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

Francisco B Ortega^{1

2

3}, Bojan Leskošek⁴, Rok Blagus^{4

5

6}, José J Gil-Cosano^{7

8}, Jarek Mäestu⁹, Grant R Tomkinson¹⁰, Jonatan R Ruiz^{7

3

11}, Evelin Mäestu⁹, Gregor Starc⁴, Ivana Milanovic¹², Tuija H Tammelin¹³, Maroje Sorić^{4

14}, Claude Scheuer^{15

16}, Attilio Carraro¹⁷, Mónika Kaj¹⁸, Tamás Csányi^{18

19

20}, Luis B Sardinha²¹, Matthieu Lenoir²², Arunas Emeljanovas²³, Brigita Mieziene²³, Labros S Sidossis²⁴, Maret Pihu⁹, Nicola Lovecchio^{25

26}, Kenn Konstabel^{27

28}, Konstantinos D Tambalis^{29

30}, Lovro Štefan^{14

31

32}, Clemens Drenowatz³³, Lukáš Rubín^{34

35}, Seryozha Gontarev³⁶, José Castro-Piñero^{37

38}, Jérémy Vanhelst³⁹, Brendan O'Keeffe⁴⁰, Oscar L Veiga⁴¹, Thordis Gisladottir⁴², Gavin Sandercock⁴³, Marjeta Misigoj-Durakovic¹⁴, Claudia Niessner⁴⁴, Eva-Maria Riso⁹, Stevo Popovic^{45

46}, Saima Kuu⁴⁷, Mai Chinapaw⁴⁸, Iván Clavel^{49

50}, Idoia Labayen⁵¹, Janusz Dobosz⁵², Dario Colella⁵³, Susi Kriemler⁵⁴, Sanja Salaj¹⁴, Maria Jose Noriega⁵⁵, Klaus Bös⁴⁴, Mairena Sánchez-López^{56

57}, Timo A Lakka^{58

59

60}, Garden Tabacchi⁶¹, Dario Novak¹⁴, Wolfgang Ahrens⁶², Niels Wedderkopp⁶³, Gregor Jurak⁶⁴; FitBack, HELENA and IDEFICS consortia

