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CHAPTER 9

INTERPRETING FITNESSGRAM RESULTS

FITNESSGRAM uses criterion-referenced standards to evaluate tness performance. These standards have been established to represent a level of tness that offers some degree of protection against hypokinetic diseases (i.e., conditions that result from sedentary living). Performance is classied in two general areas: Healthy Fitness Zone (HFZ) and the Needs Improvement zone. Attaining the HFZ for a test indicates that the child has a sufcient tness level to provide important health benets. The Needs Improvement zone should be interpreted as an indication that the child may be at risk if that level of tness stays the same over time. This chapter explains how the criterionreferenced standards are established for the different assessments, how maturation and development can inuence tness results, and how to specically interpret results from the different dimensions of tness.

Derivation of CriterionReferenced Standards


To help children understand and interpret these results, it is important to have a basic understanding of how the standards are established. Unlike the percentile-based standards that are used in some tness batteries, the criterion-referenced standards used in FITNESSGRAM are anchored to an outcome that has inherent meaning and importance. Detailed information on the derivation of the criterion-referenced standards is available in the FITNESSGRAM Reference Guidesee the chapter Physical Fitness Standards for Children by Morrow and Falls. The following paragraphs provide brief descriptions of the basis for the standards. The aerobic capacity (cardiorespiratory tness) standards were based on results from a series of

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epidemiological research studies conducted by Dr. Steve Blair and colleagues at The Cooper Institute. These studies demonstrated that low tness levels are associated with a signicantly greater risk for coronary heart disease and early death. The risks were especially great for individuals in the bottom 20% of the sample population. The fact that individuals above this lowest tness category had reasonable protection from the health risks revealed that extremely high levels of tness were not needed for good health. The HFZ for FITNESSGRAM was established based on the documented results from these studies; but adjustments were made in these values to take into account differences in running economy with age, distribution of body fat with age, and other maturational factors. Thus, the HFZ values reect the range of scores (by age and sex) that would provide health benets if the same level of tness were maintained into adulthood. There is an upper range on the HFZ because epidemiological evidence also suggests that the additional improvements from progressively higher levels of tness are not signicant. Detailed information on the derivation of these standards is available in the chapter Aerobic Capacity Assessments in the FITNESSGRAM Reference Guide. Body composition standards are based on studies that document links between body fatness and some cardiovascular disease risks. Specically, studies have shown that children with body fat levels above 25% for boys and 30% to 35% for girls are more likely than others to exhibit elevated cholesterol levels and hypertension. The beginning of the HFZ corresponds to these levels of body fatness. The body mass index (BMI) values were established in a similar way. The Centers for Disease Control and Prevention (CDC) has recently released a new set of age- and sex-specic cutpoints for BMI that were developed to directly link with the widely used adult BMI standards. The BMI cutpoints are used in surveillance research by the CDC and in many published research studies, but it is important to note that these are percentile-based standards and are not based on criterion-referenced standards. While there are some differences between the CDC and FITNESSGRAM values, the FITNESSGRAM values tend to fall in between the levels used to designate the clinical designations of overweight and obesity. Therefore, the zone is set a bit higher than that used by public health researchers to dene overweight but lower than that used to dene obesity. Detailed information on the derivation of the FITNESSGRAM standards is available in the chapter Body Composition Assessment in the FITNESSGRAM Reference Guide.

Criterion-referenced standards for the musculoskeletal tness assessments are more difcult to establish than those for aerobic capacity or body composition. The reason is that there are few immediate health risks associated with poor musculoskeletal tness. Lack of strength, muscle endurance, and exibility may increase the risk of injuries and back problems later in life, but children are not as susceptible to these health problems. This delayed risk makes it more difcult to determine how much tness is needed to provide important health benets in this dimension of tness. The approach for most of these test items is to utilize a contrasting group methodology to determine the amount of tness in each of the tests that would be possible with a reasonable amount of training. By comparing a trained group to an untrained group it is possible to establish cutpoints that are empirically based and anchored to training responses from exercise rather than health outcomes. Tables 9.1 and 9.2 provide a list of standards that dene the HFZ for each of the assessments. All students should strive to achieve a score that places them inside the HFZ. It is possible for some students to score above the HFZ. FITNESSGRAM acknowledges performances above the HFZ but does not recommend this level of performance as an appropriate goal level for all students. However, students who desire to achieve a high level of athletic performance may need to consider setting goals beyond the HFZ. Students, especially younger students, may need assistance in setting realistic goals.

