Acknowledgments. A tutorial on health-related physical fitness testing in school settings

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1 A tutorial on health-related physical fitness testing in school settings L. D. Erdmann C. S. McMillan Acknowledgments Supported by: The Joe Decker Children's Health-Related Fitness Research Award Department of Kinesiology 8 th Annual Illinois School Wellness Conference: Every Kid Healthyᵀᴹ 2015 Let s Start With The Obesity Epidemic Body Mass Index in Children Overweight: BMI (kg. m -2 ) for age and sex > the 85 th percentile (CDC, 2000) Obesity: BMI (kg. m -2 ) for age and sex > the 95 th percentile (CDC, 2000). U.S. Prevalence of Overweight and Obese Children using CDC Growth Charts Overweight ( BMI > 85 th %tile) 2-5y 6-11y 12-19y All (%) Boys (%) Girls (%) Obese ( BMI > 95 th %tile) All (%) Boys (%) Girls (%) Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, JAMA. 2014:311(8):

2 Trends in U.S. Prevalence (%) of Obese Children: Ages 6-11 yrs National Health and Nutrition Examination Survey (NHANES) A History of Youth Fitness Testing The go to article: Morrow JR Jr, Zhu W, Franks BD et al : 50 years of youth fitness tests in the United States. Res Q Exerc Sport 2008; 80: AAHPERD Youth Fitness Test 1976 Ages yrs Physical Fitness Component Test Item Aerobic Capacity 600-yard run, (optional: 1-mile or 9- min run optional for ages <13 yrs and 1 ½ mile or 12-min run for ages 13 and older) Body Composition None Muscular Strength/Endurance Agility Power Speed Flexibility 1-min timed bent-knee sit-up (hands behind head), boys pull-up, girls flexed-arm hang (hands pronated for both) Shuttle run (3X10 yd, carry blocks) Standing long jump 50-yd dash None AAHPERD HRPF Test 1980 Ages 5 18 yrs Health-related Physical Fitness Components Aerobic Capacity Body Composition Muscular Strength/Endurance & Flexibility Test Items 1-mile or 9-min run (1 ½ or 12-min run is optional for ages 13 and older) Triceps+subscapular (triceps only is optional) 1-min timed bent-knee sit-up (arms crossed) Sit-and-reach (double leg) National samples used to establish norms NCYFS I HRPF Test 1985 Ages yrs Health-related Physical Fitness Components Test Items National Children and Youth Fitness Study I Ages yrs [1985, JOPERD: 56(1)] National Children and Youth Fitness Study II Ages 6 9 yrs [1987, JOPERD: 58(9)] Aerobic Capacity Body Composition Muscular Strength/Endurance & Flexibility 1-mile run/walk Triceps & subscapular (triceps only is optional) 1-min timed bent-knee sit-up (arms crossed) Pull-up (supinated grip) Sit-and-reach (double leg) 2

3 NCYFS II HRPF Test 1987 Ages 6 9 yrs Health-related Physical Fitness Components Test Items Aerobic Capacity 1-mile run/walk (ages 8 & 9) Half-mile run/walk (ages 6 & 7) Body Composition Muscular Strength/Endurance & Flexibility Triceps+subscapular+calf (any 1 site or triceps+calf is optional) 1-min timed bent-knee sit-up (arms crossed) Modified pull-up (pronated grip) Sit-and-reach (double leg) FITNESSGRAM HRPF Test 2010 Ages 5 - >17 Health-related Physical Test Items Fitness Components Aerobic Capacity Body Composition Muscular Strength/Endurance & Flexibility PACER, 1-mile run/walk, 1-mile walk BMI or %BF (triceps+calf) Curl-up, Trunk lift, Push-up, Modified pull-up, flexed arm hang, [Pull-up in older software] Sit-and-reach (single leg), Shoulder stretch, Trunk lift The Macomb Children s Health-Related Physical Fitness Testing Project Project Overview The Macomb Children s Health-related Physical Fitness Testing Program was piloted in the fall of 1987 and began in the spring of 1988 as a requirement of the regular elementary physical education curriculum of the Macomb Illinois Community Unit School District # 185. Children in grades kindergarten through five, inclusive, were tested annually (spring) at the McDonough County YMCA from Project Overview (cont.) Measured Variables Height and Weight body mass index (kg. m -2 ) Skinfolds triceps + calf (% body fat) 1-mile run/walk time in min, 13-lap/mile, indoor Sit-up # in 1-min, knees bent, heels on mat, ankles held, arms folded, elbows to thighs Pull-up grip pronated, chin over bar, swing controlled Sit-and-reach double leg Project Overview (cont.) The tests were administered through a collaborative effort by university kinesiology department faculty and majors; school district physical educators and classroom teachers; and YMCA staff. Testing was completed in circuit fashion during a single session, with the 1-mile run/walk test completed last. 3