Affiliations

¹ Faculty of Sport Sciences, University of Granada, Department of Physical and Sports Education; Sport and Health University Research Institute (iMUDS), CIBERobn Physiopathology of Obesity and Nutrition, Granada, Spain ortegaf@ugr.es Gregor.Jurak@fsp.uni-lj.si.
² Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
³ Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.
⁴ Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.
⁵ Institute for Biostatistics and Medical Informatics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
⁶ Faculty of Mathematics, Natural Sciences and Information technologies, University of Primorska, Glagoljaška, Slovenia.
⁷ Faculty of Sport Sciences, University of Granada, Department of Physical and Sports Education; Sport and Health University Research Institute (iMUDS), CIBERobn Physiopathology of Obesity and Nutrition, Granada, Spain.
⁸ Department of Communication and Education, Universidad Loyola Andalucía, Dos Hermanas, Spain.
⁹ Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia.
¹⁰ Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
¹¹ Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain.
¹² University of Belgrade, Faculty of Sport and Physical Education, Belgrade, Serbia.
¹³ JAMK University of Applied Sciences, School of Health and Social Studies, LIKES, Jyväskylä, Finland.
¹⁴ University of Zagreb, The Faculty of Kinesiology, Zagreb, Croatia.
¹⁵ European Physical Education Association (EUPEA).
¹⁶ Department of Education and Social Work, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
¹⁷ Faculty of Education, Free University of Bozen-Bolzano, Brixen, Italy.
¹⁸ Hungarian School Sport Federation, Budapest, Hungary.
¹⁹ Department of Physical Education Theory and Methodology, Hungarian University of Sports Science, Budapest, Hungary.
²⁰ Department of Physical Education, Faculty of Primary and Pre-School Education, ELTE, Eötvös Loránd University, Budapest, Hungary.
²¹ Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, 1499-002 Cruz-Quebrada, Portugal.
²² Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
²³ Lithuanian Sports University, Department of Physical and Social Education, Kaunas, Lithuania.
²⁴ Mediterranean Lifestyle Medicine Institute and Department of Kinesiology and Health, Rutgers University, New Brunswick, USA.
²⁵ Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy.
²⁶ Confederation of Italian Associations of Physical Education Teachers (Capdi & LSM), Venezia, Italy.
²⁷ Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia.
²⁸ Institute of Psychology, University of Tartu, Tartu, Estonia.
²⁹ Harokopio University, Department of Nutrition and Dietetics, Athens, Greece.
³⁰ National and Kapodistrian University of Athens, Department of Physical Education and Sport Science, Athens, Greece.
³¹ Faculty of Sports Studies, Masaryk University, Brno, Czech Republic.
³² Recruitment and Examination (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic.
³³ Division of Sport, Physical Activity and Health, University of Education Upper Austria, Linz, Austria.
³⁴ Institute of Active Lifestyle, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic.
³⁵ Department of Physical Education and Sport, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic.
³⁶ Faculty of Physical Education, Sport and Health. Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia.
³⁷ GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, Cadiz, Spain.
³⁸ Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
³⁹ Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Centre of Research in Epidemiology and Statistics - University of Paris Cité (CRESS), Bobigny, France.
⁴⁰ Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.
⁴¹ EstiLIFE Research Group. Department of Physical Education, Sport and Human Movement, Faculty of Teaching Training and Education, Autonomous University of Madrid, Madrid, Spain.
⁴² Center of Sport and Health Sciences, School of Education, University of Iceland, Reykjavik Iceland.
⁴³ School of Sport Rehabilitation and Exercise Science, University of Essex, Colchester, UK.
⁴⁴ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.
⁴⁵ University of Montenegro, Faculty for Sport and Physical Education, Niksic, Montenegro.
⁴⁶ Western Balkan Sport Innovation Lab, Podgorica, Montenegro.
⁴⁷ Tallinn University, School of Natural Sciences and Health, Tallinn, Estonia.
⁴⁸ Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
⁴⁹ Galician Sport Foundation, General Sport Secretariat, Galician Government, Santiago de Compostela, Spain.
⁵⁰ Performance and Health Group, Faculty of Sport Sciences and Physical Education, Department of Physical Education and Sports, University of A Coruña, Coruña, Spain.
⁵¹ Research Institute for Innovation & Sustainable Food Chain Development, Department of Health Sciences, Public University of Navarra, Pamplona, Spain.
⁵² Józef Piłsudski University of Physical Education in Warsaw, Poland.
⁵³ Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy.
⁵⁴ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
⁵⁵ Department of Physiology & Pharmacology University of Cantabria, Cantabria, Spain.
⁵⁶ Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.
⁵⁷ Universidad de Castilla-La Mancha, School of Education, Ciudad Real, Spain.
⁵⁸ Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, Finland.
⁵⁹ Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland.
⁶⁰ Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland.
⁶¹ Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy.
⁶² Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
⁶³ The Pediatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
⁶⁴ Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia ortegaf@ugr.es Gregor.Jurak@fsp.uni-lj.si.

PMID: 36623866
PMCID: PMC9985767
DOI: 10.1136/bjsports-2022-106176

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

Francisco B Ortega et al. Br J Sports Med. 2023 Mar.

. 2023 Mar;57(5):299-310.

doi: 10.1136/bjsports-2022-106176. Epub 2023 Jan 9.