Inuence of Body Size and Maturity on Fitness


Body size (height and weight) is to some extent related to physical tness as measured by a combination of tests. Although there is much variability among individuals, the inuence of body size on tness is especially apparent in two ways: 1. Excess weight associated with fatness tends to have a negative inuence on aerobic capacity and on test items in which the body must be lifted or moved (e.g., upper body strength items). 2. Variation in body size associated with maturity can inuence tness around the time of the adolescent growth spurt and sexual maturation. There is considerable variation among individuals in the timing of this maturation period. In adequately nourished children, the timing is largely determined

TABLE 9.1

FITNESSGRAM Standards for Healthy Fitness Zone


BOYS PACER (no. of laps) Participation in run. Lap count standards not recommended. One-mile run (min:sec) Completion of distance. Time standards not recommended. 11:30 11:00 10:30 10:00 9:30 9:00 8:30 8:30 8:30 9:00 8:30 8:00 7:30 7:00 7:00 7:00 7:00 7:00 42 42 42 42 42 42 52 52 52 52 52 52 Walk test . (VO2max) Body mass index 20 20 20 20 20 21 21 22 23 24.5 25 26.5 27 27.8 14.7 14.7 14.9 15.1 15.2 15.3 15.8 16.0 16.6 17.5 18.1 18.5 18.8 19.0 Curl-up (no. completed) 2 2 4 6 9 12 15 18 21 24 24 24 24 24 10 10 14 20 24 24 28 36 40 45 47 47 47 47

Age 5 6 7 8 9 10 11 12 13 14 15 16 17 17+

. VO2max (ml kg 1 min1)

Percent fat 25 25 25 25 25 25 25 25 25 25 25 25 25 25 10 10 10 10 10 10 10 10 10 10 10 10 10 10

42 42 42 42 42 42 42 42 42

52 52 52 52 52 52 52 52 52

23 23 32 41 41 51 61 61 61

61 72 72 72 83 94 94 94 94

Age 5 6 7 8 9 10 11 12 13 14 15 16 17 17+

Trunk lift (inches) 6 6 6 6 6 9 9 9 9 9 9 9 9 9 12 12 12 12 12 12 12 12 12 12 12 12 12 12

90 push-up (no. completed) 3 3 4 5 6 7 8 10 12 14 16 18 18 18 8 8 10 13 15 20 20 20 25 30 35 35 35 35

Modied pull-up (no. completed) 2 2 3 4 5 5 6 7 8 9 10 12 14 14 7 7 9 11 11 15 17 20 22 25 27 30 30 30

Pull-up (no. completed) 1 1 1 1 1 1 1 1 1 2 3 5 5 5 2 2 2 2 2 2 3 3 4 5 7 8 8 8

Flexed arm hang (seconds) 2 2 3 3 4 4 6 6 12 15 15 15 15 15 8 8 8 8 10 10 13 13 17 20 20 20 20 20

Back-saver sit and reach* (inches) 8 8 8 8 8 8 8 8 8 8 8 8 8 8

Shoulder stretch Healthy Fitness Zone = touching ngertips together behind the back on both the right and left sides.

Number on left is lower end of HFZ; number on right is upper end of HFZ. *Test scored Pass/Fail; must reach this distance to pass.
1992, 1999, 2004 The Cooper Institute, Dallas, Texas.

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TABLE 9.1

FITNESSGRAM Standards for Healthy Fitness Zone


GIRLS PACER (no. of laps) Participation in run. Lap count standards not recommended. One-mile run (min:sec) Completion of distance. Time standards not recommended. 12:30 12:00 12:00 11:30 11:00 10:30 10:00 10:00 10:00 9:30 9:00 9:00 9:00 8:30 8:00 8:00 8:00 8:00 37 36 35 35 35 35 45 44 43 43 43 43 Walk test . (VO2max) Body mass index 21 21 22 22 23 23.5 24 24.5 24.5 25 25 25 26 27.3 16.2 16.2 16.2 16.2 16.2 16.6 16.9 16.9 17.5 17.5 17.5 17.5 17.5 18.0 Curl-up (no. completed) 2 2 4 6 9 12 15 18 18 18 18 18 18 18 10 10 14 20 22 26 29 32 32 32 35 35 35 35

Age 5 6 7 8 9 10 11 12 13 14 15 16 17 17+

. VO2max (ml kg1 min1)

Percent fat 32 32 32 32 32 32 32 32 32 32 32 32 32 32 17 17 17 17 17 17 17 17 17 17 17 17 17 17