4 Project Overview (cont.) A component of the project was longitudinal surveillance of adiposity and health-related physical fitness test performances in elementary-aged children of the school district. How well do adiposity and healthrelated physical fitness track in children? Individual reports were provided to parents. McMillan CS, Erdmann LD. Tracking adiposity and healthrelated physical fitness test performances from early childhood through elementary school. Pediatric Exercise Science. 2010:22: What is tracking? The stability of a characteristic The maintenance of relative rank or position in a group, over a period of time Tracking requires longitudinal observations of the same individual. There is limited knowledge about how well HRPF tracks in young children. Tracking Body Composition in Boys Inter-period correlations (Spearman s) at five grades with baseline: kindergarten st 2nd 3rd 4th 5th BMI %BF Tracking Body Composition in Girls Tracking Fitness Measures in Boys Inter-period correlations (Spearman s) at five grades with baseline: kindergarten st 2nd 3rd 4th 5th BMI %BF Inter-period correlations (Spearman s) at five grades with baseline: kindergarten 4

5 Inter-period correlations (Spearman s) at five grades with baseline: kindergarten Tracking Fitness Measures in Girls What are the strengths of the relationships between fatness and fitness in children, from a longitudinal perspective? Erdmann LD, McMillan CS. Longitudinal relations of body composition field measures to healthrelated physical fitness components in children. International Journal of Body Composition Research. 2011:9(1):11-8. Relations of %BF to Fitness Measures in Boys Inter-period correlations (Spearman s) at six grades with %BF K 1st 2nd 3rd 4th 5th mile sit-up pull-up reach Relations of BMI to Fitness Measures in Boys Inter-period correlations (Spearman s) at six grades with %BF K 1st 2nd 3rd 4th 5th mile sit-up pull-up reach Relations of %BF to Fitness Measures in Girls Inter-period correlations (Spearman s) at six grades with %BF K 1st 2nd 3rd 4th 5th mile sit-up pull-up reach Relations of BMI to Fitness Measures in Girls Inter-period correlations (Spearman s) at six grades with %BF K 1st 2nd 3rd 4th 5th mile sit-up pull-up reach 5

