and (iii) "implement regular and consistent international/national fitness surveys using common measures". CONCLUSIONS: The priorities identified in this study provide guidance for future international collaborations and research efforts on the physical fitness of children and adolescents over the next decade and beyond.

Ringing the bell for quality P.E.: What are the realities of remote physical education?

BACKGROUND: To date, few data on the quality and quantity of online physical education (P.E.) during the COVID-19 pandemic have been published. We assessed activity in online classes and reported allocated curriculum time for P.E. in a multi-national sample of European children (6-18 years). METHODS: Data from two online surveys were analysed. A total of 8395 children were included in the first round (May-June 2020) and 24 302 in the second round (January-February 2021). RESULTS: Activity levels during P.E. classes were low in spring 2020, particularly among the youngest children and in certain countries. 27.9% of students did not do any online P.E. and 15.7% were hardly ever very active. Only 18.4% were always very active and 14.9% reported being very active quite often. In winter 2020, we observed a large variability in the allocated curriculum time for P.E. In many countries, this was lower than the compulsory requirements. Only 65.7% of respondents had the same number of P.E. lessons than before pandemic, while 23.8% had less P.E., and 6.8% claimed to have no P.E. lessons. Rates for no P.E. were especially high among secondary school students, and in large cities and megapolises. CONCLUSIONS: During the COVID-19 pandemic, European children were provided much less P.E. in quantity and quality than before the pandemic. Countermeasures are needed to ensure that these changes do not become permanent. Particular attention is needed in large cities and megapolises. The critical role of P.E. for students' health and development must be strengthened in the school system.

Bone characteristics and physical fitness in children and adolescents with visual impairment.

BACKGROUND: Lower habitual physical activity in adolescents with visual impairment (VI) have detrimental effect on their general health such as bone quality and physical fitness. The aim of this study was to demonstrate the bone quality in children with VI and to analyze the correlations of their bone characteristics with anthropometric and physical fitness tests. METHODS: The participants (N.=38) were adolescents (14.85±2.79 yrs) with low vision (N.=18) or blindness (N.=20). Dual-energy X-ray absorptiometry (DEXA) was used to measure bone mineral density (BMD), bone mineral content (BMC) of the total body and L1-L4 of the lumbar spinal region. After anthropometry physical fitness was examined by laboratory test (V̇O2peak) and field tests (strength and running). RESULTS: Height, weight, Body Mass Index (BMI), V̇O2peak were similar in the two groups. Blind boys showed significant higher handgrip strength. Estimated V̇O2peak (from 20-m shuttle running test) was significantly lower in blind children (43.84±4.42 mL/kg/min) than in children with low vision (35.08±5.23 mL/kg/min; P<0.001). BMD and BMC did not differ in subgroups, Z-score of total body BMD was significantly lower in blind children. Means of Z-score in L1-L4 lumbal spinal region were negative values and similar in blind and low vision adolescents' subgroups. A linear regression model in the collective group revealed significant associations of BMD (r2=0.538; P=0.0001) and BMC (r2=0.698; P=0.048) with BMI and handgrip strength test. CONCLUSIONS: Adolescents with VI have generally decreased bone health and physical fitness level. BMI and handgrip strength are predictors of total body BMD and BMC; suggesting that these measures may be adequate to estimate bone health.

Physical activity, screen time and the COVID-19 school closures in Europe - An observational study in 10 countries.

