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 sel -a chi ed e sion o an o iginal a icle. This e sion may di e om he o iginal in pagina ion and ypog aphic de ails. Au ho (s): Ti le: Yea : Ve sion: Copy igh : Righ s: Righ s u l: Please ci e he o iginal e sion: CC BY 4.0 h ps://c ea i ecommons.o g/licenses/by/4.0/ How o design and es ablish a na ional school‐based physical i ness moni o ing and su eillance sys em o child en and adolescen s : A 10‐s ep app oach ecommended by he Fi Back ne wo k © 2024 The Au ho s. Scandina ian Jou nal o Medicine & Science In Spo s published by John Wiley & Sons L d. Published e sion Joensuu, Lau a; Csányi, Tamás; Huh iniemi, Mikko; Kälbi, Ka alin; Magalhães, João; Milano ić, I ana; Mo ison, Shawnda A.; O ega, F ancisco B.; Sa dinha, Luis B.; S a c, G ego ; Tammelin, Tuija H.; Ju ak, G ego Joensuu, L., Csányi, T., Huh iniemi, M., Kälbi, K., Magalhães, J., Milano ić, I., Mo ison, S. A., O ega, F. B., Sa dinha, L. B., S a c, G., Tammelin, T. H., & Ju ak, G. (2024). How o design and es ablish a na ional school‐based physical i ness moni o ing and su eillance sys em o child en and adolescen s : A 10‐s ep app oach ecommended by he Fi Back ne wo k. Scandina ian Jou nal o Medicine and Science in Spo s, 34(3), A icle e14593. h ps://doi.o g/10.1111/sms.14593 2024 Scand J Med Sci Spo s. 2024;34:e14593. | 1 o 14 h ps://doi.o g/10.1111/sms.14593 wileyonlinelib a y.com/jou nal/sms Recei ed: 1 Oc obe 2023 | Re ised: 23 Feb ua y 2024 | Accep ed: 26 Feb ua y 2024 DOI: 10.1111/sms.14593 REVIEW How o design and es ablish a na ional school- based physical i ness moni o ing and su eillance sys em o child en and adolescen s: A 10- s ep app oach ecommended by he Fi Back ne wo k Lau aJoensuu1,2 | TamásCsányi3,4 | MikkoHuh iniemi2 | Ka alinKälbi4,5 | JoãoMagalhães6 | I anaMilano ić7 | Shawnda A.Mo ison8,9 | F ancisco B.O ega2,10 | Luis B.Sa dinha6 | G ego S a c8 | Tuija H.Tammelin1 | G ego Ju ak8 | on behal o he Fi Back Ne wo k 1LIKES, Jamk Uni e si y o Applied Sciences, Jy äskylä, Finland 2Facul y o Spo and Heal h Sciences, Uni e si y o Jy äskylä, Jy äskylä, Finland 3Depa men o Physical Educa ion Theo y and Me hodology, Hunga ian Uni e si y o Spo s Science, Budapes , Hunga y 4Hunga ian School Spo Fede a ion, Budapes , Hunga y 5Eö ös Lo ánd Uni e si y (ELTE) Bá czi Gusz á Facul y o Special Needs Educa ion, Ins i u e o he Me hodology o Special Needs Educa ion and Rehabili a ion, Budapes , Hunga y 6Exe cise and Heal h Labo a o y, CIPER, Faculdade de Mo icidade Humana, Uni e sidade de Lisboa, C uz Queb ada, Po ugal 7Facul y o Spo s and Physical Educa ion, Uni e si y o Belg ade, Belg ade, Se bia 8Facul y o Spo , Uni e si y o Ljubljana, Ljubljana, Slo enia 9Human Po en ial T ansla ional Resea ch P og amme, Yong Loo Lin School o Medicine, Na ional Uni e si y o Singapo e, Singapo e, Singapo e 10Depa men o Physical Educa ion and Spo s, Facul y o Spo Sciences, Spo and Heal h Uni e si y Resea ch Ins i u e (iMUDS), Uni e si y o G anada and CIBEROBN Physiopa hology o Obesi y and Nu i ion, G anada, Spain Co espondence Lau a Joensuu, Facul y o Spo and Heal h Sciences, Uni e si y o Jy äskylä, Rau pohjanka u 8, Jy äskylä 40700, Finland. Email: lau a.p[email p o ec ed] Funding in o ma ion Slo enian Resea ch Agency wi hin he Resea ch p og amme Bio- psycho- social con ex o kinesiology, G an /Awa d Numbe : P5- 0142; E asmus+ Spo P og amme o he Eu opean Union, G an /Awa d Numbe : 613010- EPP- 1- 2019- 1- SI- SPO- SCP Abs ac Backg ound: P o iding indi idual- and popula ion- le el da a on child en's physical i ness (PF) is a c ucial public heal h and educa ion p io i y. Howe e , ew na ional i ness moni o ing o su eillance sys ems a e cu en ly in p ac ice in e na ionally. We aim o summa ize he cu en Eu opean PF moni o ing and su eillance sys ems o school- aged child en and o p o ide expe ience- based guidelines on how o design such sys ems. Me hods: The Fi Back ne wo k consis s o expe s om di e se backg ounds wi h he common in e es