6 How do fitness levels of children with persistently high body fat compare with those of children with healthy body fat? What are the implications? Erdmann LD, McMillan CS. A comparison of FITNESSGRAM aerobic capacity estimates in children of persistently healthy body fat levels compared to children of persistently high-risk body fat levels. Illinois Journal for Health, Physical Education, Recreation and Dance. (In Press). METHODS Initially reviewed were school-based health-related physical fitness test data from 269 boys and 248 girls with body mass index (BMI, kg. m -2 ) and %BF (estimated from medial calf and triceps skinfolds) values at ages 8, 9, 10, and 11 years, and 1-mile run/walk elapsed time at age 11 years. We retained data for analyses from 85 boys and 58 girls, with %BF in the FITNESSGRAM & ACTIVITYGRAM Test Administration Manual, Updated Fourth Edition healthy fitness zone (HFZ) at each of the four ages, whom we considered to have long-term healthy BF. We also considered 26 boys and 31 girls, with highrisk %BF at each of the four ages, to have long-term high-risk BF. FITNESSGRAM & ACTIVITYGRAM Test Administration Manual, Updated Fourth Edition cut-points, identifying healthy and high-risk body fat (BF) by age-and-sex. Age (years) Healthy BF (%) Boys: Girls: High-risk BF (%) Boys: > 27.0 > 30.1 > 33.2 > 35.4 Girls: > 28.4 > 30.8 > 33.0 > 34.5 Descriptive statistics (m+sd) and comparisons of height and mass in 11-year-olds by sex-and-body fat classification. All Strata Long-term Long-term t test results BF Healthy BF High-risk BF t P n Boys: Girls: Ht (m) Boys: <0.001 Girls: <0.001 Mass (kg) Boys <0.001 Girls <0.001 Descriptive statistics (m+sd) and comparisons of BMI and %BF in 11-year-olds by sex-and-body fat classification. 1-mile run/walk results (mean in min) in 11-year-olds by sex-and-body fat classifications. All Strata Long-term Long-term t test results of BF Healthy BF High-risk BF t p n Boys: Girls: BMI (kg. m -2 ) Boys: <0.001 Girls: <0.001 BF (%) Boys: <0.001 Girls: <

7 Finding the 1-mile finish line: Comparing 11-yr-olds with long-term health and high-risk body fat The average high-risk BF boy finished 520 m (or 569 yds) behind the average healthy BF boy (124 v. 183 m/min). The average high-risk BF girl finished 350 m (or 383 yds) behind the average healthy BF girl (125 v. 159 m/min). Inclusion Challenges for Obese Children As school- and community-based physical activity and sports programs typically include running, children with long-term high-risk BF may find themselves struggling to keep up with their long-term healthy BF peers. Consequently, to ensure exercise is appropriate and tolerable, modifications in activity mode, intensity, and/or duration may be warranted for elementary-aged children with long-term high-risk BF. Illinois Learning Standards ILLearningStandardsGoal20PE.pdf State Goal 20: Achieve and maintain a healthenhancing level of physical fitness based upon continual self assessment. State of Illinois Public Act The School Code is amended by adding Section as follows: (105 ILCS 5/ new) Sec Physical fitness assessments in schools. (a) As used in this Section, Physical fitness assessment means a series of assessments to measure aerobic capacity, body composition, muscular strength, muscular endurance, and flexibility. State of Illinois Public Act (b) To measure the effectiveness of State Goal 20 of the Illinois Learning Standards for Physical Development and Health, beginning with the school year and every year thereafter, the State Board of Education shall require all public schools to use scientifically-based, healthrelated physical fitness assessment for grades 3 through 12 and periodically report fitness information to the State Board of Education, as set forth in subsections (c) and (e) of this section, to assess student fitness indicators. State of Illinois Public Act Public schools shall integrate health-related fitness testing into the curriculum as an instructional tool, except in grades before the 3 rd grade. Fitness tests must be appropriate to students developmental levels and physical abilities. The testing must be used to teach students how to assess their fitness levels, set goals for improvement, and monitor progress in reaching their goals. Fitness scores shall not be used for grading students or evaluating teachers. 7