40 39 38 37 36 35 35 35 35

48 47 46 45 44 43 43 43 43

15 15 23 23 23 23 32 41 41

41 41 41 51 51 51 61 61 61

Age 5 6 7 8 9 10 11 12 13 14 15 16 17 17+

Trunk lift (inches) 6 6 6 6 6 9 9 9 9 9 9 9 9 9 12 12 12 12 12 12 12 12 12 12 12 12 12 12

90 push-up (no. completed) 3 3 4 5 6 7 7 7 7 7 7 7 7 7 8 8 10 13 15 15 15 15 15 15 15 15 15 15

Modied pull-up (no. completed) 2 2 3 4 4 4 4 4 4 4 4 4 4 4 7 7 9 11 11 13 13 13 13 13 13 13 13 13

Pull-up (no. completed) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Flexed arm hang (seconds) 2 2 3 3 4 4 6 7 8 8 8 8 8 8 8 8 8 10 10 10 12 12 12 12 12 12 12 12

Back-saver sit and reach* (inches) 9 9 9 9 9 9 10 10 10 10 12 12 12 12

Shoulder stretch Healthy Fitness Zone = touching ngertips together behind the back on both the right and left sides.

Number on left is lower end of HFZ; number on right is upper end of HFZ. *Test scored Pass/Fail; must reach this distance to pass.
1992, 1999, 2004, The Cooper Institute, Dallas, Texas.

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by genetics. Within a given age group of earlyadolescent children, there will be great variation in the maturation level. Changes in body fatness and body size can have major effects on fitness test performance. Boys show a clear growth spurt in muscle mass, strength, power, and endurance and a decrease in subcutaneous fat on the arms and legs. Girls show considerably smaller growth spurts in strength, power, and endurance and tend to accumulate body fat compared to boys. During periods of rapid maturational change, children may experience an increase or decrease in their abilities to perform on certain test items completely independent of their levels of physical activity.

item will print (PACER, percent body fat, 90 push-up, back-saver sit and reach). While the assessments in the FITNESSGRAM battery have good reliability and validity, the results of the tests should still be used as only rough indicators. A number of factors can inuence tness scores, and most are not within a childs control. As mentioned previously, maturation and development can have a major impact on a childs tness scores. A childs tness level and response to training are also determined to a great degree by their genetics. Some children will improve performance more rapidly than others. Some children will be able to perform at a much higher level than others regardless of training levels. Rather than emphasizing a childs tness scores, it is more important to emphasize involvement in regular physical activity. Good physical tness levels will not be of much value if they are not maintained through continued involvement in physical activity. Built-in algorithms within the FITNESSGRAM software have been prepared to facilitate this type of instruction. If the FITNESSGRAM physical activity questions are completed (see chapter 8), the individualized feedback provided on the FITNESSGRAM report will factor in the childs responses to the physical activity questions. This allows a child to receive positive encouragement for being active even if he or she is not in the HFZ. Conversely, this feedback provides clear indications to other children that it is important to be active even if they are already t. The conceptual matrix in table 9.3 illustrates the general content of the integrated tness and activity feedback. Although the actual feedback will be specic for each dimension of tness (aerobic, musculoskeletal, and body composition) and will be more detailed, this chart illustrates the general concept. The questions are optional but strongly recommended. If children do not complete the questions, then the feedback will be based only on their tness scores, and this may send the wrong message. Because the different dimensions of tness are inuenced by different factors, the following sections provide specic information to help summarize how each dimension of tness should be interpreted and how each can be improved.

Interpreting Performance on Physical Fitness Assessments


The FITNESSGRAM report provides personalized feedback that can help a child (and parent) become more informed about levels of health-related tness. A sample report is shown in gure 9.1 to highlight some of the features. As is evident in the illustration, the report uses easy-to-read bar charts to indicate tness levels for each of the completed tests. Comparisons between the past and the current tests allow for some indication of trends over time. Personalized feedback messages that appear in the text blocks help provide individualized feedback to the students. The feedback is processed using internal algorithms in the software that take into account a childs overall tness prole. Students with favorable scores on the assessments (i.e., those reaching the HFZ) receive congratulatory messages and reminders to maintain their involvement in physical activity. Students with less favorable scores (i.e., those in the Needs Improvement zone) receive supportive messages and prescriptive feedback about how to be more active and how to improve their scores. If scores for more than one assessment in a tness area are entered in the software, the following guidelines are used to determine which result will be printed:

If one performance is in the HFZ and the other is not, the better performance will be printed. If the performances on all assessments are in the HFZ or are not in the HFZ, the default

Aerobic Capacity
Aerobic capacity indicates the ability of the respiratory, cardiovascular, and muscular systems to take up, transport, and utilize oxygen during . exercise and activity. A laboratory measure of VO2max is

FIGURE 9.1

Sample FITNESSGRAM computer report.

