Health-related physical fitness and physical activity in elementary school students

A favorable built environment is associated with better physical fitness in European adolescents

<p dir="ltr">Background</p><p dir="ltr">Physical inactivity and functional decline represent significant challenges for aging populations, warranting effective intervention strategies and reliable assessment methodologies. This thesis investigated test-retest reliability of physical activity and fitness measurements in older adults, examined effects of structured exercise, and assessed longitudinal recovery trajectories in hip osteoarthritis patients following total hip arthroplasty (THA).</p><p dir="ltr">Methods</p><p dir="ltr">Four studies were conducted. Study I (n=78, age 70.9+4.7 years) evaluated accelerometer measurement reliability and monitored physical activity changes following an 8-week exercise intervention (twice-weekly, 60-minute combined training). Study II (n=1,407, age 65-84 years) assessed test-retest reliability of a comprehensive field-based fitness test battery and post an 8-week exercise period across multiple age groups. Study III (n=265, age 71.4+4.7 years) examined sustained and cumulative effects of identical 8-week exercise programs performed in consecutive years. Study IV (n=78, age 74.0+4.5 years) investigated physical fitness and activity patterns in hip osteoarthritis patients undergoing THA, with two assessments pre-operative, 4 months, and 1-year post-surgery.</p><p dir="ltr">Results</p><p dir="ltr">Physical activity parameters demonstrated good to excellent test-retest reliability. Similarly, field-based fitness tests generally showed good reliability across age and sex strata. The 8-week exercise intervention produced significant improvements in physical activity pattens and multiple physical fitness tests. Most fitness test parameters remained stable during the 9-month inter-intervention period, with declines observed in trunk strength endurance. Hip osteoarthritis patients exhibited pre-operative deficits compared to healthy controls in several fitness tests and in moderate- to vigorous physical activity, whereas post-operative improvements at 1-year follow-up were observed for a multitude of physical fitness parameters and exceeding the recommended physical activity levels.</p><p dir="ltr">Conclusions</p><p dir="ltr">This thesis established good test-retest reliability of accelerometer-measured physical activity and most included fitness assessments for monitoring older adults. Structured exercise generated physical activity and fitness benefits in healthy older adults. Moreover, substantial functional and activity improvements were seen following total hip arthroplasty without structured post-operative intervention. These findings underscore the importance of exercise engagement and appropriate surgical intervention to improve both functional capacity and physical activity in older adult populations.</p><h3>List of scientific papers</h3><p dir="ltr">This thesis includes four papers, these will be referenced using their Roman numerals listed below:</p><p dir="ltr">I. <b>Manne Godhe</b>, Marjan Pontén, Johnny Nilsson, Lena Kallings & Eva Andersson. Reliability of the accelerometer to control the effects of physical activity in older adults. Plos One, 17(9), e0274442. (2022). <br><a href="https://doi.org/10.1371/journal.pone.0274442">https://doi.org/10.1371/journal.pone.0274442</a><br><br></p><p dir="ltr">II. <b>Manne Godhe</b>, Gustaf Rönquist, Johnny Nilsson, Örjan Ekblom, Lillemor Nyberg, Gustav Edman, & Eva Andersson Reliability in Novel Field-Based Fitness Measurements and Postexercise Scores from a Physical Fitness Test Battery in Older Adults. Gerontology, 70(6), 639-660. (2024). https://doi.org/10.1159/000538446<br><a href="https://doi.org/10.1159/000538446">https://doi.org/10.1159/000538446</a><br><br></p><p dir="ltr">III. <b>Manne Godhe</b>, Johnny Nilsson, & Eva Andersson. Short-and Long-Term Effects on Physical Fitness in Older Adults: Results from an 8-Week Exercise Program Repeated in Two Consecutive Years. Geriatrics, 10(1), 15. (2025). https://doi.org/10.3390/geriatrics10010015<br><a href="https://doi.org/10.3390/geriatrics10010015">https://doi.org/10.3390/geriatrics10010015</a><br><br></p><p dir="ltr">IV. <b>Manne Godhe</b>, Anders Stålman, Johnny Nilsson & Eva Andersson. Physical fitness Improvements and Achievement of Recommended Physical Activity Levels One Year After Total Hip Arthroplasty: A Longitudinal Study of Physical Function and Activity Patterns [Manuscript]</p><p dir="ltr">Papers I & III were published under Creative Commons CC BY license. Paper II is reproduced in this thesis with permission from Karger Publishers. Paper IV is in manuscript form.</p>