8 State of Illinois Public Act State of Illinois Public Act (c) [paraphrased] The State Superintendent of Education appointed a 15-member stakeholder and expert task force, who submitted recommendations on physical fitness (on or before April 1, 2015) concerning: (1) Methods for ensuring the validity and uniformity of reported physical fitness assessment scores, including assessment administration protocols and professional development approaches for physical education teachers; (2) How often physical fitness assessment scores should be reported to the State Board of Education (3) the grade levels within elementary, middle, and high school categories for which physical education assessment scores should be reported to the State Board of Education; (4) the minimum fitness indicators that should be reported to the State Board of Education, including, but not limited to, a score for aerobic capacity (for grades 4 through 12); muscular strength; endurance; and flexibility; State of Illinois Public Act (5) the demographic information that should accompany scores, including, but not limited to, grade and gender; (6) the development of protocols regarding the protection of students confidentiality and individual information and identifiers; and (7) How physical fitness assessment data should be reported by the State Board of Education to the public, including potential correlations with student academic achievement, attendance, and discipline data and other recommended uses of the reported data. State of Illinois Public Act (d) On or before December 31, 2015, the State Board of Education shall use the recommendations of the task force under subsection (c) of this Section to adopt rules for the implementation of physical fitness assessment by each public school for the school year and every school year thereafter. (e) On or before September 1, 2016, The State Board of Education shall adopt rules for data submission by school districts and develop a system for collecting and reporting the aggregated fitness information from the physical fitness assessments. This system shall also support the collection of data from school districts that use a fitness testing software program. State of Illinois Public Act (f) School districts may report the aggregate findings of physical fitness assessments by grade level and school to parents and members of the community through typical communication channels, such as Internet websites, school newsletters, school board reports, and presentations. Districts may also provide individual fitness assessment reports to students parents. (g) Nothing in this Section precludes schools from implementing a physical fitness assessment before the school year or from implementing more robust forms of physical fitness assessment. FITNESSGRAM With the establishment of the Presidential Youth Fitness Program in 2012, it became the recognized health-related physical fitness test in the U.S. It is used in more than 67,000 schools in all 50 states. The standards are criterion-referenced, rather than norm-referenced, based on how fit children need to be for good health. 8

9 Healthy Fitness Zone Test items are scored using criterion-referenced standards. Criterion-referenced standards are established based on the level of fitness needed for good health. There are separate standards by sex and age. Most students who perform regular physical activity will be able to achieve a score placing them in or above the HFZ. FITNESSGRAM resources The Cooper Institute. (2010). FITNESSGRAM & ACTIVTYGRAM : Test Administration Manual (updated 4 th ed.). Champaign, IL: Human Kinetics. Presidential Youth Fitness Program Stakeholder and Task Force on Physical Education: Health-related Physical Fitness Assessment Recommendations ILFitnessTest-report pdf pdf Testing Recommendation (1) The Illinois State Board of Education (ISBE) require schools to administer annual fitness testing for the following fitness components for all grades 3-12, and to report to ISBE aggregate results for grades 5, 7 and 10 each year: Aerobic capacity (Grades 4-12 only; Recommended test: PACER test, Alternate test: Mile Run test), Flexibility (Recommended test: Back- Saver Sit and Reach test, Alternate test: Trunk lift test), Muscular endurance (Test: Curl-up test) and Muscular strength (Test: Push-up test). Testing Recommendation (2) Schools should use the Brockport fitness testing methodologies, when appropriate as determined by an Individualized Education Program (IEP) team, for students with disabilities. 9

