composition also was not conducted because, even though this component is frequently included in fitness test batteries, its relationship to health is well known. Although the committee did not participate in the design of the literature review, members had ample opportunities to interact with the CDC in order to understand the nature of the review. The CDC literature review also did not include integrity and feasibility studies. The committee conducted further literature searches and reviews in other areas, for example, to assess the integrity of specific fitness tests or to complement the CDC’s systematic review.

In addition, the committee drew on the work and experience of other organizations and countries to the extent that this information is available to the public. The committee also benefited from expert presentations during an open session on November 15-16, 2011; the agenda for this open session is in Appendix A. Presenters had extensive experience in the development of fitness test batteries and in the associations of fitness with metabolic risk factors and body composition. Other presenters had experience in implementing and interpreting results of a battery of fitness tests in the field, providing the committee with insight into feasibility considerations and challenges encountered at the time of test implementation.

The main purpose of this report is to identify fitness measures that are associated with health markers in youth and that are also practical in a field setting. To accomplish this purpose, the committee agreed on various concepts and on a general conceptual framework that guided its decisions. Before reviewing the literature, the committee decided on a stepwise process for identifying the best test items for each fitness component. As will be obvious from the description in Chapter 3, the literature review was designed to provide information about potential associations of fitness tests with health markers (or risk factors) and outcomes in youth as opposed to those that might be seen later in life. For that reason, the majority of health issues explored during the review were health markers (or risk factors) for a disease and not health outcomes per se, as most health conditions or diseases do not manifest until adulthood. As is clear from the discussion throughout the report, studies that follow youth into adulthood are infrequent. Since the 1980s, moreover, organizations and relevant government agencies have focused their efforts on the health benefits of physical activity among youth rather than on fitness, which was the focus prior to the 1980s. The lack of a recent focus on fitness has resulted in a less than ideal scientific literature base addressing questions of fitness and health. Nevertheless, the knowledge base has increased sufficiently to support the conduct of a national fitness survey. The focus on health in youth is a unique feature of this report and one that presented many challenges given the inadequate amount and nature of the relevant literature. However, this focus is in tune with current thinking that factors related to health in adults cannot neces-



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