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Interpreting FITNESSGRAM Results

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TABLE 9.3

Conceptual Matrix Used to Integrate Fitness and Activity Results


Physically active? Yes No Congratulations.You are in the Healthy Fitness Zone. To keep t it is important that you do regular physical activity. Your scores were not in the Healthy Fitness Zone. Try to increase your activity levels to improve your tness and health.

Fitness results

Scores in Healthy Congratulations.You are in the Healthy FitFitness Zone ness Zone.You are doing regular physical activity and this is keeping you t. Scores not in Healthy Fitness Zone Even though your scores were not in the Healthy Fitness Zone, you are doing enough physical activity. Keep up the good work.

generally the best measure of aerobic capacity. In addition to providing the actual score on the onemile run, the PACER, or the walk test, FITNESS. GRAM calculates an estimated VO2max that may be used to compare performance from one test date to another or among different test items. A low score on the eld test estimates of aerobic capacity may be inuenced by many factors. These include

actual aerobic capacity level, body composition, running and walking efciency and economy, motivation level during the actual testing experience, extreme environmental conditions, ability to pace on the one-mile run and the walk test, and genetics and innate ability.

growing years. For girls, aerobic capacity tends to remain constant between ages 5 and 10 years but decreases after age 10 due to increasing sex-specic essential fat. Running economy, however, also exerts an inuence on absolute performance. In boys, for example, one-mile run and PACER test scores tend to . improve progressively with age, even though VO2max expressed relative to body weight tends to remain constant, because running economy improves. In 10- to 12-year-old girls, these eld test scores also tend to improve due to improved running economy; but between ages 12 and 18, scores tend to remain relatively constant because improved running economy is offset by declining . VO2max expressed relative to body weight. The differences in age-related changes in the relation of the one-mile run or PACER test scores to running economy are taken into .account when the scores are converted to estimate VO2max by equations in the FITNESSGRAM program software.

Body Composition
Body composition standards have been established for both percent body fat calculated from triceps and calf skinfold measurements (for college students, abdominal skinfold is also included) and for BMI calculated from measurements of weight and height. The standards represent the boundaries of the HFZ. Scores that fall either below or above this zone should receive attention, for these students have greater potential than others to develop health problems related to their level of fatness or leanness. Tables 9.4 and 9.5 have been adapted to indicate the HFZ for both percent fat and BMI. The HFZ begins at 25% fat for boys (20 to 27.8 BMI depending on age) and 32% fat for girls (21 to 27.3 BMI depending on age). Please notice that there is an

Changes in any of these factors may inuence the test score. Aerobic capacity can be improved substantially in an unconditioned person who participates regularly in sustained activities involving large muscle groups. The amount of improvement is related to the beginning level of tness and to the intensity, duration, and frequency of the training. The major part of the improvement will occur during the rst six months. Thereafter, improvement will be much slower. Boys and girls who are overfat may expect an improvement in the aerobic capacity measure with a reduction in body fat. Changes due to maturation can inuence results on the tests. For boys, aerobic capacity relative to body weight stays relatively constant during the

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TABLE 9.4

The FITNESSGRAM Body Composition Classication


BOYS 42 Very high Needs Improvement 38 35 31 28 High
(25)

Percent fat (all ages)

24 Mod. high

20

17

13

10 Low

7 Very low

Optimal range Healthy Fitness Zone

Body mass index (age) 5 6 7 8 9 10 11 12 13 14 15 16 17 1825 20 20 20 20 20 21 21 22 23 24.5 25 26.5 27 27.8

Very lean message 14.7 14.7 14.9 15.1 15.2 15.3 15.8 16.0 15.0 16.6 15.0 15.7 17.5 15.7 16.4 18.1 16.4 16.6 18.5 16.6 16.8 18.8 16.8 17.0 19.0 17.0

14.7 14.7 14.9 15.1 15.2 15.3 15.8 16.0 16.6 17.5 18.1 18.5 18.8 19.0

Adapted, by permission, from T. Lohman, 1987, The use of skinfold to estimate body fatness in children and youth, Journal of Physical Education, Recreation and Dance 58(9): 98-102.