To date, few data on how the COVID-19 pandemic and restrictions affected children's physical activity in Europe have been published. This study examined the prevalence and correlates of physical activity and screen time from a large sample of European children during the COVID-19 pandemic to inform strategies and provide adequate mitigation measures. An online survey was conducted using convenience sampling from 15 May to 22 June, 2020. Parents were eligible if they resided in one of the survey countries and their children aged 6-18 years. 8395 children were included (median age [IQR], 13 [10-15] years; 47% boys; 57.6% urban residents; 15.5% in self-isolation). Approximately two-thirds followed structured routines (66.4% [95%CI, 65.4-67.4]), and more than half were active during online P.E. (56.6% [95%CI, 55.5-57.6]). 19.0% (95%CI, 18.2-19.9) met the WHO Global physical activity recommendation. Total screen time in excess of 2 h/day was highly prevalent (weekdays: 69.5% [95%CI, 68.5-70.5]; weekend: 63.8% [95%CI, 62.7-64.8]). Playing outdoors more than 2 h/day, following a daily routine and being active in online P.E. increased the odds of healthy levels of physical activity and screen time, particularly in mildly affected countries. In severely affected countries, online P.E. contributed most to meet screen time recommendation, whereas outdoor play was most important for adequate physical activity. Promoting safe and responsible outdoor activities, safeguarding P.E. lessons during distance learning and setting pre-planned, consistent daily routines are important in helping children maintain healthy active lifestyle in pandemic situation. These factors should be prioritised by policymakers, schools and parents. HighlightsTo our knowledge, our data provide the first multi-national estimates on physical activity and total screen time in European children roughly two months after COVID-19 was declared a global pandemic.Only 1 in 5 children met the WHO Global physical activity recommendations.Under pandemic conditions, parents should set pre-planned, consistent daily routines and integrate at least 2-hours outdoor activities into the daily schedule, preferable on each day. Schools should make P.E. lessons a priority. Decision makers should mandate online P.E. be delivered by schools during distance learning. Closing outdoor facilities for PA should be considered only as the last resort during lockdowns.

Physical Activity Recommendations for Segments of School Days in Adolescents: Support for Health Behavior in Secondary Schools.

School physical activity (PA) is an indispensable part of daily PA, the foundation for developing lifelong PA and fitness, and an easy way to gain physical and health literacy. School PA is equally important for understanding the continuity of physical and mental health, even in broader psychosocial aspects. Regarding long-term outcomes, significant attention has been paid to the determination of daily and weekly recommendations for adolescent PA. However, comprehensive approaches suggesting recommendations for PA in segments of the school day are rare. This study aimed to (a) provide a rationale for PA recommendations in segments of school days and incorporate it into generally accepted PA recommendations, and (b) promote radical changes in the educational process toward a healthy school lifestyle through PA recommendations in segments of school days. The results of research conducted in 98 secondary schools in the Czech Republic and 104 secondary schools in Poland from 2009 to 2017 were used in this study. In total, 3,860 boys and 5,237 girls from the Czech Republic and 3,052 boys and 3,329 girls from Poland, all aged 15-19, participated. We recommended at least 2,000 steps (or 10 min of moderate-to-vigorous PA) for the before school segment and at least 6,000 steps (or 30 min of moderate-to-vigorous PA) for the after-school segment. For the time spent at school, we further recommended at least 500 steps/h (alternatively, at least 3,000 steps/school time), 20 min of moderate-to-vigorous PA (≥3METs or 60% HRmax), and at least one HRsubmax/max response to significant stress during PA to mitigate educational stress and high levels of sedentary behavior in schools. PA should account for at least 25% of school time, even on days with no scheduled physical education lessons. We propose using PA recommendations in segments of school days to achieve positive changes in the educational process and school lifestyle. Acceptance of PA recommendations in segments of school days theories on physical education could help refine and concretize demands for changes in PA and lifestyle in secondary schools. In practice, it could support the creation of innovative and comprehensive school PA programs. Future research should focus on obtaining evidence in support for adolescent PA by applying PA recommendations in segments of school days.

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

PURPOSE: The purpose of this study was to cross-validate FITNESSGRAM® aerobic and body composition standards in a representative sample of Hungarian youth. METHOD: A nationally representative sample (N = 405) of Hungarian adolescents from the Hungarian National Youth Fitness Study (ages 12-18.9 years) participated in an aerobic capacity assessment via treadmill test to maximum to determine peak oxygen consumption (VO2peak) and a bioelectrical impedance assessment to estimate percent body fat (%BF). Additionally, metabolic syndrome status was assessed via finger-stick blood sample. Youth were categorized into Healthy Fitness Zone (HFZ) and Needs Improvement (NI) groups based on Fitnessgram standards. Prevalence of metabolic syndrome was calculated and logistic regression was used to estimate odds of metabolic syndrome. RESULTS: Hungarian youth were generally fit with a low prevalence of metabolic syndrome. Approximately 69% to 77% of boys and 55% to 57% of girls were classified into the HFZ based on %BF and VO2peak. Youth in the NI health risk zones for VO2peak and %BF were 4 times to 5 and 2 times to 3 times more likely to have metabolic syndrome than children in the lower-risk groups, respectively. CONCLUSIONS: Fitnessgram standards for aerobic capacity and body composition were associated with metabolic syndrome status, though odds ratios were larger for VO2peak than for %BF and varied by sex. Even though these standards were developed in U.S. youth, they can be applied in Hungary and still provide a criterion-referenced indication of fitness.

