Fitness Measures and Health Outcomes in Youth (2012)

2


Measuring Fitness in Youth

Fitness testing for youth emerged from the field of physical education, which has a long-standing history of fitness testing. Over the years, social and political circumstances have dictated the emphasis, progress, and use of fitness testing in the United States. In particular, an early emphasis on performance outcomes—particularly military performance—has given way to a focus on health outcomes as a result of concerns about the health of the nation’s youth. While the components of fitness have remained virtually the same, moreover, the tests and protocols used to measure it have evolved as more data have accumulated on their validity and reliability and their relationship to desired outcomes. Although efforts have been ongoing to standardize and validate the constructs for fitness testing, the range of fitness test batteries currently in use, as detailed in this chapter, reveals that consensus on these issues remains elusive. The research needs identified in Chapter 10 therefore include a comprehensive reevaluation of the past and current approaches to fitness testing in youth.

This chapter begins with a brief early history of physical fitness testing. It then describes more recent historical events related specifically to measuring physical fitness among U.S. youth.¹ The final section includes a table that lists the various batteries of fitness tests currently in use worldwide.

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¹For more information about the history of youth fitness testing in the United States, the reader is referred to Corbin (2012), Mood et al. (2007), Morrow (2005), Morrow et al. (2009), and Plowman et al. (2006).

EARLY HISTORY OF PHYSICAL FITNESS TESTING²

Although organized youth fitness testing did not begin until the mid–20th century, the foundation of national youth fitness testing began to be established a century earlier. Park (1989) notes that early leaders in physical education, many of whom were medical doctors and YMCA leaders, focused the outcomes of instruction on anthropometric measurements. During the last half of the 19th century, national physical education organizations emerged (e.g., the American Association for the Advancement of Physical Education [AAAPE]), and the leaders who founded the organizations continued with a measurement focus (e.g., strength and lung capacity assessments). Dudley Sargent, one of the pioneers of physical testing, developed the vertical jump test that is still used today and is commonly referred to as the “Sargent jump.” It is generally believed that Sargent thought of the vertical jump as a general measure of fitness and health. He published the books Health, Strength and Power (Sargent, 1904) and Universal Test for Strength, Speed and Endurance of the Human Body (Sargent, 1902).

By the late 1800s and early 1900s, the purpose of fitness testing had expanded beyond anthropometric measurements with the introduction of the concept of “physical efficiency,” characterized as efficient functioning of body systems, such as the circulatory, respiratory, muscular, and nervous systems (Park, 1989). Fitness testing evolved from a focus on athletic performance to a focus on health in the early 1900s as researchers such as McCurdy and McKenzie studied blood pressure fatigue (McCurdy, 1901; McKenzie, 1913), and Storey studied pulse rate (Storey, 1903). Prior to World War I, tests of “motor ability” that included tests of jumping, climbing, lifting, vaulting, and running were popular. One prominent test, the Playground Association of America Athletic Badge Test, was introduced for boys in 1913 and girls in 1916. During and immediately after World War I, the focus on physical education and physical training in schools increased, with a shift toward fitness for war. Many physical educators led physical training programs for the military during the war era. The theme that many Americans were unfit was popular in the media.

After World War I, the Public Health Service and many different organizations focused attention on fitness tests and programs because of their potential link to preparedness for war. The Public Health Service booklet Keeping Fit emphasized many personal factors (e.g., willpower, courage, self-control) in addition to those related to health (USPHS, 1918). During the early 1900s, there was considerable debate about the importance

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²The information included in this section is based on Park (1989).

of “efficiency” testing and what should be included in physical efficiency tests. Various test batteries were developed, including the Physical Fitness Index (PFI), developed by Rogers (several strength items) (Rogers, 1925), and a test of athletic power developed by McCloy (general motor ability and strength) (McCloy, 1934, 1941). Both Rogers and McCloy conducted research that provided a basis for the items selected for their tests. Other tests of the era were often developed by groups of professionals based on group consensus.

“Financial austerities” due to the Great Depression resulted in decreases in physical education and a reduced emphasis on physical fitness testing (Park, 1989). The interest in general physical fitness testing in schools that was common after World War I diminished, while interest in laboratory-based measures of fitness grew.