o imp o e he accessibili y o PF moni o ing o young people globally. Th ough Fi Back ne wo k, we iden i ied and compa ed he na- ional o egional PF moni o ing and su eillance sys ems cu en ly in ope a ion ac oss Eu ope. We o mula ed a 10- s ep app oach o designing and es ablishing This is an open access a icle unde he e ms o he C ea i e Commons A ibu ion License, which pe mi s use, dis ibu ion and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. © 2024 The Au ho s. Scandina ian Jou nal o Medicine & Science In Spo s published by John Wiley & Sons L d. Tuija H. Tammelin and G ego Ju ak con ibu ed equally o his wo k. 2 o 14 | JOENSUU e al. 1 | INTRODUCTION Physical i ness (PF) e e s o a se o a ibu es ha an indi idual has o achie es,1 which p o ide an abil- i y o ca y ou daily asks wi h igo , ale ness, and ample ene gy o enjoy leisu e- ime pu sui s o o mee an un o eseen eme gency.2 These a ibu es include: body composi ion (p opo ion o di e en issues in he human body), ca dio espi a o y i ness (abili y o he whole- body o sus ain p olonged pe o mance), muscu- loskele al i ness wi h muscula s eng h and endu ance (muscle p ope ies enabling wo k) and lexibili y ( ange o mo ion a ailable a a join o g oup o join s), and mo o i ness (speed o mo emen , agili y, and coo di- na ion).3–5 The e is subs an ial accumula ed e idence suppo ing he impo ance o main aining adequa e PF a a young age, no only limi ed o one's unc ional capaci y and pe o mance, bu also in e ms o encou - aging li elong heal h and educa ional aspec s. Physical i ness in you h is consis en ly associa ed wi h a o able educa ional a ainmen , b ain p ope ies and cogni i e unc ion,6–11 soma ic and men al heal h,12–14 as well as lowe mo bidi y and mo ali y la e in li e.15–18 Physical i ness also associa es closely wi h physical li e acy— he “mo i a ion, con idence, physical compe ence, knowl- edge and unde s anding o alue and ake esponsibili y o engagemen in physical ac i i ies o li e,”19 a con- s uc ha is well- posi ioned in educa ional policies as a key componen o main aining a heal hy and ac i e li es yle.20,21 The secula ends o child en- and adolescen - speci ic i ness componen s a ies based on he socie al and en i- onmen al ac o s child en ace o e ime.22 Fi ness mon- i o ing and su eillance is an una oidable con empo a y opic since many global p essu es (e.g., con lic , clima e change, pandemics, and cul u al e olu ion h ough ech- nological de elopmen ) can di ec ly (o indi ec ly) nega- i ely a ec child PF.23 Su eying childhood i ness a scale can cap u e a wide a ie y o physical a ibu es, which a e highly ele an o cha ac e izing child en and adolescen s' cu en and u u e heal h ou comes, and complemen s al- eady exis ing amewo ks, which egula ly moni o 24- h mo emen beha io s such as physical ac i i y, seden a y beha io , and sleep.24 Physical i ness moni o ing and su eillance was one o he op 10 p io i ies ou lined by in e na ional expe s in he i ness domain,25 and he de- elopmen o such sys ems is a high p io i y o enhance he desc ip ion o child en and adolescen s heal h s a us globally. Accu a e ongoing assessmen s o he s a e o a popula ion's i ness can also be used o c ea e mo e e ec- i e policy in e en ions when u u e ex e nal challenges o socie y ine i ably a ise. He ein, we e e o “moni o ing” as obse ing and/o assessing he changes o one's i ness o e ime, usually o a special pu pose (e.g., educa ional o heal h- ela ed), whe eas “su eillance” emphasizes he impo ance o dissemina ing he da a and ela ed indings o pa ies e- sponsible o p e en ing and con olling public heal h con- ce ns.26 Globally, he e a e limi ed examples o a - scale PF moni o ing and su eillance sys ems in ope a ion.24,25,27,28 one's own sys em, based on analysis o expe ienced s eng hs, weaknesses, op- po uni ies, and h ea s o moni o ing childhood i ness. Resul s: We iden i ied a o al o eigh PF moni o ing sys ems in Finland, F ance, Galicia o Spain, Hunga y, Li huania, Po ugal, Se bia, and Slo