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

This is a self-archived version of an original article. This version may differ from the original in pagination and typographic details. Author(s): Title: Year: Version: Copyright: Rights: Rights url: Please cite the original version: CC BY 4.0 https://creativecommons.org/licenses/by/4.0/ 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 © 2024 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd. Published version Joensuu, Laura; Csányi, Tamás; Huhtiniemi, Mikko; Kälbi, Katalin; Magalhães, João; Milanović, Ivana; Morrison, Shawnda A.; Ortega, Francisco B.; Sardinha, Luis B.; Starc, Gregor; Tammelin, Tuija H.; Jurak, Gregor Joensuu, L., Csányi, T., Huhtiniemi, M., Kälbi, K., Magalhães, J., Milanović, I., Morrison, S. A., Ortega, F. B., Sardinha, L. B., Starc, G., Tammelin, T. H., & Jurak, G. (2024). 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. Scandinavian Journal of Medicine and Science in Sports, 34(3), Article e14593. https://doi.org/10.1111/sms.14593 2024 Scand J Med Sci Sports. 2024;34:e14593. | 1 of 14 https://doi.org/10.1111/sms.14593 wileyonlinelibrary.com/journal/sms Received: 1 October 2023 | Revised: 23 February 2024 | Accepted: 26 February 2024 DOI: 10.1111/sms.14593 REVIEW How to design and establish a national schoolbased physical fitness monitoring and surveillance system for children and adolescents: A 10step approach recommended by the FitBack network LauraJoensuu1,2 | TamásCsányi3,4 | MikkoHuhtiniemi2 | KatalinKälbi4,5 | JoãoMagalhães6 | IvanaMilanović7 | Shawnda A.Morrison8,9 | Francisco B.Ortega2,10 | Luis B.Sardinha6 | GregorStarc8 | Tuija H.Tammelin1 | GregorJurak8 | on behalf of the FitBack Network 1LIKES, Jamk University of Applied Sciences, Jyväskylä, Finland 2Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland 3Department of Physical Education Theory and Methodology, Hungarian University of Sports Science, Budapest, Hungary 4Hungarian School Sport Federation, Budapest, Hungary 5Eötvös Loránd University (ELTE) Bárczi Gusztáv Faculty of Special Needs Education, Institute for the Methodology of Special Needs Education and Rehabilitation, Budapest, Hungary 6Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, Portugal 7Faculty of Sports and Physical Education, University of Belgrade, Belgrade, Serbia 8Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia 9Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore 10Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada and CIBEROBN Physiopathology of Obesity and Nutrition, Granada, Spain Correspondence Laura Joensuu, Faculty of Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8, Jyväskylä 40700, Finland. Email: laura.p[email protected] Funding information Slovenian Research Agency within the Research programme Biopsychosocial context of kinesiology, Grant/Award Number: P50142; Erasmus+ Sport Programme of the European Union, Grant/Award Number: 613010EPP120191SISPOSCP Abstract Background: Providing individualand populationlevel 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 schoolaged children and to provide experiencebased 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 10step approach for designing and establishing This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2024 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd. Tuija H. Tammelin and Gregor Jurak contributed equally to this work. 2 of 14 | JOENSUU etal. 1 | INTRODUCTION Physical fitness (PF) refers to a set of attributes that an individual has or achieves,1 which provide an ability to carry out daily tasks with vigor, alertness, and ample energy to enjoy leisuretime pursuits or to meet an unforeseen emergency.2 These attributes include: body composition (proportion of different tissues in the human body), cardiorespiratory fitness (ability of the wholebody to sustain prolonged performance), musculoskeletal fitness with muscular strength and endurance (muscle properties enabling work) and flexibility (range of motion available at a joint or group of joints), and motor fitness (speed of movement, agility, and coordination).3–5 There is substantial accumulated evidence supporting the importance of maintaining adequate PF at a young age, not only limited to one's functional capacity and performance, but also in terms of encouraging lifelong health and educational aspects. Physical fitness in youth is consistently associated with favorable educational attainment, brain properties and cognitive function,6–11 somatic and mental health,12–14 as well as lower morbidity and mortality later in life.15–18 Physical fitness also associates closely with physical literacy—the “motivation, confidence, physical competence, knowledge and understanding to value and take responsibility for engagement in physical activities for life,”19 a construct that is wellpositioned in educational policies as a key component for maintaining a healthy and active lifestyle.20,21 The secular trends of childrenand adolescentspecific fitness components varies based on the societal and environmental factors children face over time.22 Fitness