Agreement and Diagnostic Performance of FITNESSGRAM®, International Obesity Task Force, and Hungarian National BMI Standards.

PURPOSE: This study examined agreement between all 3 standards (as well as relative diagnostic associations with metabolic syndrome) using a representative sample of youth from the Hungarian National Youth Fitness Study. METHOD: Body mass index (BMI) was assessed in a field sample of 2,352 adolescents (ages 10-18.5 years) and metabolic syndrome status was assessed in a laboratory subsample of 373 youth. All youth were categorized into weight status groups based on the FITNESSGRAM®, International Obesity Task Force (IOTF), and Hungarian growth standards. Classification agreement was compared between all pairs of standards via cross-tabulation. Logistic regression was used to estimate the odds of metabolic syndrome by weight status. RESULTS: The 3 BMI standards agreed on ≥  88% of cases, with better agreement on girls' standards than boys' standards. Kappa values ranged from .65 to .89. Using the Hungarian standards over the Fitnessgram or IOTF standards resulted in 5% to 10% more youth being classified as normal weight. The overweight/obesity groups were 4 times to 6 times more likely to have metabolic syndrome than those classified as normal weight regardless of the classification standards. These odds ratios increased to 8 times to 17 times when comparing the normal-weight/overweight groups to the obesity category. Odds ratios for boys tended to be slightly larger than those for girls. CONCLUSIONS: All 3 standards provide similar information about weight status and metabolic syndrome classification. To more easily facilitate international comparisons, it may be of greater benefit to use the IOTF standards, which also had better agreement with the U.S. Fitnessgram thresholds.

Establishing Normative Reference Values for Handgrip Among Hungarian Youth.

PURPOSE: The purpose of this study was to examine age- and sex-related variation in handgrip strength and to determine reference values for the Hungarian population. METHOD: A sample of 1,086 Hungary youth (aged 11-18 years old; 654 boys and 432 girls) completed a handgrip strength assessment using a handheld dynamometer. Quantile regression was used to compute separate models for boys and girls and included a linear, cubic, and quadratic term for age to account for nonlinear patterns. These terms were tested for statistical significance using the Wald statistical test with p < .05. Age- and sex-specific centiles were generated and the 50th percentile was used to describe the overall patterns in handgrip strength. RESULTS: The linear, cubic, and quadratic terms for age fitted the data well for boys (p < .05), while both linear and quadratic terms for age were statistically significant for girls (p < .05). The 50th percentile values resulted in 21.4 kg, 21.7 kg, 25.0 kg, 30.0 kg, 35.4 kg, 40.0 kg, 42.6 kg, and 42.0 kg for boys aged 11 to 18 years old, respectively. The same percentile resulted in 20.0 kg, 19.5 kg, 19.6 kg, 20.3 kg, 21.6 kg, 23.5 kg, 26.1 kg, and 29.2 kg for girls aged 11 to 18 years old, respectively. CONCLUSIONS: Muscle strength as determined by handgrip has distinct age-related patterns in boys and girls. We have accounted for biological age differences and developed norm-referenced values that can be used to interpret handgrip assessment scores obtained from school-aged children in Hungary.

Overview of the Hungarian National Youth Fitness Study.

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

Establishing Normative Reference Values for Standing Broad Jump Among Hungarian Youth.