enia. The Fi Back ne wo k ecommends he ollowing s eps o designing and es ablishing one's own sys em: (1) se up mission s a emen s and aims, (2) in ol e s akeholde s, (3) u ilize scien i ic backg ound, (4) go e nance s uc u e, (5) ensu e su icien und- ing, (6) da a managemen planning, (7) p o ide meaning ul eedback, (8) conduc pilo es ing, (9) plan implemen a ion p ocess, and (10) in es in communica ion wi h s akeholde s. Conclusions: This s udy p o ides an upda ed o e iew o he bes p ac- ices o school- aged child en's i ness moni o ing and su eillance in Eu ope. Addi ionally, i o e s a 10- s ep app oach o assis in he c ea ion o simila sys- ems in Eu ope o globally. KEYWORDS assessmen , disease p e en ion, educa ion, epidemiology, NCDs, physical li e acy, policy, popula ion heal h 16000838, 2024, 3, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/sms.14593 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [26/03/2024]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License | 3 o 14 JOENSUU e al. Fo he ones ha do exis , hei de elopmen is bes op- e a ionalized h ough he in e na ional coope a ion o di- e se pa ne s in science, ci il socie ies, and educa ional o ganiza ions.29 P e iously, mos o his wo k ega ding sys ema ic i ness moni o ing has been a he compa - men alized and localized. To add ess his dispa i y, he Eu opean Union E asmus+ Spo unded a la ge- scale p ojec named “The Eu opean Ne wo k o he Suppo o De elopmen o Sys ems o Moni o ing Physical Fi ness o Child en and Adolescen s' (abb e ia ed as ‘Fi Back’).”30 Fi Back is a nonp o i coali ion o 10 Eu opean ounde - membe s who ha e had expe ise conduc ing child i ness assessmen , moni o ing, o su eillance a he popula ion le el. The Fi Back p ojec builds on a p e ious Eu opean Union- unded wo k called he “ALPHA p ojec ,” which es ablished and e alua ed an e idence- based heal h- ela ed ield- es ba e y o school- aged child en.3,31 This s udy communica es he wo k conduc ed wi hin he Fi Back p ojec 2020- 2022. Mo e speci ically, he wo main aims o his s udy we e as ollows: (1) o iden i y, compa e, and con as examples o cu en bes - p ac ice PF moni o ing and su eillance sys ems among school- aged child en in Eu ope, and (2) o p o ide an expe ience- based easy- o- ollow se o guidelines o policymake s, which can be used o design hei own PF moni o ing and su eillance sys em. De ailed ou comes o he Fi Back p ojec can be ound by accessing i s online, ee- o - use, web po al he e: h ps:// www. i ba ckeu ope. eu/ en- us/ . 2 | METHODS 2.1 | Iden i ying cu en PF moni o ing bes - p ac ices in Eu ope The Fi Back p ojec was launched on Feb ua y 12, 2020, jus be o e he COVID- 19 global pandemic was decla ed by he Wo ld Heal h O ganiza ion. Despi e hese chal- lenges, he p ocess began in ea nes by iden i ying and desc ibing exis ing na ional o egional PF moni o ing and su eillance sys ems ac oss Eu ope, he ein unca ed o “sys ems.” In o ma ion ela ed o na ional and/o e- gional sys ems was disco e ed la gely om nonacademic publica ions, and in local languages. Hence, a na a i e e iew app oach was selec ed. Eligible sys ems we e iden- i ied by he expe s in ol ed in he Fi Back conso ium, and hei espec i e p o essional ne wo ks. The Fi Back wo king g oup hen o med a s uc u ed ques ionnai e ha was sen o ep esen a i es o he iden- i ied sys ems. Rep esen a i es we e eques ed o p o ide desc ip ions o hei i ness sys em, including de ails such as he aims, design, ela ionship o physical educa- ion p og ams in schools, ope a ional ime lines, leading ins i u ions, subjec s, es i ems, ins uc ional ma e ials, da a collec ion, eedback, e e ence alues, c i e ia o possible in e en ions and sou ces o u he in o ma- ion. All ep esen a i es o he iden i ied sys ems we e success ul in p o iding de ailed desc ip ions o hei e- gional wo ks. 2.2 | Compiling guidelines o designing no el school- based PF moni o ing and su eillance sys ems In he second phase o he p ocess, a key guideline docu- men en i led “How o design a physical i ness moni o - ing sys em” was c ea ed. These guidelines we e p epa ed in collabo a ion wi h i e ounde - membe s o he Fi Back conso ium—Finland, Hunga y, Po ugal, Se bia, and Slo enia—coun ies ha also possess unique expe iences in es ablishing and ope a ing hei own na ional- le el child i ness sys ems. The o ma ion o he guidelines ollowed an i e a i e design, which included an ini ial planning s age, conside a ion o equi emen s, analysis, design, es ing, and e alua ion. The wo king g oup analyzed he S eng hs, Weaknesses, Oppo uni ies, and Th ea s (SWOT) ela ed o each sys em by illing ou a SWOT o m, whe ea e , answe s we e hema ically clus e ed. The mos common SWOT hemes we e i s discussed wi hin he wo king g oup, and po en ial solu ions o add ess hese opics, (e.g., key guidelines), we e ca e ully conside ed. A e se e al i e a ion ounds, he wo king g oup decided upon 10 p i- o i y guidelines. Discussions also included how o lis /com- munica e hei o de o p esen a ion. The inal ma e ials we e hen p epa ed in se e al o ma s wi hin he wo king g oup be o e being sha ed wi h he Fi Back conso ium a la ge, and p io o inal publica ion on he Fi Back online web po al (www. i ba ckeu ope. eu/ en- us/ moni o ing - i ne ss/ 10- s ep- o- design). These key guidelines, con en s, docu- men s, and he online po al i sel ha e since been success- ully pilo ed among ac ual policy make s.32 3 | RESULTS 3.1 | Eu opean na ional and egional school- based PF moni o ing and su eillance sys ems o child en and adolescen s 3.1.1 | Exis ing PF moni o ing and su eillance sys ems The Fi Back ne wo k iden i ied eigh na ional- o egional- le el sys ems in ope a ion wi hin Eu ope. They a e: Mo e! 16000838, 2024, 3, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/sms.14593 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [26/03/2024]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License 4 o 14 | JOENSUU e al. (Finland), Diagno o m (F ance), DAFIS (Galicia, Spain), NETFIT (Hunga y), The assessmen o s uden 's i ness in p ima y and seconda y schools (Li huania), FITescola (Po ugal), he Na ional Physical Fi ness Su eillance Sys em (Se bia), and SLO i (Slo enia). Long- o m de- sc ip ions o each sys em a e a ailable on he Fi Back web po al (Fi Ba ck- Iden i ica ion- and- desc ip io ns- o - good- p ac ices- in- diagn osing - he- physi cal- i ne ss. pd ( i ba ckeu ope. eu) ). In his a icle, we p o ide an upda ed sum- ma y o hese sys ems' cha ac e is ics (Table1). The i s su eillance sys em was launched o e 40 yea s ago in Slo enia, back in 1982. O he sys ems we e launched mo e ecen ly: in F ance and Galicia 2010–2012, and in Finland, Hunga y, Li huania, Po ugal, and Se bia 2015–2020. These sys ems a e loca ed in di e se o al popula ions anging om app oxima ely 2.1 million in- habi an s (Slo enia) o 68 million (F ance). The sys ems span Eu ope, ep esen ing geog aphical a eas o he no h (Finland), sou h (Po ugal), eas (Li huania), and wes (F ance) (Figu e1). Fi ness sys ems a e ope a ing p i- ma ily wi hin high- income coun ies (Finland, F ance, Galicia, Hunga y, Li huania, Po ugal, and Slo enia), and one uppe middle- income (Se bia) coun y whose G oss Domes ic P oduc pe capi a anges om 9230 $ (Se bia) o 53 655 $ (Finland).33 All sys ems aim o assess PF among school- aged chil- d en, wi h a speci ic emphasis on suppo ing physical ed- uca ion, s uden s' physical and heal h li e acy, and heal h ( o u he de ails, see he long- o m desc ip ions om he Fi Back pla o m). All sys ems ope a e in a school con ex wi hin he physical educa ion subjec . In F ance, Galicia, Li huania, Po ugal, and Slo enia schools a e ecom- mended o u ilize hei egional/na ional sys em o assess s uden 's PF, whe eas in Finland, Hunga y, and Se bia, he use o he sys em is manda o y pa o he cu iculum. The sys ems encompass a b oad ange o school- aged child en, anging om 5 yea s o he younges (F ance) o ≥19 yea in he oldes (Hunga y, Se bia, Slo enia). The majo i y o sys