As was the case prior to, during, and immediately after World War I, World War II produced much military, governmental, and societal interest in fitness programs and fitness testing. While there was much fanfare and many proposals for action were made, most efforts with youth relied on volunteer leaders and local funding. A 1941 supplement to the Research Quarterly focused on physical fitness and fitness testing (Carpenter, 1941; Cureton and Larson, 1941; Larson, 1941; McCloy, 1941). Park (1989) indicates that the U.S. Department of Education, in cooperation with the Army, Navy, and Public Health Service, prepared a fitness booklet (Physical Fitness through Physical Education for the Victory Corps) in 1942. In addition, at the request of the U.S. Department of Education, the American Association for Health, Physical Education, and Recreation’s (AAHPER’s) section on women’s athletics prepared a fitness test battery for high school girls. Fitness manuals were prepared for college students as well, and the armed services developed fitness programs of their own during the war. Also during the war, many conferences and committees focused on youth fitness. Park (1989, p. 11) notes that the “predominant interpretation given to the term physical fitness during World War II was the ability to sustain long, hard, muscular effort.” The joint involvement of health, education, physical education, and military groups underscores the mixed purposes of physical fitness testing. Health was a concern, but so were general fitness and fitness for war.

NATIONAL YOUTH FITNESS TESTING: 1950 TO 1980

The physical fitness focus that was prominent during World War II gave way to a more generalized emphasis for youth during the postwar years. The popularity of college and professional sports led physical education programs to focus on athletic capabilities. The Korean War in the early

TABLE 2-1 Key Historical Events/Publications in Youth Fitness Testing in the United States, 1950-1979

SOURCE: Adapted from Morrow et al., 2009.

1950s did bring some focus back to physical fitness, but it was research by Kraus and Hirschland (1953, 1954) that provided the impetus for the national youth physical fitness testing movement. Their reports indicated that children in the United States passed fewer fitness test items than children from European countries. For their research, Kraus and Hirschland used the Kraus-Weber test, a battery of six items testing minimum muscular fitness and flexibility originally developed as a measure of potential for back pain. Although this test was rudimentary by current standards, the results gained traction after being reported in the mainstream media (see for example, the article in Sports Illustrated titled “The Report That Shocked the President” [Boyle, 1955]). Published during the Cold War era, the results implying less fitness in American than in European youth raised major concern about the nation’s military preparedness. Consequently, Kraus was granted an audience with then President Eisenhower to discuss the study results. After that meeting, Eisenhower established a cabinet-level President’s Council on Youth Fitness (now the President’s Council on Fitness, Sports, and Nutrition [PCFSN]). A chronology of these and other key events/publications relating to youth fitness, 1950 to 1979, is presented in Table 2-1.

TABLE 2-2 Changes in the Youth Fitness Test, 1958-1976

SOURCE: Adapted from Corbin and Pangrazi, 1992.

In 1957, the Council and a citizen’s advisory group called on professional groups to improve efforts to promote youth fitness. Many different organizations, including the newly created American College of Sports Medicine and the American Medical Association, urged action. The AAHPER Research Council appointed a committee, chaired by Anna Espenschade of the University of California, that created the first youth physical fitness test battery (the Youth Fitness Test) for use in a large-scale national survey. The test included the items shown in Table 2-2. These test items included measures of strength and muscular endurance common in earlier fitness test batteries and a 600-yard run/walk believed at the time to be a measure of cardiovascular fitness; these measures often were considered to be health related. Also included, however, were items more related to physical education objectives and skill-related fitness, such as the softball throw and the 50-yard dash, reflecting in part societal concerns at the time regarding the athletic capabilities and military preparedness of youth (Morrow et al., 2009). The test items were administered in a national survey conducted by the University of Michigan (led by Paul Hunsicker), with funding from the U.S. Department of Education (AAHPER, 1958). As was the case with other testing in schools at the time (e.g., achievement tests), normative standards were developed and reported in the first test manual (AAHPER, 1958). AAHPER also designed awards (certificates and emblems) for students who met those standards (Park, 1989).