monitoring and surveillance is an unavoidable contemporary topic since many global pressures (e.g., conflict, climate change, pandemics, and cultural evolution through technological development) can directly (or indirectly) negatively affect child PF.23 Surveying childhood fitness at scale can capture a wide variety of physical attributes, which are highly relevant to characterizing children and adolescents' current and future health outcomes, and complements already existing frameworks, which regularly monitor 24h movement behaviors such as physical activity, sedentary behavior, and sleep.24 Physical fitness monitoring and surveillance was one of the top 10 priorities outlined by international experts in the fitness domain,25 and the development of such systems is a high priority to enhance the description of children and adolescents health status globally. Accurate ongoing assessments of the state of a population's fitness can also be used to create more effective policy interventions when future external challenges to society inevitably arise. Herein, we refer to “monitoring” as observing and/or assessing the changes of one's fitness over time, usually for a special purpose (e.g., educational or healthrelated), whereas “surveillance” emphasizes the importance of disseminating the data and related findings to parties responsible for preventing and controlling public health concerns.26 Globally, there are limited examples of atscale PF monitoring and surveillance systems in operation.24,25,27,28 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 schoolaged children's fitness monitoring and surveillance in Europe. Additionally, it offers a 10step approach to assist in the creation of similar systems in Europe or globally. KEYWORDS assessment, disease prevention, education, epidemiology, NCDs, physical literacy, policy, population health 16000838, 2024, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/sms.14593 by University Of Jyväskylä Library, Wiley Online Library on [26/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License | 3 of 14 JOENSUU etal. For the ones that do exist, their development is best operationalized through the international cooperation of diverse partners in science, civil societies, and educational organizations.29 Previously, most of this work regarding systematic fitness monitoring has been rather compartmentalized and localized. To address this disparity, the European Union Erasmus+ Sport funded a largescale project named “The European Network for the Support of Development of Systems for Monitoring Physical Fitness of Children and Adolescents' (abbreviated as ‘FitBack’).”30 FitBack is a nonprofit coalition of 10 European foundermembers who have had expertise conducting child fitness assessment, monitoring, or surveillance at the population level. The FitBack project builds on a previous European Unionfunded work called the “ALPHA project,” which established and evaluated an evidencebased healthrelated fieldtest battery for schoolaged children.3,31 This study communicates the work conducted within the FitBack project 20202022. More specifically, the two main aims of this study were as follows: (1) to identify, compare, and contrast examples of current bestpractice PF monitoring and surveillance systems among schoolaged children in Europe, and (2) to provide an experiencebased easytofollow set of guidelines for policymakers, which can be used to design their own PF monitoring and surveillance system. Detailed outcomes of the FitBack project can be found by accessing its online, freeforuse, web portal here: https:// www. fitba ckeur ope. eu/ enus/ . 2 | METHODS 2.1 | Identifying current PF monitoring bestpractices in Europe The FitBack project was launched on February 12, 2020, just before the COVID19 global pandemic was declared by the World Health Organization. Despite these challenges, the process began in earnest by identifying and describing existing national or regional PF monitoring and surveillance systems across Europe, herein truncated to “systems.” Information related to national and/or regional systems was discovered largely from nonacademic publications, and in local languages. Hence, a narrative review approach was selected. Eligible systems were identified by the experts involved in the FitBack consortium, and their respective professional networks. The FitBack working group then formed a structured questionnaire that was sent to representatives of the identified systems. Representatives were requested to provide descriptions of their fitness system, including details such as the aims, design, relationship to physical education programs in schools, operational time lines, leading institutions, subjects, test items, instructional materials, data collection, feedback, reference values, criteria for possible interventions and sources for further information. All representatives of the identified systems were successful in providing detailed descriptions of their regional works. 