10 Testing Recommendation (3) ISBE require schools to use the fitness testing protocols that were developed by Fitnessgram. Testing Recommendation (3a) Prior to administering aerobic capacity tests, schools should measure out the 15 or 20-meter or 1 mile mark-off point and have another staff member check the measurement for accuracy. Going forward, the school need only re-measure if the space changes or the markings deteriorate. Testing Recommendation (3b) All schools should follow the Fitnessgram protocols for identifying when a student has completed the fitness test. On form breaks, the first form break should be counted in the total number of repetitions/cycles for each test, e.g. PACER laps, push-ups, etc. The second form break signals the end of the test (no matter when the second form break occurs). Testing Recommendation (4) ISBE suggest that schools integrate fitness testing into physical education classes when covering content related to Illinois State Learning Standard 20. Education about the importance of the five components of fitness (aerobic capacity, muscular strength, muscular endurance, flexibility and body composition) should be included. Teachers should follow the Illinois Learning Standard 20 performance descriptors to identify appropriate times to integrate fitness testing into class. Reporting Recommendation (5) ISBE require schools report the number of students tested (using recommended tests or Brockport alternatives) and the number meeting the "healthy fitness zone" and "needs improvement" categories for each of the required fitness testing components for grades 5, 7 and 10 at the end of each academic year. Each school will submit its aggregate data to its district administrator and he/she will submit that aggregate data for each school and the district as a whole to ISBE yearly via the ISBE Web Application Security (IWAS) system. Reporting Recommendation (6) ISBE should not require any demographic information accompany the scores when reported in aggregate to ISBE. However, ISBE should explore the feasibility and utility of collecting demographic and achievement information in conjunction with fitness scores for potential longer-term enhancements to the fitness testing and reporting requirement. To that end, ISBE should undertake a pilot data collection program with school districts that volunteer to participate. 10

11 Reporting Recommendation (7) At a minimum, ISBE report the "healthy fitness zone" results for each fitness component at each school and district on the ISBE website, annually, for grades 5, 7, and 10. Reporting Recommendation (8) ISBE include "healthy fitness zone" results on the School Report Card. Confidentiality Recommendation (9) ISBE require that schools have procedures for protecting student data and confidentiality that comply with all related state and federal laws. Professional Development Recommendation (10) Every person administering fitness testing in Illinois must receive in-person or web-based Fitnessgram instruction related to administering and scoring the fitness tests for the required fitness components. ISBE shall create a compliance oversight mechanism to ensure everyone required has completed the training. Testing Suggestion (11) ISBE suggest that schools include all students in annual fitness testing, whether or not they are enrolled in physical education. Testing Suggestion (12) ISBE suggest schools do pre-and post-fitness tests with students each year (or semester, as applicable). Post-test results shall be used for reporting scores to ISBE. 11

12 Reporting Suggestion (13) ISBE work with universities to develop methodologies and tools to correlate fitness scores with other available data, like attendance, academic performance, behavior, etc. Local school districts can use the methodologies and tools to track progress at a local level and determine a plan of action for improving P.E. programs in order to create the most benefits for academics, behavior, and health. Professional Development Suggestion (14) Recommend that ISBE and other organizations offer professional development opportunities to administrators to understand fitness testing and how to effectively evaluate P.E. teachers without using student fitness scores as a measure of student growth (which is prohibited by Public Act ). Professional Development Suggestion (15) ISBE should work with P.E. supporting organizations, universities, and associations to develop professional development opportunities for integrating fitness testing into the P.E. curriculum as an instructional tool and work with stakeholders to disseminate the professional development opportunities across the state. Professional Development Suggestion (16) ISBE should work to compile all available free and paid resources and trainings related to fitness testing, and post the compendium, with links to other resources, on its website. Other Suggestion (17) ISBE should convene a committee of stakeholders to look for additional funding and resources to support implementation of fitness testing, with a focus on Fitnessgram software, professional development, and general support to schools and districts for implementing the recommendations and suggestions from the Task Force. Other Suggestion (18) ISBE should engage an outside evaluator to evaluate the impact of the implementation of fitness testing in Illinois and track changes in aggregate fitness data over time. 12