PURPOSE: The purpose of this study was to examine age and sex trends in anaerobic power assessed by a standing broad jump and to determine norm-referenced values for youth in Hungary. METHOD: A sample of 2,427 Hungarian youth (1,360 boys and 1,067 girls) completed the standing broad jump twice, and the highest distance score was recorded. Quantile regression was used to fit standing broad jump trends across linear and quadratic functions of age. Statistical significance was determined with bootstrap confidence intervals and the Wald test with p < .05. Age-by-sex specific centiles were generated and the 50th percentile was used to describe the overall patterns. RESULTS: Standing broad jump scores increased steadily in boys from age 11 through 18 years with a discrete plateau at the end of adolescence. Girls' standing broad jump scores of those who performed above the median increased with age and plateaued later in the adolescence. Both linear and quadratic age terms were statistically significant predictors of standing broad jump trends across age (p < .05), but the relations varied depending on the percentile. The 50th percentile values resulted in 147.0 cm, 162.0 cm, 175.0 cm, 186.0 cm, 195.0 cm, 202.0 cm, 207.0 cm, and 210.0 cm for boys aged 11 to 18 years old, respectively, and 140.0 cm, 143.9 cm, 147.3 cm, 150.0 cm, 152.1 cm, 153.7 cm, 154.6 cm, and 155.0 cm for girls aged 11 to 18 years old, respectively. CONCLUSIONS: This study provides normative reference charts that take into account age and sex differences in standing broad jump performance. The proposed reference values can be used to interpret standing broad jump scores in Hungarian youth.

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.

Agreement Between Omron 306 and Biospace InBody 720 Bioelectrical Impedance Analyzers (BIA) in Children and Adolescents.

PURPOSE: The purpose of this study was to test the convergent validity of Omron 306 using Biospace InBody 720. METHOD: A total of 267 participants (145 boys; aged 10.4-17.9 years) completed testing during a single session. Each measure provided percent body fat (%BF), while the InBody 720 included fat-free mass (FFM). The validity was examined using the Pearson correlation. Limits of agreement (LOA) and multiple linear regression were also used to determine the impact of both age and FFM on the associations between the 2 measures. RESULTS: The 2 measures of %BF were correlated by .63 (p < .001) in boys and .89 (p < .001) in girls. The mean difference (i.e., InBody - Omron) for %BF in boys was - 4.7% with a lower LOA of - 20.5% and upper LOA of 11.2%. The same comparison for girls resulted in a difference of 3.0% with a lower LOA of - 10% and upper LOA of 4%. Examination of the residuals obtained from multiple linear regression indicated that FFM was the only statistically significant predictor of differences in boys (ßFFM = - 0.25 ± 0.08%, p = .001). There were no significant associations for girls. CONCLUSIONS: Findings indicate that estimates of %BF obtained from Omron in boys exceed estimates from InBody 720. Disagreement was evident in younger boys with lower levels of FFM. Girls' %BF was closer between the 2 bioelectrical impedance analyzer measures (less residual) with age and FFM not explaining the disagreement. Overall, the 2 measures were not equivalent.

Associations Between Attitudes Toward Physical Education and Aerobic Capacity in Hungarian High School Students.

PURPOSE: The purpose of this study was to create a physical education (PE) attitude scale and examine how it is associated with aerobic capacity (AC). METHOD: Participants (n = 961, aged 15-20 years) were randomly selected from 26 Hungarian high schools. AC was estimated from performance on the Progressive Aerobic Cardiovascular and Endurance Run test, and the attitude scale had 31 items measured on a Likert scale that ranged from 1 to 5. Principal component analysis was used to examine the structure of the questionnaire while several 2-way analyses of variance and multiple linear regression (MLR) were computed to examine trends in AC and test the association between component scores obtained from the attitude scale and AC, respectively. RESULTS: Five components were identified: health orientation in PE (C1), avoid failure in PE (C2), success orientation in PE (C3), attitude toward physical activity (C4), and cooperation and social experience in PE (C5). There was a statistically significant main effect for sex on C3 (p < .05), C4 (p < .001), and C5 (p < .05) indicating that boys' scores were higher than girls. The Sex × Age interaction was also statistically significant (p < .05) and follow-up comparisons revealed sex differences in C5 for 15-year-old participants. Girls showed statistically significant higher values than boys in C5 at the age of 16 years. MLR results revealed that component scores were significantly associated with AC (p < .05). Statistically significant predictors included C1, C2, C3, and C4 for boys and C2 and C4 for girls. CONCLUSION: The 5-component scale seems to be suitable for measuring students' attitudes toward PE. The design of the study does not allow for direct associations between attitudes and AC but suggests that these 2 might be related.