ems assess i ness annually as pa o he child en's educa ional pa hway, wi h up o 13- yea ajec- o ies (Slo enia). As an excep ion, in Finland, child en and adolescen s pa icipa e in na ional da a collec ion wice a speci ic ages (in G ades 5 and 8, a ages 11 and 14). Based on da a om sys ems wi h cen alized egis e s (i.e., Finland, F ance, Galicia, Hunga y, Po ugal, and Slo enia), app oxima ely one million child en and adoles- cen s pa icipa e o i ness moni o ing pe yea . The la ges absolu e numbe o school- aged child en a e in ol ed in he Hunga y's sys em, which es s app oxima ely 650 000 s uden s annually, co esponding o app oxima ely 93% o hei age- speci ic popula ion. The second la ges sys em iden i ied based on pu e pa icipa ion a e is Slo enia, wi h app oxima ely 200 000 annual pa icipan s (i.e., ~96% o he age- speci ic popula ion), ollowed by Po ugal 120 000 (~12%), and Finland 100 000 (~96%). F ance and Galicia ha e lowe pa icipa ion a es, wi h app oxima ely 32 000 and 26 000 pa icipan s since hei launch, espec i ely. In Li huania and Se bia, ele an da a we e no a ailable a he ime o analysis. 3.1.2 | Compa ing PF moni o ing and su eillance sys ems A compa ison be ween sys ems e ealed ha , whe eas each sys em assesses simila PF componen s, hey u ilize di e en es i ems o his pu pose (Table1). The e - minology used o compa e PF i ems ac oss sys ems was adop ed om he ALPHA p ojec , which ca ego izes i - ness in o body composi ion, ca dio espi a o y, musculo- skele al (including muscula s eng h and endu ance, and lexibili y) and mo o i ness. In his con ex , we u ilized he e ms “musculoskele al i ness” and “mo o i ness,” al hough in many physical educa ion cu icula hese es i ems a e used o assess a s uden 's “mo o compe ence.” Impo an ly, bo h Finland and Hunga y p o ide adap ed i ness es s o s uden s wi h special needs. An h opome ics and body composi ion All sys ems, excep Finland and Li huania, assess an h o- pome ics and/o body composi ion. Mos sys ems as- sess an h opome ics; body mass index (F ance, Galicia, Hunga y, Po ugal, Se bia, and Slo enia), wais ci cum e - ence (Galicia and Po ugal), o wais - o- hip a io (Galicia). Addi ionally, Hunga y, Po ugal, and Slo enia assess body composi ion by body a pe cen age ( ia bioelec ical im- pedance [Hunga y, Po ugal], o skin olds [Po ugal, Slo enia]). Ca dio espi a o y i ness is assessed using a a ie y o echniques. I is mos equen ly de e mined using he 20- m shu le un (Finland, Galicia, Hunga y, Li huania, Po ugal, and Se bia). In Li huania, seconda y school s uden s a e assessed using he 20- m shu le un bu p ima y s uden s comple e a 6- min un. In Po ugal, a 1- mile un is p o ided as an al e na i e o he 20- m shu le un es . In F ance and Slo enia, ca dio espi a o y i ness is assessed using a 6- min “ un and walk es ” and a 600- m un, espec i ely. Musculoskele al i ness/muscula s eng h and endu ance Va ious es s a e used o assess muscula s eng h and endu ance. Uppe - body s eng h is assessed by hand- g ip s eng h (Galicia, Hunga y), ben - a m hang (Galicia, Li huania [seconda y s uden s only], Se bia, and Slo enia), and push- up (Finland, Hunga y, and Po ugal). Cen al body assessmen s include si - ups (Se bia, Slo enia), cu l- up 16000838, 2024, 3, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/sms.14593 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [26/03/2024]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License | 5 o 14 JOENSUU e al. TABLE 1 O e iew o he cu en school- based physical i ness moni o ing and su eillance sys ems in Eu ope acco ding o he yea o es ablishmen . Coun y Slo enia F ance Galicia, Spain Hunga y Po ugal Finland Se bia Li huania Desc ip i es Name SLO i Diagno o m DAFIS (Da os Ac i idad ísica Saludable) NETFIT FITescola Mo e!