<p dir="ltr">Background</p><p dir="ltr">Physical inactivity and functional decline represent significant challenges for aging populations, warranting effective intervention strategies and reliable assessment methodologies. This thesis investigated test-retest reliability of physical activity and fitness measurements in older adults, examined effects of structured exercise, and assessed longitudinal recovery trajectories in hip osteoarthritis patients following total hip arthroplasty (THA).</p><p dir="ltr">Methods</p><p dir="ltr">Four studies were conducted. Study I (n=78, age 70.9+4.7 years) evaluated accelerometer measurement reliability and monitored physical activity changes following an 8-week exercise intervention (twice-weekly, 60-minute combined training). Study II (n=1,407, age 65-84 years) assessed test-retest reliability of a comprehensive field-based fitness test battery and post an 8-week exercise period across multiple age groups. Study III (n=265, age 71.4+4.7 years) examined sustained and cumulative effects of identical 8-week exercise programs performed in consecutive years. Study IV (n=78, age 74.0+4.5 years) investigated physical fitness and activity patterns in hip osteoarthritis patients undergoing THA, with two assessments pre-operative, 4 months, and 1-year post-surgery.</p><p dir="ltr">Results</p><p dir="ltr">Physical activity parameters demonstrated good to excellent test-retest reliability. Similarly, field-based fitness tests generally showed good reliability across age and sex strata. The 8-week exercise intervention produced significant improvements in physical activity pattens and multiple physical fitness tests. Most fitness test parameters remained stable during the 9-month inter-intervention period, with declines observed in trunk strength endurance. Hip osteoarthritis patients exhibited pre-operative deficits compared to healthy controls in several fitness tests and in moderate- to vigorous physical activity, whereas post-operative improvements at 1-year follow-up were observed for a multitude of physical fitness parameters and exceeding the recommended physical activity levels.</p><p dir="ltr">Conclusions</p><p dir="ltr">This thesis established good test-retest reliability of accelerometer-measured physical activity and most included fitness assessments for monitoring older adults. Structured exercise generated physical activity and fitness benefits in healthy older adults. Moreover, substantial functional and activity improvements were seen following total hip arthroplasty without structured post-operative intervention. These findings underscore the importance of exercise engagement and appropriate surgical intervention to improve both functional capacity and physical activity in older adult populations.</p><h3>List of scientific papers</h3><p dir="ltr">This thesis includes four papers, these will be referenced using their Roman numerals listed below:</p><p dir="ltr">I. <b>Manne Godhe</b>, Marjan Pontén, Johnny Nilsson, Lena Kallings & Eva Andersson. Reliability of the accelerometer to control the effects of physical activity in older adults. Plos One, 17(9), e0274442. (2022). <br><a href="https://doi.org/10.1371/journal.pone.0274442">https://doi.org/10.1371/journal.pone.0274442</a><br><br></p><p dir="ltr">II. <b>Manne Godhe</b>, Gustaf Rönquist, Johnny Nilsson, Örjan Ekblom, Lillemor Nyberg, Gustav Edman, & Eva Andersson Reliability in Novel Field-Based Fitness Measurements and Postexercise Scores from a Physical Fitness Test Battery in Older Adults. Gerontology, 70(6), 639-660. (2024). https://doi.org/10.1159/000538446<br><a href="https://doi.org/10.1159/000538446">https://doi.org/10.1159/000538446</a><br><br></p><p dir="ltr">III. <b>Manne Godhe</b>, Johnny Nilsson, & Eva Andersson. Short-and Long-Term Effects on Physical Fitness in Older Adults: Results from an 8-Week Exercise Program Repeated in Two Consecutive Years. Geriatrics, 10(1), 15. (2025). https://doi.org/10.3390/geriatrics10010015<br><a href="https://doi.org/10.3390/geriatrics10010015">https://doi.org/10.3390/geriatrics10010015</a><br><br></p><p dir="ltr">IV. <b>Manne Godhe</b>, Anders Stålman, Johnny Nilsson & Eva Andersson. Physical fitness Improvements and Achievement of Recommended Physical Activity Levels One Year After Total Hip Arthroplasty: A Longitudinal Study of Physical Function and Activity Patterns [Manuscript]</p><p dir="ltr">Papers I & III were published under Creative Commons CC BY license. Paper II is reproduced in this thesis with permission from Karger Publishers. Paper IV is in manuscript form.</p>