2.2 | Compiling guidelines for designing novel schoolbased PF monitoring and surveillance systems In the second phase of the process, a key guideline document entitled “How to design a physical fitness monitoring system” was created. These guidelines were prepared in collaboration with five foundermembers of the FitBack consortium—Finland, Hungary, Portugal, Serbia, and Slovenia—countries that also possess unique experiences in establishing and operating their own nationallevel child fitness systems. The formation of the guidelines followed an iterative design, which included an initial planning stage, consideration of requirements, analysis, design, testing, and evaluation. The working group analyzed the Strengths, Weaknesses, Opportunities, and Threats (SWOT) related to each system by filling out a SWOT form, whereafter, answers were thematically clustered. The most common SWOT themes were first discussed within the working group, and potential solutions to address these topics, (e.g., key guidelines), were carefully considered. After several iteration rounds, the working group decided upon 10 priority guidelines. Discussions also included how to list/communicate their order of presentation. The final materials were then prepared in several formats within the working group before being shared with the FitBack consortium at large, and prior to final publication on the FitBack online web portal (www. fitba ckeur ope. eu/ enus/ monit oring - fitne ss/ 10steptodesign). These key guidelines, contents, documents, and the online portal itself have since been successfully piloted among actual policy makers.32 3 | RESULTS 3.1 | European national and regional schoolbased PF monitoring and surveillance systems for children and adolescents 3.1.1 | Existing PF monitoring and surveillance systems The FitBack network identified eight nationalor regionallevel systems in operation within Europe. They are: Move! 16000838, 2024, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/sms.14593 by University Of Jyväskylä Library, Wiley Online Library on [26/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 4 of 14 | JOENSUU etal. (Finland), Diagnoform (France), DAFIS (Galicia, Spain), NETFIT (Hungary), The assessment of student's fitness in primary and secondary schools (Lithuania), FITescola (Portugal), the National Physical Fitness Surveillance System (Serbia), and SLOfit (Slovenia). Longform descriptions of each system are available on the FitBack web portal (FitBa ckIdent ifica tionanddescr iptio nsofgoodpract icesindiagn osing - thephysi calfitne ss. pdf (fitba ckeur ope. eu) ). In this article, we provide an updated summary of these systems' characteristics (Table1). The first surveillance system was launched over 40 years ago in Slovenia, back in 1982. Other systems were launched more recently: in France and Galicia 2010–2012, and in Finland, Hungary, Lithuania, Portugal, and Serbia 2015–2020. These systems are located in diverse total populations ranging from approximately 2.1 million inhabitants (Slovenia) to 68 million (France). The systems span Europe, representing geographical areas to the north (Finland), south (Portugal), east (Lithuania), and west (France) (Figure1). Fitness systems are operating primarily within highincome countries (Finland, France, Galicia, Hungary, Lithuania, Portugal, and Slovenia), and one upper middleincome (Serbia) country whose Gross Domestic Product per capita ranges from 9230 $ (Serbia) to 53 655 $ (Finland).33 All systems aim to assess PF among schoolaged children, with a specific emphasis on supporting physical education, students' physical and health literacy, and health (for further details, see the longform descriptions from the FitBack platform). All systems operate in a school context within the physical education subject. In France, Galicia, Lithuania, Portugal, and Slovenia schools are recommended to utilize their regional/national system to assess student's PF, whereas in Finland, Hungary, and Serbia, the use of the system is mandatory part of the curriculum. The systems encompass a broad range of schoolaged children, ranging from 5 years for the youngest (France) to ≥19 year in the oldest (Hungary, Serbia, Slovenia). The majority of systems assess fitness annually as part of the children's educational pathway, with up to 13year trajectories (Slovenia). As an exception, in Finland, children and adolescents participate in national data collection twice at specific ages (in Grades 5 and 8, at ages 11 and 14). Based on data from systems with centralized registers (i.e., Finland, France, Galicia, Hungary, Portugal, and Slovenia), approximately one million children and adolescents participate to fitness monitoring per year. The largest absolute number of schoolaged children are involved in the Hungary's system, which tests approximately 650 000 students annually, corresponding to approximately 93% of their agespecific population. The second largest system identified based on pure participation rate is Slovenia, with approximately 200 000 annual participants (i.e., ~96% of the agespecific population), followed by Portugal 120 000 (~12%), and Finland 100 000 (~96%). France and Galicia have lower participation rates, with approximately 32 000 and 26 000 participants since their launch, respectively. In Lithuania and Serbia, relevant data were not available at the time of analysis. 