—moni o ing sys em o physical unc ional capaci y Na ional Physical Fi ness Su eillance Sys em The assessmen o s uden 's i ness in p ima y and seconda y schools Launched (yea ) 1982 2010 2012 2015 2016 2016 2017 2020 Popula ion (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/capi a (2021)33 29 291 $ 43 659 $ 31 272 $52 18 728 $ 24 567 $ 53 655 $ 9230 $ 23 723 $ Measu emen s Timeline Annually du ing Ap il No manda o y imeline No manda o y imeline Annually be ween Janua y and May No manda o y imeline Annually du ing Augus /Sep embe Annually du ing Sep embe / Oc obe and in May Annually be ween Feb ua y and May Age g oups 6–19- yea s 5–11- yea s 6–17- yea s 10–19- yea s 10–18- yea s 11 and 14- yea sa9–19- yea s 7–18- yea s Annual pa icipan s (% o age- speci ic popula ion) 200 000 (~96%) ~3500 ~2600 650 000 (~93%) 120 000 (~12%) 100 000 (~96%) NA NA An h opome ics and body composi ion BMI, body a pe cen age (skin old) BMI BMI, wais ci cum e ence, wais - o- hip a io BMI, body a pe cen age (BIA) BMI, wais ci cum e ence, body a pe cen age (BIA, skin old) NAbBMI NA Ca dio espi a o y i ness 600- m un 6- min un and walk es 20- m shu le un 20- o 15- m shu le un 20- m shu le un o 1- mile un 20- m shu le un 20- m shu le un 6- min unP, 20- m shu le unS Musculoskele al i ness/ Muscula s eng h and endu ance Ben - a m hang, si - ups, s anding long jump S anding long jump Handg ip s eng h, ben - a m hang, s anding long jump Handg ip s eng h, push- up, cu l- up, unk li , s anding long jump Push- up, cu l- up, squad jump o e ical jump, s anding long jump Push- up, cu l- up Ben - a m hang, si - ups, s anding long jump S anding long jump, ben - a m hangS Musculoskele al i ness/ Flexibili y S and and each Lowe - back ex ension in s anding posi ion Back- sa e si and each Back- sa e si and each Si and each, shoulde s e ch Squa , lowe - back ex ension in si ing pos u e, shoulde s e ch Si and each Si and eachS Mo o i ness 20- s a m pla e apping, Obs acle cou se backwa ds, 60- m dash 5- s un es , Hopsco ch es 4 × 10- m shu le un NA 4 × 10- m shu le un Speed in 20- o 40- m 5- leaps es , Th owing- ca ching combina ion es 4 × 10- m shu le un Tennis ball h ow, 10 × 5- m shu le un, Flamingo balanceS Adap ed i ness es s No No No Yes No Yes No No (Con inues) 16000838, 2024, 3, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/sms.14593 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [26/03/2024]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License 6 o 14 | JOENSUU e al. Coun y Slo enia F ance Galicia, Spain Hunga y Po ugal Finland Se bia Li huania Feedback No ma i e- ela ed eedback (main age- and sex- speci ic cen iles) ≥40 h i zone (G een), 10 h–40 h need o imp o e (yellow), <10 h s ongly ecommended o imp o e (Red)34 ≥90 h e y high, 70 h–90 h high, 30–70 h medium, 10 h–30 h low, <10 h e y low o all ≥80 h g een, 60 h–80 h blue, 40 h–60 h yellow, 20 h–40 h o ange, <20 h ed, o ben - a m hang,35,36 s anding long jump,35,36 and 4 × 10- m shu le un35 Heal hy Zone ≥50 h o 4 × 10- m shu le un, ≥20 h o e ical and s anding long jump,39 and ≥50 h o 20- o 40- m sp in es 46 >66 h good, 33 d–66 h su icien , <33 d needs imp o emen , o o he s han lexibili y 25 h–75 h heal hy zone <25 h needs imp o emen zone o all49 ≥ 40 h heal hy, 40 h–5 h needs imp o emen , <5 h heal h isk, o o he s han speci ied (Va ying age- and sex speci ic cen iles o o he h esholds) Cen iles o all34 NA Wais ci cum e ence, and wais - o- hip a io,37 20- m shu le un,35 handg ip s eng h,35,38 back- sa e si and each39,40 Fo o he s han speci ied44 Fo o he s han speci ied39 Flexibili y: 0/1 p pe measu emen . 