During the late 1950s and early 1960s, the fitness movement continued. President Kennedy advocated for youth physical fitness in his article “The Soft American,” published in Sports Illustrated (Kennedy, 1960). He

convened a conference on youth fitness, and the President’s Council subsequently prepared a booklet on the subject, commonly referred to as the “Blue Book,” that included information about the seven-item Youth Fitness Test of 1958. This booklet was intended to emphasize the importance of having an active lifestyle and its role in establishing fitness and health. Kennedy wrote a second article in Sports Illustrated in 1962, entitled “The Vigor We Need” (Kennedy, 1962). By executive order, the name of the Council was changed to the President’s Council on Physical Fitness (PCPF) to reflect interest in promoting fitness among people of all ages and ability levels. In 1965, a second survey was conducted using a modified version of the Youth Fitness Test (AAHPER, 1965). Changes in the test items used for the 1965 survey included the addition of a flexed arm hang test to replace the modified pull-up for girls (see Table 2-2). This change was made primarily to produce more reliable test scores. In 1966, the President’s Council established the Presidential Physical Fitness Award Program, jointly administered by AAHPER and the PCPF, to acknowledge youth who met or exceeded the 85th percentile on all seven test items.

The third national survey using the Youth Fitness Test was published in 1976 (AAHPERD, 1976). As noted in Table 2-2, the softball throw was deleted, the sit-up was modified, and distance runs longer than 600 yards were included as options. The softball throw was deleted because it was considered to be a skill rather than a fitness-related item. The modification of sit-up testing was based on the idea that the bent-knee approach was less stressful on the back than the straight-leg approach. Finally, research indicating greater validity for longer runs and their association with aerobic capacity led to the inclusion of longer runs as optional items (Morrow et al., 2009).

During the 1960s and 1970s, evidence linking fitness and physical activity to good health accumulated. Correspondingly, interest grew in the development of youth fitness test batteries focused primarily on health-related physical fitness. The Texas Physical Fitness Motor Ability Test (Coleman and Jackson, 1973) included health-based test items, and evidence was included to support the test items selected.

NATIONAL YOUTH FITNESS TESTING: 1980 TO 1990

In the 1970s, several committees were appointed by the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) to study the Youth Fitness Test. Recommendations of these committees led to the development of a Health-Related Physical Fitness Test by AAHPERD in 1980. AAHPERD continued to maintain both the health-related test and the Youth Fitness Test. The Youth Fitness Test included an awards program

administered by the renamed President’s Council on Physical Fitness and Sports (PCPFS) and a newly created fitness report card created and administered by the Cooper Institute in Dallas, Texas. Table 2-3 lists these and other key events related to national youth fitness testing during 1980 to 1990.

In 1984, AAHPERD published a technical manual for the Health-Related Physical Fitness Test documenting the theoretical basis for the adopted test items and for replacements for the normative standards of the Youth Fitness Test (Morrow et al., 2009). Test items targeting cardiorespiratory fitness, musculoskeletal fitness, and body composition were included in the battery as fitness components related to health. Also in 1984, an ad hoc committee of AAHPERD recommended that the Health-Related Physical Fitness Test become the primary AAHPERD test and that the Youth Fitness Test be made a secondary test. However, that recommendation was not implemented, and in 1985 another AAHPERD committee was appointed (the Manual Task Force) to merge the two AAHPERD tests (see below). During this period, several national surveys were completed. In 1986, the School Population Fitness Survey was conducted by the then PCPFS (now PCFSN) using a revised version of the Youth Fitness Test. The revised battery is described later in this chapter. Of note are the removal of the 50-yard dash and the long jump and the addition of a V-sit test of flexibility.

Two additional youth fitness surveys were conducted in the mid-1980s. The National Children and Youth Fitness Study I, results of which were published in 1985 by the U.S. Department of Health and Human Services (McGinnis, 1985), focused on measuring the fitness of secondary school youth using health-related fitness test items developed specifically for the study. In 1986, the National Children and Youth Fitness Study II (Ross and Pate, 1987) was conducted to assess the fitness of elementary school youth using the health-related items from the National Children and Youth Fitness Study I.

AAHPERD’s Manual Task Force “was charged with developing a single AAHPERD fitness test battery, establishing criterion-referenced standards, examining existing awards schemes, and writing the appropriate manual” (Plowman et al., 2006, p. S8). Before the task force could produce a document, however, the PCPFS initiated its fitness testing and awards program in 1986, based primarily on the 1985 version of the Youth Fitness Test and existing award schemes. Even after much discussion among relevant organizations (PCPFS, AAHPERD, Cooper Institute) regarding the establishment of a unified national fitness testing battery, the PCPFS continued with its test and awards program, named the President’s Challenge Program (1987), while the Cooper Institute introduced a health-related fitness test and

TABLE 2-3 Key Historical Events/Publications in Youth Fitness Testing in the United States, 1980-1990

SOURCE: Adapted from Morrow et al., 2009.

reporting program called Fitnessgram^® (1988), and AAHPERD developed a health-based fitness testing and reporting program called Physical Best (1988). Table 2-4 shows the evolution of test items from the PCPFS/PCFSN and Fitnessgram batteries, including current and previously included items; the Physical Best battery is no longer in use. A comprehensive discussion of the events leading to the development of these test batteries is provided in Plowman et al. (2006). Issues that led these groups to devise different tests included the use of health versus motor fitness items, the use of health criteria versus normative standards, the inclusion of a body composition item, and the inclusion of award schemes.

In 1988, the Chrysler Amateur Athletic Union (AAU) Fitness Test was introduced. The YMCA Youth Fitness Test Manual was published the following year (Franks, 1989).

YOUTH FITNESS TESTING SINCE 1990

Despite the above efforts to develop a unified battery of fitness tests and the implementation of new tests, no new large-scale national fitness surveys have been conducted since the 1980s. In 1994, the Cooper Institute published The Prudential Fitnessgram^® Technical Reference Manual (Morrow et al., 1994), which has been updated and published online (http://www.cooperinstitute.org/reference-guide). Fitnessgram uses health-based criterion references. Key events in youth fitness testing since 1990 are listed in Table 2-5.

In 1994, AAHPERD adopted Fitnessgram as its national fitness test. Physical Best, no longer a fitness test battery, became the AAHPERD fitness education program rather than a testing program. In 1996, the PCPFS introduced a new health-related fitness program using criterion-referenced health standards as opposed to normative standards, but it was subsequently discontinued. Items in the PCPFS battery (modified version of the Youth Fitness Test) introduced in 1986 are shown in Table 2-4. Over the years, the test battery has evolved to include mostly items considered to be health related (with the exception of the shuttle run). The PCFSN battery included in the President’s Challenge Program still uses normative standards and offers awards based on those standards.

During the 1990s, calls for a public health basis for youth fitness testing received much attention (Sallis and McKenzie, 1991; Simons-Morton et al., 1988). Papers were published questioning the use of youth fitness tests and award schemes (Corbin et al., 1990; Keating, 2003; Rowland, 1995), and concerns about the proper use and misuse of tests were expressed (Corbin et al., 1990). Some research led to a call for the end of youth fitness testing as a result of findings implying the adverse effects of testing in academic settings and its ineffectiveness in promoting physical activity (Cale et al.,

TABLE 2-4 Evolution of President’s Council on Physical Fitness and Sports (PCPFS)/President’s Council on Physical Fitness, Sports, and Nutrition (PCFSN) and Fitnessgram^® National Test Batteries

NOTE: The year shown indicates when the test was first implemented. “Current” indicates items in the current version of the battery. “Alternative” means the item is an alternative for measuring the particular construct.

TABLE 2-5 Key Historical Events/Publications in Youth Fitness Testing in the United States, 1990-2012

SOURCE: Adapted from Morrow et al., 2009.

2007; Rowland, 1995). Others, however, recognizing the potential of youth fitness to promote lifelong physical activity, emphasized the importance of continuing research aimed at improving the reliability and validity of pertinent test batteries and identifying strategies for preventing the misuse of such testing (Corbin, 2007; Corbin et al., 1995). Also emphasized was the role of professional and governmental agencies in developing fitness testing policies, including guidelines and standards for appropriate implementation and interpretation of results.

In light of the lack of a national youth fitness survey since the 1980s, several calls have been made for an updated survey. The National Children and Youth Fitness Studies (McGinnis, 1985; Ross and Pate, 1987) and the National School Population Fitness Survey (PCPFS, 1986) were the last national studies of youth fitness.

Several large-scale statewide surveys of youth physical fitness have been carried out (Morrow et al., 2010); more than a dozen states have conducted or are considering conducting fitness testing on a mandatory or large-scale voluntary basis (Morrow and Ede, 2009). Other large administrative units (e.g., New York City) also have implemented extensive youth fitness surveys in recent years. Some of these testing efforts have been on a routine basis, while others have not. For example, Texas has implemented mandatory health-related physical fitness testing for youth in grades 3 to 12 since 2007; California has been monitoring the fitness status of students in grades 5, 7, and 9; and New York City tests 600,000 students in grades K-12 annually (Morrow and Ede, 2009). Levels of funding to support such efforts have varied considerably.

In addition, the potential of fitness measures to reflect or predict health status has led to the inclusion of these measures in national health surveys such as the National Health and Nutrition Examination Survey (NHANES), which includes components pertinent to physical fitness, such as body composition, cardiovascular fitness, and physical activity (Morrow et al., 2009). Including fitness-related items in NHANES enables not only the longitudinal monitoring of fitness components but also the identification of associations between fitness status and health indices (Ortega et al., 2008; Suni et al., 1998). For example, epidemiological analyses with these data revealed the association of low cardiorespiratory endurance status with increased prevalence of the risk factors for cardiovascular disease in adolescents and adults (Carnethon et al., 2005) and with cases of obesity in adulthood (Wang et al., 2010). These data can also be used to establish cut-points (cutoff scores) for fitness tests, which are essential for interpreting test results and communicating them to individuals and families, as well as establishing individual performance goals related to health improvements.

Reflecting the initial impetus for developing fitness tests, all active duty U.S. military personnel are required to adhere to standards for body composition, physical fitness, and appearance for enlistment and retention (IOM, 1998). Recognizing the association of physical fitness with health and readiness for military tasks, the Department of Defense has mandated annual assessment of fitness components for service members (DoD, 2004) and also has implemented remedial programs for those who fail to meet the cut-points for physical fitness or readiness tests. The effectiveness of routine fitness tests for establishing a minimum level of fitness in military personnel has been widely acknowledged (IOM, 1998). Components assessed by these tests (which vary among the services) include cardiorespiratory endurance; muscular strength and endurance; whole-body flexibility; and parameters indicating balance, agility, and explosive power.

When implemented in schools, fitness testing also can serve the purpose of assessing and improving physical literacy among youth (Tremblay and Lloyd, 2010). Regular physical activity is widely considered part of a healthy lifestyle given its beneficial effects on various health outcomes and fitness levels (Bouchard and Shephard, 1994; Pate et al., 1995; Simons-Morton et al., 1988). Of note are the reciprocal effects of physical activity, fitness, and health. In other words, an increase in habitual physical activity can result in increased fitness, while health status affects one’s fitness or ability to carry out physical activity (Bouchard and Shephard, 1994). Based on this relationship and considering fitness as a primary outcome of physical activity, fitness testing is regarded as an effective means of monitoring the status of physical activity in population-based studies, as well as promoting lifelong physical activity, which may eventually lead to improved health status (Corbin, 2007; Tremblay and Lloyd, 2010). Indeed, the rationale for programs described in this chapter is based on the influence of the dispositions and habits established during childhood on physical activity, fitness, and health status in adulthood (Malina, 2001; Morrow and Ede, 2009; Simons-Morton et al., 1988). At the same time, it is important to acknowledge the potential adverse effects of inappropriate uses of fitness testing (Ernst et al., 2006). The implementation of fitness measures for educational purposes is discussed in detail in Chapter 9.

CURRENT BATTERIES OF YOUTH FITNESS TESTS

A variety of tests have been designed to test physical fitness in youth in the United States and other countries by both governmental and nongovernmental organizations. Table 2-6 lists selected batteries of tests currently in use in the United States and other countries. The committee found that the evidence and criteria for selecting these tests are not always clear.

TABLE 2-6 International Batteries of Youth Fitness Tests

NOTE: This table is not an exhaustive listing of international tests. China and South Korea, for example, conduct fitness tests regularly, but relevant publications are not available in English translations. All tests listed are field tests currently in use. In addition to field tests, laboratory tests, questionnaires such as the International Fitness Scale, and other assessment methods may be used.

^aAvailable at http://www.achper.org.au/bookshop/achper-resources/afea-kit (accessed August 31, 2012).

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