3.1.2 | Comparing PF monitoring and surveillance systems A comparison between systems revealed that, whereas each system assesses similar PF components, they utilize different test items for this purpose (Table1). The terminology used to compare PF items across systems was adopted from the ALPHA project, which categorizes fitness into body composition, cardiorespiratory, musculoskeletal (including muscular strength and endurance, and flexibility) and motor fitness. In this context, we utilized the terms “musculoskeletal fitness” and “motor fitness,” although in many physical education curricula these test items are used to assess a student's “motor competence.” Importantly, both Finland and Hungary provide adapted fitness tests for students with special needs. Anthropometrics and body composition All systems, except Finland and Lithuania, assess anthropometrics and/or body composition. Most systems assess anthropometrics; body mass index (France, Galicia, Hungary, Portugal, Serbia, and Slovenia), waist circumference (Galicia and Portugal), or waisttohip ratio (Galicia). Additionally, Hungary, Portugal, and Slovenia assess body composition by body fat percentage (via bioelectrical impedance [Hungary, Portugal], or skinfolds [Portugal, Slovenia]). Cardiorespiratory fitness is assessed using a variety of techniques. It is most frequently determined using the 20m shuttle run (Finland, Galicia, Hungary, Lithuania, Portugal, and Serbia). In Lithuania, secondary school students are assessed using the 20m shuttle run but primary students complete a 6min run. In Portugal, a 1mile run is provided as an alternative to the 20m shuttle run test. In France and Slovenia, cardiorespiratory fitness is assessed using a 6min “run and walk test” and a 600m run, respectively. Musculoskeletal fitness/muscular strength and endurance Various tests are used to assess muscular strength and endurance. Upperbody strength is assessed by handgrip strength (Galicia, Hungary), bentarm hang (Galicia, Lithuania [secondary students only], Serbia, and Slovenia), and pushup (Finland, Hungary, and Portugal). Central body assessments include situps (Serbia, Slovenia), curlup 16000838, 2024, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/sms.14593 by University Of Jyväskylä Library, Wiley Online Library on [26/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License | 5 of 14 JOENSUU etal. TABLE 1 Overview of the current schoolbased physical fitness monitoring and surveillance systems in Europe according to the year of establishment. Country Slovenia France Galicia, Spain Hungary Portugal Finland Serbia Lithuania Descriptives Name SLOfit Diagnoform DAFIS (Datos Actividad física Saludable) NETFIT FITescola Move!—monitoring system for physical functional capacity National Physical Fitness Surveillance System The assessment of student's fitness in primary and secondary schools Launched (year) 1982 2010 2012 2015 2016 2016 2017 2020 Population (2021)33 2 108 079 67 749 632 2 696 88052 9 709 891 10 325 147 5 541 017 6 834 326 2 800 839 GDP/capita (2021)33 29 291 $ 43 659 $ 31 272 $52 18 728 $ 24 567 $ 53 655 $ 9230 $ 23 723 $ Measurements Timeline Annually during April No mandatory timeline No mandatory timeline Annually between January and May No mandatory timeline Annually during August/September Annually during September/ October and in May Annually between February and May Age groups 6–19years 5–11years 6–17years 10–19years 10–18years 11 and 14yearsa9–19years 7–18years Annual participants (% of agespecific population) 200 000 (~96%) ~3500 ~2600 650 000 (~93%) 120 000 (~12%) 100 000 (~96%) NA NA Anthropometrics and body composition BMI, body fat percentage (skinfold) BMI BMI, waist circumference, waisttohip ratio BMI, body fat percentage (BIA) BMI, waist circumference, body fat percentage (BIA, skinfold) NAbBMI NA Cardiorespiratory fitness 600m run 6min run and walk test 20m shuttle run 20or 15m shuttle run 20m shuttle run or 1mile run 20m shuttle run 20m shuttle run 6min runP, 20m shuttle runS Musculoskeletal fitness/ Muscular strength and endurance Bentarm hang, situps, standing long jump Standing long jump Handgrip strength, bentarm hang, standing long jump Handgrip strength, pushup, curlup, trunk lift, standing long jump Pushup, curlup, squad jump or vertical jump, standing long jump Pushup, curlup Bentarm hang, situps, standing long jump Standing long jump, bentarm hangS Musculoskeletal fitness/ Flexibility Stand and reach Lowerback extension in standing position Backsaver sit and reach Backsaver sit and reach Sit and reach, shoulder stretch Squat, lowerback extension in sitting posture, shoulder stretch Sit and reach Sit and reachS Motor fitness 20s arm plate tapping, Obstacle course backwards, 60m dash 5s run test, Hopscotch test 4 × 10m shuttle run NA 4 × 10m shuttle run Speed in 20or 40m 5leaps test, Throwingcatching combination test 4 × 10m shuttle run Tennis ball throw, 10 × 5m shuttle