4 p Good lexibili y, 1- 3p Needs some imp o emen , 0p Needs imp o emen <60 h Heal hy, 60 h–95 h Needs imp o emen , >95 h Heal h isk, o 10 × 5- m shu le un Heal h- ela ed eedback (Th esholds de i ed om ROC cu e o o he analysis in ela ion o a heal h ou come)c BMI41 NA BMI41 BMI,41 Body a pe cen age,42 20- m shu le un,43 Handg ip s eng h45 BMI,47 20- m shu le un es and 1- mile un48 NA NA NA A hle ic capaci y (Age- and sex- speci ic cen iles) NA NA NA NA ≥90 h he a hle ic p o ile NA >75 h po en ial spo alen zone NA Resou ces Websi e h ps:// en. slo i . o g/ h ps:// i o. / h ps:// da is. xun a. es/ es/ h ps:// www. ne i . eu/ public/ pb_ ne i . php h ps:// i es cola. dge. mec. p / home. aspx h ps:// www. oph. i/ en/ mo e NA NA No e: The e minology o i ness componen s ollows de ini ions o he ALPHA p ojec . In his con ex , we u ilize he e ms musculoskele al i ness and mo o i ness al hough in many physical educa ion cu icula hese es i ems a e used o assess s uden 's mo o compe ence. Abb e ia ions: BIA, bioimpedance analysis; BMI, body mass index; GDP, g oss domes ic p oduc ; NA, no applicable; p, poin s; P, p ima y school s uden s (7–10- yea s); ROC, ecei e ope a ing cha ac e is ic; S, seconda y school s uden s (11–18- yea s). aNa ional esul s a e ga he ed om 11- and 14- yea s s uden s. Howe e , no ma i e e e ence alues a e a ailable o 9–16 yea - olds and he schools a e encou aged o use he measu emen s annually. bMeasu emen s a e add essed in school heal hca e whe e heigh , weigh and wais ci cum e ence a e measu ed sepa a ely. cThe age- and sex- speci ic BMI cu - poin s p oposed by he In e na ional Obesi y Task Fo ce (Cole e al. 2000), Wo ld Heal h O ganiza ion o simila , o example, he U.S Cen e s o Disease Con ol and P e en ion, ha e been linked o u u e heal h widely and consis en ly, including la ge coho s udies and e idence ha childhood obesi y (de ined wi h hose cu - poin s) associa es wi h u u e mo ali y and mo bidi y he e o e p o iding s ong le el o e idence. So e en i he cu o poin s in pedia ic ages a e gene a ed based on cen iles o g ow h cu es, he Fi Back ne wo k conside s hem alida ed agains heal h ou comes and classi y hem as heal h- ela ed eedback; The long o m o sys em desc ip ions is a ailable a he Fi Back webpages (Fi Ba ck- Iden i ica ion- and- desc ip io ns- o - good- p ac ices- in- diagn osing - he- physi cal- i ne ss. pd ( i ba ckeu ope. eu) ). TABLE 1 (Con inued) 16000838, 2024, 3, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/sms.14593 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [26/03/2024]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License | 7 o 14 JOENSUU e al. (Finland, Hunga y, Po ugal), and unk li (Hunga y), and lowe body assessmen s s anding long jump (Galicia, Li huania [p ima y s uden s only], F ance, Hunga y, Se bia, and Slo enia), and squa jump o e ical jump (Po ugal). Musculoskele al i ness/ lexibili y All sys ems include a leas one assessmen o lexibili y. Si - and- each (Li huania [only o seconda y s uden s], Po ugal, and Se bia) o back- sa e si - and- each es s (Galicia, Hunga y) a e mos u ilized. Slo enia u ilizes a s and- and- each es , while Finland and F ance use di - e en e sions o lowe back ex ension. Shoulde s e ch is u ilized in Finland and Po ugal, and in Finland also squa . Mo o i ness Excep o Hunga y, all sys ems assess a leas one meas- u e o mo o i ness. A 4 × 10- m shu le un es is u ilized in Galicia, Po ugal, and Se bia. An addi ional 12 i ems a e sys em- speci ic: 5- leap es and h owing- ca ching combi- na ion es in Finland; 5- s un es and Hopsco ch es in F ance; ennis ball h ow, 10 × 5- m shu le un, and la- mingo balance (only in seconda y s uden s) in Li huania; 20- o 40- m sp in es in Po ugal; and 20- s a m pla e apping, obs acle cou se backwa ds, and a 60- m dash in Slo enia. All sys ems p o ide eedback di ec ly o s uden s, and o he s akeholde s as well, (e.g., pa en s, eache s, school adminis a o s, and medical p o essionals) on heal h- ela ed i ness. Addi ionally, Po ugal and Se bia p o ide eedback on a hle ic po en ial. Sys ems u ilize no ma i e- ela ed eedback (Finland, F ance, Galicia, Hunga y, Li huania, Po ugal, Se bia, and Slo enia) and heal h- ela ed eedback (Hunga y, Galicia, Po ugal, and Slo enia) om unpublished na ional esea ch s udies o published scien i ic li e a u e.34–49 Heal h- ela ed eed- back e e s o h esholds de i ed om ecei e ope a ing cha ac e is ic (ROC) cu e o o he analysis in ela ion o a heal h ou come, and no ma i e- ela ed eedback o o he s. The child's indi idual esul s a e add essed wi hin he physical educa