13 Other Suggestion (19) ISBE should work with Presidential Youth Fitness Program and/or Fitnessgram to modify the Microsoft Excel reporting spreadsheet to meet the specific needs/requirements of Illinois. FITNESSGRAM TEST ITEMS Aerobic Capacity PACER (recommended IL aerobic capacity test) 1-mile run/walk (alternate IL aerobic capacity test) 1-mile walk FITNESSGRAM TEST ITEMS FITNESSGRAM TEST ITEMS Muscular Strength/Muscular Endurance Curl-up (recommended IL muscular endurance test) Trunk lift Push-up (recommended IL muscular strength test) Modified pull-up Flexed arm hang Pull-up (in older software) Flexibility Sit and reach (recommended IL flexibility test) Back-Saver (single leg) Trunk lift (alternate IL flexibility test) Shoulder stretch FITNESSGRAM TEST ITEMS Body Composition Body mass index (BMI) Percent body fat The Stakeholder and Expert Task Force did not recommend that body composition assessment be an IL state requirement but suggests including it in the education content, along with the other four healthrelated physical fitness components. Appropriate and Inappropriate Uses of FITNESSGRAM Appropriate Personal testing to help students evaluate their healthrelated physical fitness levels Provide group data for teachers to use in curriculum development Teach students about the types of activity needed to reach criterion-referenced health standards Inappropriate Grading students Evaluating teacher effectiveness Evaluating overall physical education program quality 13

14 Test Validity and Reliability Validity The degree to which a test item measures what it is supposed to measure The most important characteristic of testing Reliability A measure of the degree of consistency or repeatability of a test Measurement error can result from the following: Intrasubject (within subjects) variability Lack of interrater (between raters) agreement Intrarater (within raters) variability Failure of the test itself to provide consistent results Solutions/Best Practices Test organization and administration Enhancement of physical activity time Key Objectives for Testing Success Students enjoy physical activity Components & Process Students are involved in MVPA for 50% of class time All students are provided with many opportunities to participate and practice skills Students are encouraged to participate in physical activity outside of class Components Physical Education Physical Activity during School (Recess/Classroom) Physical Activity before and after school Staff involvements Family and community involvement Process Establish/Develop Implement Evaluate Fitness testing linked to the curriculm Goals To provide a variety of school-based physical activities to enable all students to participate in 60 minutes of moderate-to-vigorous physical activity each day. To provide coordination among the components to maximize understanding, application, and practice of the knowledge and skills learned in physical education so that all students will be fully physically educated and well-equipped for a lifetime of physical activity. Physical Activity During School This includes classroom activity and recess: Classroom activity Even 5-10 minutes in duration contributes to cognitive health Can be prek-12 Recess Minimum 20 minutes per day Activity zones, active supervision, equipment and multiple approaches Drop-in physical activity in secondary schools 14

15 Physical Activity Before & After School School or community sponsored activities/clubs/programs before and after school Active commuting to school Walk and bike to school Walking school bus Physical activity walking and running clubs Intramurals (voluntary, student-centered, and all students) Joint use agreements with community centers/buildings Physical Education Must implement quality Physical Education Adequate instructional time & well designed lessons Classes taught by qualified PE specialist Proper equipment and facilities Adaptions for students with disabilities Opportunities for students to be active most of class time Physical Education Must implement quality PE (continued): Not using physical activity as punishment Appropriate use of fitness assessment tools Ongoing opportunities for students to conduct self-assessments and practice self monitoring of physical activity Well-developed, planned, and sequential curricula for PE Aligns with your State and National Standards for PE Steps Before Testing MVPA of 50% Provide PA outside of class Practice the tests Procedures/Activities Peer teaching Teacher assisted Trusted partner Procedures/Activities Test administration 40 students 40 minutes Games/examples 15

16 Benefits to Students Teaching knowledge & values Enjoyable Participation Barriers Large class sizes (multiple classes) Limited space Not enough equipment Not enough time All students can be successful Psychological Implications Promote testing as enjoyable Practice in fun game like conditions Self- responsibility Non-competitive Self-improvement Benefits to Students INDIVIDUALIZED Students compete only with themselves! Results/printouts Intrinsic motivation Philosophy for Students Enjoyable Realistic Fair The Stairway to Lifetime Fitness C.B. Corbin and R.P. Pangrazi, Participate in Regular Exercise 2. Achieve Physical Fitness 3. Personal Exercise Patterns 4. Evaluate Own Fitness Levels 5. Problem Solve/Decision Making 16

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