run, Flamingo balanceS Adapted fitness tests No No No Yes No Yes No No (Continues) 16000838, 2024, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/sms.14593 by University Of Jyväskylä Library, Wiley Online Library on [26/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 6 of 14 | JOENSUU etal. Country Slovenia France Galicia, Spain Hungary Portugal Finland Serbia Lithuania Feedback Normativerelated feedback (main ageand sexspecific centiles) ≥40th fit zone (Green), 10th–40th need to improve (yellow), <10th strongly recommended to improve (Red)34 ≥90th very high, 70th–90th high, 30–70th medium, 10th–30th low, <10th very low for all ≥80th green, 60th–80th blue, 40th–60th yellow, 20th–40th orange, <20th red, for bentarm hang,35,36 standing long jump,35,36 and 4 × 10m shuttle run35 Healthy Zone ≥50th for 4 × 10m shuttle run, ≥20th for vertical and standing long jump,39 and ≥50th for 20or 40m sprint test46 >66th good, 33rd–66th sufficient, <33rd needs improvement, for others than flexibility 25th–75th healthy zone <25th needs improvement zone for all49 ≥ 40th healthy, 40th–5th needs improvement, <5th health risk, for others than specified (Varying ageand sex specific centiles or other thresholds) Centiles for all34 NA Waist circumference, and waisttohip ratio,37 20m shuttle run,35 handgrip strength,35,38 backsaver sit and reach39,40 For others than specified44 For others than specified39 Flexibility: 0/1 p per measurement. 4 p Good flexibility, 13p Needs some improvement, 0p Needs improvement <60th Healthy, 60th–95th Needs improvement, >95th Health risk, for 10 × 5m shuttle run Healthrelated feedback (Thresholds derived from ROC curve or other analysis in relation to a health outcome)c BMI41 NA BMI41 BMI,41 Body fat percentage,42 20m shuttle run,43 Handgrip strength45 BMI,47 20m shuttle run test and 1mile run48 NA NA NA Athletic capacity (Ageand sexspecific centiles) NA NA NA NA ≥90th the athletic profile NA >75th potential sport talent zone NA Resources Website https:// en. slofit. org/ https:// irfo. fr/ https:// dafis. xunta. es/ es/ https:// www. netfit. eu/ public/ pb_ netfit. php https:// fites cola. dge. mec. pt/ home. aspx https:// www. oph. fi/ en/ move NA NA Note: The terminology for fitness components follows definitions of the ALPHA project. In this context, we utilize the terms musculoskeletal fitness and motor fitness although in many physical education curricula these test items are used to assess student's motor competence. Abbreviations: BIA, bioimpedance analysis; BMI, body mass index; GDP, gross domestic product; NA, not applicable; p, points; P, primary school students (7–10years); ROC, receiver operating characteristic; S, secondary school students (11–18years). aNational results are gathered from 11and 14years students. However, normative reference values are available for 9–16 yearolds and the schools are encouraged to use the measurements annually. bMeasurements are addressed in school healthcare where height, weight and waist circumference are measured separately. cThe ageand sexspecific BMI cutpoints proposed by the International Obesity Task Force (Cole etal. 2000), World Health Organization or similar, for example, the U.S Centers for Disease Control and Prevention, have been linked to future health widely and consistently, including large cohort studies and evidence that childhood obesity (defined with those cutpoints) associates with future mortality and morbidity therefore providing strong level of evidence. So even if the cutoff points in pediatric ages are generated based on centiles or growth curves, the FitBack network considers them validated against health outcomes and classify them as healthrelated feedback; The long form of system descriptions is available at the FitBack webpages (FitBa ckIdent ifica tionanddescr iptio nsofgoodpract icesindiagn osing - thephysi calfitne ss. pdf (fitba ckeur ope. eu) ). TABLE 1 (Continued) 16000838, 2024, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/sms.14593 by University Of Jyväskylä Library, Wiley Online Library on [26/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License | 7 of 14 JOENSUU etal. (Finland, Hungary, Portugal), and trunk lift (Hungary), and lower body assessments standing long jump (Galicia, Lithuania [primary students only], France, Hungary, Serbia, and Slovenia), and squat jump or vertical jump (Portugal). Musculoskeletal fitness/flexibility All systems include at least one assessment of flexibility. Sitandreach (Lithuania [only for secondary students], Portugal, and Serbia) or backsaver sitandreach tests (Galicia, Hungary) are most utilized. Slovenia utilizes a standandreach test, while Finland and France use different versions of lower back extension. Shoulder stretch is utilized in Finland and Portugal, and in Finland also squat. Motor fitness Except for Hungary, all systems assess at least one measure of motor fitness. A 4 × 10m shuttle run test is utilized in Galicia, Portugal, and Serbia. An additional 12 items are systemspecific: 5leap test and throwingcatching combination test in Finland; 5s run test and Hopscotch test in