ion cu iculum in all sys ems. Fu he mo e, indi idual ollow- up da a a e also a ail- able o la e pe sonal use in Finland, Galicia, Hunga y, Po ugal, and Slo enia. Da a a e linked o heal h ca e in Finland, Galicia, and Slo enia. In Finland, Galicia, Hunga y, Po ugal, and Slo enia, egional/na ional da a a e made a ailable o policymaking ( o u he de ails, FIGURE 1 Iden i ied eigh na ional- o egional- le el physical i ness moni o ing and su eillance sys ems in Eu ope: Mo e! (Finland), Diagno o m (F ance), DAFIS (Galicia, Spain), NETFIT (Hunga y), The assessmen o s uden 's i ness in p ima y and seconda y schools (Li huania), FITescola (Po ugal), Na ional Physical Fi ness Su eillance Sys em (Se bia), and SLO i (Slo enia). 16000838, 2024, 3, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/sms.14593 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [26/03/2024]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License 8 o 14 | JOENSUU e al. see he long o m o desc ip ions om Fi Ba ck- Iden i ica ion- and- desc ip io ns - o - good- p ac ices - in- diagn osing - he- physi cal- i ne ss. pd ( i ba ckeu ope. eu) ). 3.1.3 | Commonly expe ienced s eng hs, weaknesses, oppo uni ies, and h ea s Figu e2 p esen s he mos commonly expe ienced s eng hs, weaknesses, oppo uni ies, and h ea s ela ed o moni o ing and su eilling PF in school- aged child en. S eng hs include p o iding a solid scien i ic and heo e i- cal ounda ion o de e mining he bene i s o PF, easi- bili y in school se ings, he use ulness o he sys em o a ious p o essionals, and he p o ision o aluable da a o educa ion, heal h policy, and spo s. The ele ance o public heal h is e iden as moni o ing he PF s a us and ends o child en and adolescen s can p o ide comp e- hensi e assessmen o hei heal h, esponsi eness o acu e c ises such as pandemics, collabo a ion wi h heal h- ca e p o ide s, and high- quali y e alua ion o communi y in e en ions. The iden i ied weaknesses o es ablishing i ness su - eillance sys ems include a po en ially long implemen a- ion p ocess. The sys em migh no be well- adop ed by he end use s and/o he sys em e alua o s may lack ele an expe ise i no p ope ly ained. The exis ing sys em migh be di icul o e ol e due lack o unding o in o ma ion, o he complexi y o cu en go e nmen al s uc u es. Oppo uni ies include he u he de elopmen o PF, physical and heal h li e acy, and physical educa- ion cu icula, and he po en ial o iden i y child en and amilies o i ness and heal h in e en ions. The knowl- edge gained om he sys em has he po en ial o in o m decision- making a local, egional, and na ional le el. Insu icien unding and changes in legisla ion, such as Da a P o ec ion laws, may pose h ea s o es ablish- ing o al eady es ablished i ness su eillance sys ems. Addi ionally, he sys em may no be able o ope a e i i s philosophy is no adop ed ac oss p o essional disciplines, epu a ional c ises eme ge, o poli ical suppo luc ua es. 3.2 | Ten- s eps o designing a PF moni o ing o su eillance sys em These guidelines a e designed o o e p ac ical s eps, examples, and solu ions o o e come commonly- obse ed challenges when one is wo king owa d es- ablishing a no el sys em. The in og aphic is p esen ed in Figu e3. The in e ac i e e sion o his in og aphic is displayed on he Fi Back web po al and cu en ly a ailable in six language e sions (English, Es onian, Ge man, Spanish, I alian, and F ench) (10 s eps o desig n a physi cal i ne ss moni o ing sys e m | Fi Ba ck ( i ba ckeu ope. eu) ). In addi ion, a classical PDF in og aphic is cu en ly a ailable in 15 language e sions (B azilian Po uguese, C oa ian, English, Es onian, F ench, FIGURE 2 Commonly expe ienced s eng hs, weaknesses, oppo uni ies, and h ea s in popula ion le el physical i ness moni o ing among school- aged child en. 16000838, 2024, 3, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/sms.14593 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [26/03/2024]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License