optimal range within the HFZ. Ideally, students should strive to be within this optimal range, which is 10% to 20% fat for boys and 15% to 25% fat for girls. Using this chart may simplify the explanation of the body composition assessment item. A BMI in the Needs improvement range indicates that the students weight is too heavy for his or her height. When interpreting body composition scores, it is important to remember the following:

muscular development and a large percent of fat as being in the HFZ when the person is actually overfat. In general, students who score in the area above the HFZ should be encouraged to work toward this area by slowly changing their body weight through increased physical activity and decreased consumption of high-fat, high-calorie, low-nutrition foods. Changing dietary habits and exercise habits can be very difcult. Students with severe obesity or eating disorders may need professional assistance in their attempts to modify their behaviors. Evidence in adults clearly indicates that participation in regular physical activity moderates the health risks associated with obesity. Because this relationship likely holds for children as well, emphasis for overweight children should be on being physically active and not on absolute weight or fat loss. It is important to remember when interpreting body composition results that most students who

Skinfold measurements offer an estimate of body fatness. A 3% to 5% body fat measurement error is associated with the skinfold method. Body mass index provides an estimate of the appropriateness of the weight for the height. Body mass index may falsely identify a very muscular lean person as overfat (too heavy for height) or a lightweight person with little

Interpreting FITNESSGRAM Results

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TABLE 9.5

The FITNESSGRAM Body Composition Classication


GIRLS 43 Very high Needs Improvement 39 36 32 High 29 Mod. high 25 21 18(17) 14(13) Low 11 7 Very low Very lean message 16.2 16.2 16.2 16.2 16.2 16.6 16.9 16.9 17.5 17.5 17.5 17.5 17.5 18.0 14.9 14.9 14.9 14.9 14.9 15.0

Percent fat (all ages)

Optimal range

Body mass index (age) 5 6 7 8 9 10 11 12 13 14 15 16 17 1825 21 21 22 22 23 23.5 24 24.5 24.5 25 25 25 26 27.3

Healthy Fitness Zone

Adapted, by permission, from T. Lohman, 1987, The use of skinfold to estimate body fatness in children and youth, Journal of Physical Education, Recreation and Dance 58(9): 98-102.

are overfat may also have performances in other test areas that are outside the HFZ. An improvement in body composition will generally result in an improved performance in aerobic capacity and also muscle strength and endurance, especially in the upper body, due to a reduction in excess weight. For children above the age of 12 years, FITNESSGRAM also identies students who are very lean, having less than 8% fat for boys (less than 13.1 to 17.0 BMI depending on age) and 13% fat for girls (less than 14.1 to 15.0 BMI depending on age), with a message indicating that being this lean may not be best for health. Parents and teachers should notice students who are categorized as very lean and should consider factors that may be responsible for their low level of body fat. Many students may naturally be very lean while others may have inappropriate nutritional patterns. A few students may have an eating disorder. A factor to consider is whether the students level of fat has suddenly changed from within the optimal range to a level

identied as very lean. Severe changes may signal a potential problem. Creating awareness of a childs current status is the primary purpose in identifying lean students. Changes in status should be monitored. FITNESSGRAM results can be very helpful in allowing students to follow changes in their levels of body fat over time. Obesity is a health problem both for children and for adults, and results of tracking studies reveal that overweight and obesity track through the life span. To reduce problems with weight later in life, it is important to address the problem earlier, before the lifestyle patterns and physiological changes are rmly established.

Muscular Strength, Endurance, and Flexibility


Students who score poorly in one or more areas of muscle strength, endurance, and exibility should be encouraged to participate in calisthenics and

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other strengthening and stretching activities that will develop those areas. However, it is essential to remember that physical tness training is very specic and that the areas of the body being tested represent only a fraction of the total body. To focus on activities that develop the extensors of the arms without equal attention to the exors of the arms will not accomplish the important objective, which is to develop an overall healthy musculoskeletal system. Remember, you must have strength and exibility in the muscles on both sides of every joint. A useful activity for all students is to identify exercises to strengthen and stretch the muscles at every major joint of the trunk, upper body, and lower body. Poor performance on the measures of abdominal strength and trunk extensor strength and exibility may merit special attention. Gaining strength and exibility in these areas may help prevent low back pain, which affects millions of people, young and old.

Summary of Fitness Testing Principles


In interpreting performance on physical tness assessments, it is most important to remember the following:

The physical tness experience should always be fun and enjoyable. Physical tness testing should not become a competitive sport. The performance of one student should not be compared to that of another student. The primary reason for testing is to provide the student with personal information that may be used in planning a personal tness program. The performance level on tness tests should not be used as a basis for grading.

FITNESSGRAM does not advocate a recognition program that focuses primarily on tness performance. Recognition should reinforce the establishment of physical activity behaviors that will lead to tness development.