France; tennis ball throw, 10 × 5m shuttle run, and flamingo balance (only in secondary students) in Lithuania; 20or 40m sprint test in Portugal; and 20s arm plate tapping, obstacle course backwards, and a 60m dash in Slovenia. All systems provide feedback directly to students, and other stakeholders as well, (e.g., parents, teachers, school administrators, and medical professionals) on healthrelated fitness. Additionally, Portugal and Serbia provide feedback on athletic potential. Systems utilize normativerelated feedback (Finland, France, Galicia, Hungary, Lithuania, Portugal, Serbia, and Slovenia) and healthrelated feedback (Hungary, Galicia, Portugal, and Slovenia) from unpublished national research studies or published scientific literature.34–49 Healthrelated feedback refers to thresholds derived from receiver operating characteristic (ROC) curve or other analysis in relation to a health outcome, and normativerelated feedback to others. The child's individual results are addressed within the physical education curriculum in all systems. Furthermore, individual followup data are also available for later personal use in Finland, Galicia, Hungary, Portugal, and Slovenia. Data are linked to health care in Finland, Galicia, and Slovenia. In Finland, Galicia, Hungary, Portugal, and Slovenia, regional/national data are made available for policymaking (for further details, FIGURE 1 Identified eight nationalor regionallevel physical fitness monitoring and surveillance systems in Europe: Move! (Finland), Diagnoform (France), DAFIS (Galicia, Spain), NETFIT (Hungary), The assessment of student's fitness in primary and secondary schools (Lithuania), FITescola (Portugal), National Physical Fitness Surveillance System (Serbia), and SLOfit (Slovenia). 16000838, 2024, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/sms.14593 by University Of Jyväskylä Library, Wiley Online Library on [26/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 8 of 14 | JOENSUU etal. see the long form of descriptions from FitBa ckIdent ifica tionanddescr iptio ns - ofgoodpract ices - indiagn osing - thephysi calfitne ss. pdf (fitba ckeur ope. eu) ). 3.1.3 | Commonly experienced strengths, weaknesses, opportunities, and threats Figure2 presents the most commonly experienced strengths, weaknesses, opportunities, and threats related to monitoring and surveilling PF in schoolaged children. Strengths include providing a solid scientific and theoretical foundation for determining the benefits of PF, feasibility in school settings, the usefulness of the system to various professionals, and the provision of valuable data for education, health policy, and sports. The relevance to public health is evident as monitoring the PF status and trends of children and adolescents can provide comprehensive assessment for their health, responsiveness to acute crises such as pandemics, collaboration with healthcare providers, and highquality evaluation of community interventions. The identified weaknesses to establishing fitness surveillance systems include a potentially long implementation process. The system might not be welladopted by the end users and/or the system evaluators may lack relevant expertise if not properly trained. The existing system might be difficult to evolve due lack of funding or information, or the complexity of current governmental structures. Opportunities include the further development of PF, physical and health literacy, and physical education curricula, and the potential to identify children and families for fitness and health interventions. The knowledge gained from the system has the potential to inform decisionmaking at local, regional, and national level. Insufficient funding and changes in legislation, such as Data Protection laws, may pose threats to establishing or already established fitness surveillance systems. Additionally, the system may not be able to operate if its philosophy is not adopted across professional disciplines, reputational crises emerge, or political support fluctuates. 3.2 | Tensteps for designing a PF monitoring or surveillance system These guidelines are designed to offer practical steps, examples, and solutions to overcome commonlyobserved challenges when one is working toward establishing a novel system. The infographic is presented in Figure3. The interactive version of this infographic is displayed on the FitBack web portal and currently available in six language versions (English, Estonian, German, Spanish, Italian, and French) (10 steps to desig n a physi cal fitne ss monit oring syste m | FitBa ck (fitba ckeur ope. eu) ). In addition, a classical PDF infographic is currently available in 15 language versions (Brazilian Portuguese, Croatian, English, Estonian, French, FIGURE 2 Commonly experienced strengths, weaknesses, opportunities, and threats in population level physical fitness monitoring among schoolaged children. 16000838, 2024, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/sms.14593 by University Of Jyväskylä Library, Wiley Online Library on [26/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License