Abstract Recurrent climate-driven disturbances impact on the health of European forests that reacted with increased tree dieback and mortality over the course of the last four decades. There is therefore large interest in predicting and understanding the fate and survival of forests under climate change. Forest conditions are monitored within the pan-European ICP Forests programme (UN-ECE International Co-operative Programme on Assessment and Monitoring of Air Pollution Effects on Forests) since the 1980s, with tree crown defoliation being the most widely used parameter. Defoliation is not a cause-specific indicator of tree health and vitality, and there is a need to connect defoliation levels with the physiological functioning of trees. The physiological responses connected to tree crown defoliation are species-specific and concern, among others, water relations, photosynthesis and carbon metabolism, growth, and mineral nutrients of leaves. The indicators to measure physiological variables in forest monitoring programs must be easy to apply in the field with current state-of-the-art technologies, be replicable, inexpensive, time efficient and regulated by ad hoc protocols. The ultimate purpose is to provide data to feed process-based models to predict mortality and threats in forests due to climate change. This study reviews the problems and perspectives connected to the realization of a systematic assessment of physiological variables and proposes a set of indicators suitable for future application in forest monitoring programs.