Physical Activity Measures in the Healthy Communities Study.

Exercise Strategies for Children

Objective: The primary objective of this study was to evaluate the feasibility and preliminary efficacy of a school-based physical fitness intervention (Fit4Fun) on the physical fitness and physical activity (PA) levels of primary school children. Methods: A group-randomized controlled trial with a 3-month wait-list control group was conducted in two primary schools in the Hunter Region, NSW, Australia. Participants (n = 48 students; mean age = 10.9 years ± 0.7) were randomized by the schools into the Fit4Fun intervention (n = 32 students) or the control (n = 17) conditions. Fit4Fun was an 8-week programme that included: 8 × 60 min health and physical education (HPE) lessons, a break-time activity programme (recess and lunch) and a home fitness programme. The control group participated in their usual weekly 60 min HPE lessons. Assessments were taken at baseline and post-intervention (8-week) to determine changes in health-related fitness (HRF) levels, PA and attitudes towards HRF testing. Objectively measured PA (mean steps/day) was assessed using 7 days of pedometery and HRF was assessed using a battery of tests including: seven-stage sit-up test, push-up test, basketball throw, wall squat, sit and reach, shoulder stretch, 20 m shuttle test, and height and weight measurements. A questionnaire was also administered to assess perceptions of physical fitness and physical fitness testing and changes in attitudes to fitness testing. Intervention effects were assessed using analysis of covariance and Cohen's d effect sizes are reported. Results: Children in the intervention group improved in all HRF measures with significant group × time effects (p < 0.05) observed in the seven-stage sit-up test (d = 0.9), the sit and reach tests (right leg d = 1.0, left leg d = 0.9, both legs d = 1.1) and the wall squat tests (right leg d = 0.9, left leg d = 0.6). No significant group × time effect was found in the beep test, basketball throw, PA measure or psychological measures. The control group did not display significant within-group effects for any measure. Conclusions: Results indicate that a multi-component HRF intervention for primary school children that targeted the three areas of a health-promoting school and incorporated social support for participation in physical fitness activities was feasible and efficacious in improving muscular fitness and flexibility levels of children. Trial registration: Australian New Zealand Clinical Trials Registry No: ACTRN12610000642088.

This study aimed to examine the associations between objectively measured physical activity (PA), sedentary time, and health-related fitness and to investigate the combined association of PA and sedentary time on health-related fitness in youths. PA and sedentary time were assessed with accelerometers in 2506 youths age 10-18 yr (M(age) = 13.2 ± 2.3). Participants were classified as active (≥60 min·d(-1) of moderate-to-vigorous physical activity (MVPA)) versus inactive (<60 min·d(-1) of MVPA) and as "low sedentary" versus "high sedentary" (according to the median value of sedentary time per day) and thereafter grouped as active/low sedentary, active/high sedentary, inactive/low sedentary, and inactive/high sedentary. Five physical fitness tests (body mass index, push-ups, curl-ups, sit and reach, and the Progressive Aerobic Cardiovascular Endurance Run test) were assessed with FITNESSGRAM, and participants were categorized as being in the healthy fitness zone (HFZ) versus the unhealthy fitness zone. A fitness composite score was calculated using the individual fitness test z-score. Regression models were used to examine the relation between PA, sedentary time, and physical fitness. Time spent in MVPA (min·d(-1)) (β = 0.002, P < 0.001) was significantly associated with fitness score independent of sedentary time. Sedentary time was not associated with physical fitness independent of MVPA. Compared with the inactive/high sedentary group (referent), being categorized as active/low sedentary was associated with increased likelihood of being in the HFZ for sit and reach (odds ratio, 2.55; 95% confidence interval, 1.96-3.32) and having a higher fitness composite score (odds ratio, 1.38; 95% confidence interval, 1.13-1.69). Time in MVPA was associated with better physical fitness independent of sedentary time. Participants classified as active/low sedentary had higher odds of being in the HFZ, for flexibility, and to have a better fitness composite score. These findings suggest that time in MVPA contributes to better physical fitness in youths.

Physically active students are more likely to be fit and learn better in school than sedentary ones. For school-aged children, it is unclear whether physical fitness level is an important determinant for student’s activity afterschool. This study examined the association between health-related physical fitness test performance and afterschool physical activity during weekdays. Participants (n = 97, 11–13 years old) completed health-related fitness tests. They wore Actigraph GT3X accelerometers for five consecutive days, recording physical activity participation during after school hours. Descriptive statistics for both afterschool physical activity and health-related fitness were summarized. Regression analyses were conducted to determine the association between variables. Participants spent most of their afterschool hours participating in sedentary behaviors (274.27 ± 66.89 min) and light physical activity (73.68 ± 51.66 min), and only 11.35 ± 16.92 min of moderate-to-vigorous physical activity (MVPA), accumulating approximately 2058.52 ± 1690.56 steps each day afterschool. The regression model explained 22.8% of the variance in afterschool MVPA, and Progressive Aerobic Cardiovascular Endurance Run (PACER) scores were the only statistically significant predictor (β = 0.47, p &lt; 0.01). Fit students do tend to exercise more after school. Promoting physical fitness in school is an important factor for students’ afterschool physical activity participation during weekdays.

Physical activity (PA) and physical fitness (PF) are crucial for bone health. However, children participating in competitive sports with high PA are at a greater risk of fracture from trauma or overuse. Given the importance of bone development during adolescence, associations between commonly used physical fitness tests with distal third radius (R-SoS) and midshaft tibia (T-SoS) speed of sound by quantitative ultrasound were assessed in adolescent athletes and nonathletes. The relationship between physical fitness tests and R-SoS and T-SoS will differ depending on sex and athletic status. Cross-sectional study. Level 3. Physical fitness of 285 boys (156 athletes) and 311 girls (74 athletes) aged 10 to 18 years was assessed through strength, speed, agility, and cardiorespiratory tests. Linear regression was used to assess the associations of physical fitness tests with R-SoS and T-SoS. For boys, favorable associations were observed between physical fitness tests with R-SoS in athletes and T-SoS in both athletes and nonathletes (P < 0.05). For nonathlete girls, favorable associations were found for handgrip (R-SoS and T-SoS, both P < 0.05), whereas the progressive aerobic cardiovascular endurance run, vertical jump, speed at 20 m and 40 m were only favorably associated with T-SoS. For athlete girls, the association between handgrip (P = 0.03), vertical jump, and 4 × 10 m shuttle run (P < 0.05) with T-SoS was significantly related to a bone outcome. The handgrip test and vertical jump were associated with T-SoS in boys and girls independent of sport status. These results suggest that physical fitness is associated with bone health in adolescents, particularly boys, and that the relationship between physical fitness and bone may differ depending on sex and athletic status. Physical fitness tests are simple, easy-to-use tools for monitoring bone health and should be used by sport and health professsionals to promote healthy sport participation and prevent bone injuries.

Investigate the associations between the timing of moderate-to-vigorous physical activity and health-related physical fitness in children and adolescents. Cross-sectional study. This is a secondary analysis of data from a surveillance of Portuguese children and adolescents' physical fitness and physical activity. Moderate-to-vigorous physical activity was determined using accelerometry whereas physical fitness was determined using the FITESCOLA® battery test, the handgrip strength test, and the body mass index. Moderate-to-vigorous physical activity was defined per morning, afternoon, and total moderate-to-vigorous physical activity. A total of 2641 participants (54.9 % girls) accumulated 37.7 ± 24.2 min·day-1 of moderate-to-vigorous physical activity. Afternoon moderate-to-vigorous physical activity was associated with 20 m shuttle run, standing long jump, push-ups and curl-ups, while morning moderate-to-vigorous physical activity was associated with standing long jump and inversely associated with speed 40 m. Compared to morning and afternoon moderate-to-vigorous physical activity, total moderate-to-vigorous physical activity was more consistently associated with most physical fitness tests (20 m shuttle run, standing long jump, push-ups, curl-ups, speed 20 m, and speed 40 m). The body mass index was only inversely associated with morning moderate-to-vigorous physical activity. The associations between moderate-to-vigorous physical activity and health-related physical fitness seemed to be related to total moderate-to-vigorous physical activity accumulated throughout the day rather than the timing of moderate-to-vigorous physical activity. The morning moderate-to-vigorous physical activity was inversely associated with the body mass index, suggesting that time-of-day moderate-to-vigorous physical activity may play a role in body composition.

Physical Education, Exercise, Fitness and Sports: Early PM&R Leaders Build a Strong Foundation

The main problem in achieving learning outcomes in physical subjects at the primary school level is very complex. This study aimed to investigate the relationship between physical fitness, body fat, BMI, and physical activity levels with physical education learning outcome in elementary school students. A cross-sectional study was conducted to answer the research questions. This study involved 27 students (Aged 10.820.79) from elementary schools in Malang City, Indonesia. Instruments to determine physical fitness include endurance (PACER Test), flexibility (V sit and reach), and strength (sit-ups and squat thrust), the Indonesian Physical Fitness Test was used to determine body fat and Body Mass Index (BMI), and Physical Activity Questionnaire for Children (PAQ-C) was used to determine physical activity levels. The research result showed that physical fitness, body fat, BMI, and physical activity level were closely related to learning outcomes (R of 0.821), but only physical fitness influences physical fitness (Sig. &amp;lt; 0.05), while body fat, BMI, and physical activity level had no effect. In conclusion, students with good physical fitness tend to get good learning outcomes, so the physical education curriculum must accommodate physical activities that can increase the physical fitness level of students. Future research on academic success factors needs to be investigated, especially schools need to promote movement-based activities to support academic success.

The purpose of this study was to determine fifth grade students' perceptions of the Fitnessgram physical fitness testing program. This study examined if the Fitnessgram physical fitness testing experience promotes an understanding of the health-related fitness components and examined the relationship between individual fitness test scores and time spent participating in out-of-school physical activity. Lastly, students' thoughts and feelings concerning the Fitnessgram experience were examined. The primary participant population for the study was 110 fifth grade students at Redland Elementary School, a Miami-Dade County Public School (M-DCPS). Data were collected over the course of 5 months. Multiple sources of data allowed for triangulation. Data sources included Fitnessgram test scores, questionnaires, document analysis, and in-depth interviews. Interview data were analyzed qualitatively for common broad themes, which were identified and defined. Document analysis included analyzing student fitness test scores and student questionnaire data. This information was analyzed to determine if the Fitnessgram test scores have an impact on student views about the school fitness-testing program. Data were statistically analyzed using analysis of frequency, crosstabulations (Bryman & Duncan, 1997), and Somers'd Correlation (Bryman & Duncan, 1997). The results of the analysis of data on student knowledge of the physical fitness components tested by each Fitnessgram test revealed students do not understand the health-related fitness components. The results of determining a relationship between individuals' fitness test scores and time spent in out-of-school physical activity revealed a significant positive relationship for 2 of the 6 Fitnessgram tests. The results of examining students' thoughts and feelings about each Fitnessgram test focused around 2 broad themes: (a) these children do not mind the physical fitness testing and (b) how they felt about the experience was directly related to how they thought they had performed. If the goal of physical fitness was only to get children fit, this test may be appropriate. However, the ultimate goal of physical fitness is to encourage students to live active and healthy lifestyles. Findings suggest the Fitnessgram as implemented by M-DCPS may not be the most suitable measurement instrument when assessing attitudinal changes that affect a healthy lifelong lifestyle. ^

Simple SummaryVitamin D is a fat-soluble prohormone crucial for bone mineralization, muscle contractility, and neurological conductivity. It is theorized that Vitamin D plays an important role in sport performances, especially in young athletes. In this study we examined the associations of levels of 25-hydroxyvitamin D (25(OH)D) with physical fitness and motor-performance achievements in youth soccer players from Southern Croatia. Participants were tested on physical fitness, motor performance and vitamin D at the end of the winter period, when levels of vitamin D are known to be lowest due to low exposure to sunlight. Results showed that deficiency of 25(OH)D was widespread among youth soccer players living in Southern Croatia. Low 25(OH)D levels were associated with lower results in fitness tests (i.e., tests of energetic capacities), but there was no correlation between 25(OH)D levels and the results in motor performance tests (i.e., skill tests). Our results support the theory of the association between vitamin D and energetic capacities of athletes, but there is no evidence on association between vitamin D and skill-based capacities.Vitamin D level is known to be a factor potentially influencing physical fitness, but few studies have examined this phenomenon among youth athletes. We aimed to evaluate the associations of vitamin D levels (as measured by 25-hydroxyvitamin D concentrations—25(OH)D) with various physical fitness and motor performance tests in youth football (soccer) players. This cross-sectional study included a total of 52 youth soccer players (15.98 ± 2.26 years old) from Southern Croatia. The participants were evaluated at the end of the winter period and data were collected of anthropometric measures (body mass and body height), vitamin D status (25(OH)D levels), physical fitness tests (sprints of 10 and 20 m, 20 yards test, the countermovement jump, the reactive strength index (RSI)) and motor performance tests (the soccer-specific CODS, the soccer-specific agility, and static balance). Among the studied players, 54% had 25(OH)D insufficiency/deficiency, showing a lack of 25(OH)D is widespread even in youth athletes living at a southern latitude. The 25(OH)D level was correlated with sprint 20 m, 20 yards tests, and RSI, showing a greater role of 25(OH)D in physical fitness tests where energetic capacity is essential than in sport-related motor performance tests where skills are crucial. Our results support the idea that vitamin D can play a determinant role in physical fitness tests with a clear physiological component, but is not crucial in motor performance tests related to specific sports where skills are a key component. Future studies should investigate the effects of vitamin D supplementation on the performance in physical fitness and motor performance tests among youth athletes.

Background. Pre-school age is the period of especially fast growth and physical development, characterized by an intensive growth and development of a child’s organism, great changes in the activity of the functional systems, which is affected by increasing physical activeness and fitness (Grinienė &amp; Vaitkevičius, 2009; Howells &amp; Sääkslahti, 2019). Previous studies have identified parental influence as a factor that can shape a child’s physical self–perception and act as a stimulus for physical activity and fitness (Eddolls, McNarry, Stratton, &amp; Mackintosh, 2016). The aim of this study was to indicate physical activity of 5–6-year-old children and to determine the interaction between parents’ physical activity and physical fitness data.&#x0D; Methods. The study involved pre-school age children (n = 59) from 5 to 6 years old: 31 girls and 21 boys; also, their parents (n = 101) were involved: 57 mothers and 44 fathers. Physical activity was measured objectively using the ActiGraph GT3X model. The children performed five physical fitness tests (PFT) according to the Eurofit methodology. Also, parents were asked to fill in questionnaires about their own and their children’s physical activity, and also subjective physical fitness.&#x0D; Results. It turned out that there was a significant difference in the time spent in moderate and moderate to vigorous (MVPA) physical activity between 5 to 6-year-old children (p &lt; .05). Comparing pre-school children’s physical fitness by gender we found that boys were more physically fit than girls when performing long jumps, but girls were more physically fit than boys when performing a sit and reach test (p &lt; .05). Subjectively measured PA identified that 72.6% of parents (of both genders) were sufficiently physically active and 27.4% were inadequate physically active.&#x0D; Conclusion. The results revealed that 6-year-old children spent more time in sedentary time than 5-year-olds, who accumulated more time in moderate and total MVPA physical activity per day. No significant relation was found between parents’ and children’s physical activity and fitness.&#x0D; &#x0D; Keywords: physical activity, physical fitness, pre-school child, health, parents.