Authors

Affiliations

¹ Faculty of Sport Sciences, University of Granada, Department of Physical and Sports Education; Sport and Health University Research Institute (iMUDS), CIBERobn Physiopathology of Obesity and Nutrition, Granada, Spain ortegaf@ugr.es Gregor.Jurak@fsp.uni-lj.si.
² Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
³ Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.
⁴ Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.
⁵ Institute for Biostatistics and Medical Informatics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
⁶ Faculty of Mathematics, Natural Sciences and Information technologies, University of Primorska, Glagoljaška, Slovenia.
⁷ Faculty of Sport Sciences, University of Granada, Department of Physical and Sports Education; Sport and Health University Research Institute (iMUDS), CIBERobn Physiopathology of Obesity and Nutrition, Granada, Spain.
⁸ Department of Communication and Education, Universidad Loyola Andalucía, Dos Hermanas, Spain.
⁹ Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia.
¹⁰ Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
¹¹ Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain.
¹² University of Belgrade, Faculty of Sport and Physical Education, Belgrade, Serbia.
¹³ JAMK University of Applied Sciences, School of Health and Social Studies, LIKES, Jyväskylä, Finland.
¹⁴ University of Zagreb, The Faculty of Kinesiology, Zagreb, Croatia.
¹⁵ European Physical Education Association (EUPEA).
¹⁶ Department of Education and Social Work, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
¹⁷ Faculty of Education, Free University of Bozen-Bolzano, Brixen, Italy.
¹⁸ Hungarian School Sport Federation, Budapest, Hungary.
¹⁹ Department of Physical Education Theory and Methodology, Hungarian University of Sports Science, Budapest, Hungary.
²⁰ Department of Physical Education, Faculty of Primary and Pre-School Education, ELTE, Eötvös Loránd University, Budapest, Hungary.
²¹ Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, 1499-002 Cruz-Quebrada, Portugal.
²² Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
²³ Lithuanian Sports University, Department of Physical and Social Education, Kaunas, Lithuania.
²⁴ Mediterranean Lifestyle Medicine Institute and Department of Kinesiology and Health, Rutgers University, New Brunswick, USA.
²⁵ Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy.
²⁶ Confederation of Italian Associations of Physical Education Teachers (Capdi & LSM), Venezia, Italy.
²⁷ Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia.
²⁸ Institute of Psychology, University of Tartu, Tartu, Estonia.
²⁹ Harokopio University, Department of Nutrition and Dietetics, Athens, Greece.
³⁰ National and Kapodistrian University of Athens, Department of Physical Education and Sport Science, Athens, Greece.
³¹ Faculty of Sports Studies, Masaryk University, Brno, Czech Republic.
³² Recruitment and Examination (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic.
³³ Division of Sport, Physical Activity and Health, University of Education Upper Austria, Linz, Austria.
³⁴ Institute of Active Lifestyle, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic.
³⁵ Department of Physical Education and Sport, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic.
³⁶ Faculty of Physical Education, Sport and Health. Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia.
³⁷ GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, Cadiz, Spain.
³⁸ Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain.
³⁹ Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Centre of Research in Epidemiology and Statistics - University of Paris Cité (CRESS), Bobigny, France.
⁴⁰ Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.
⁴¹ EstiLIFE Research Group. Department of Physical Education, Sport and Human Movement, Faculty of Teaching Training and Education, Autonomous University of Madrid, Madrid, Spain.
⁴² Center of Sport and Health Sciences, School of Education, University of Iceland, Reykjavik Iceland.
⁴³ School of Sport Rehabilitation and Exercise Science, University of Essex, Colchester, UK.
⁴⁴ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.
⁴⁵ University of Montenegro, Faculty for Sport and Physical Education, Niksic, Montenegro.
⁴⁶ Western Balkan Sport Innovation Lab, Podgorica, Montenegro.
⁴⁷ Tallinn University, School of Natural Sciences and Health, Tallinn, Estonia.
⁴⁸ Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
⁴⁹ Galician Sport Foundation, General Sport Secretariat, Galician Government, Santiago de Compostela, Spain.
⁵⁰ Performance and Health Group, Faculty of Sport Sciences and Physical Education, Department of Physical Education and Sports, University of A Coruña, Coruña, Spain.
⁵¹ Research Institute for Innovation & Sustainable Food Chain Development, Department of Health Sciences, Public University of Navarra, Pamplona, Spain.
⁵² Józef Piłsudski University of Physical Education in Warsaw, Poland.
⁵³ Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy.
⁵⁴ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
⁵⁵ Department of Physiology & Pharmacology University of Cantabria, Cantabria, Spain.
⁵⁶ Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.
⁵⁷ Universidad de Castilla-La Mancha, School of Education, Ciudad Real, Spain.
⁵⁸ Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, Finland.
⁵⁹ Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland.
⁶⁰ Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland.
⁶¹ Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy.
⁶² Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
⁶³ The Pediatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
⁶⁴ Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia ortegaf@ugr.es Gregor.Jurak@fsp.uni-lj.si.

PMID: 36623866
PMCID: PMC9985767
DOI: 10.1136/bjsports-2022-106176

Abstract

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.

Keywords: physical endurance; physical fitness.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Percentile curves for cardiorespiratory and muscular strength tests among European children and adolescents. Smoothed percentiles were calculated using the generalised additive model for location, scale and shape method, and weights were applied according to country population. Data sources are available online (https://www.fitbackeurope.eu/en-us/fitness-map/sources) and in online supplemental table 1.

**Figure 2**
European fitness maps for cardiorespiratory and muscular strength in children and adolescents. Sex-specific and age-specific percentile values were calculated using available country-level data and were averaged across sexes and ages to obtain the mean percentile for each country compared with the EU reference values. Smoothed percentiles were calculated using the generalised additive model for location, scale and shape method, and weights were applied according to country population. Separate European fitness maps for girls and boys for these tests (as well as those for the obesity markers of body mass index and waist circumference) are available online (www.fitbackeurope.eu/en-us/fitness-map). The website map is interactive so that detailed information for each country is shown with the mouseover function. Not all countries have representative data, and therefore, caution should be paid when interpreting country comparisons presented in this study and in the platform. Data sources are available online (www.fitbackeurope.eu/en-us/fitness-map/sources) and in online supplemental table 1. EU, European Union.

**Figure 3**
Country average ranking in muscular strength and CRF in European children and adolescents. CRF in European children and adolescents. The ranking for muscular strength was computed as the average of the country ranking position in HGS and SLJ tests, while ranking for CRF directly reflects the country ranking position in the 20mSRT. Grey shaded areas indicate countries ranked in the top 10 for either muscular strength, CRF or both. This figure was created based on the data presented in table 4. Four countries (Albania, Bulgaria, Luxembourg and The Netherlands) were not included since they had either missing muscular strength or CRF data. Not all countries have representative data and therefore caution should be paid when interpreting country comparisons presented in this study and in the platform. Data sources are available online (www.fitbackeurope.eu/en-us/fitness-map/sources) and in online supplemental table 1. 20mSRT, 20 m shuttle run test; CRF, cardiorespiratory fitness; HGS, handgrip strength; SLJ, standing long jump.

See this image and copyright information in PMC

References

1. Ortega FB, Ruiz JR, Castillo MJ, et al. . Physical fitness in childhood and adolescence: a powerful marker of health. Int J Obes 2008;32:1–11. 10.1038/sj.ijo.0803774 - DOI - PubMed
1. Ruiz JR, Castro-Piñero J, Artero EG, et al. . Predictive validity of health-related fitness in youth: a systematic review. Br J Sports Med 2009;43:909–23. 10.1136/bjsm.2008.056499 - DOI - PubMed
1. García-Hermoso A, Ramírez-Campillo R, Izquierdo M. Is muscular fitness associated with future health benefits in children and adolescents? A systematic review and meta-analysis of longitudinal studies. Sports Med 2019;49:1079–94. 10.1007/s40279-019-01098-6 - DOI - PubMed
1. García-Hermoso A, Ramírez-Vélez R, García-Alonso Y, et al. . Association of cardiorespiratory fitness levels during youth with health risk later in life: a systematic review and meta-analysis. JAMA Pediatr 2020;174:952–60. 10.1001/jamapediatrics.2020.2400 - DOI - PMC - PubMed
1. Högström G, Ohlsson H, Crump C, et al. . Aerobic fitness 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. 10.1016/j.canep.2019.01.012 - DOI - PubMed

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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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical