Abstract
Background: Physical fitness and overweight are both important health-related parameters. Reference data from a population are important for comparisons with children with impairments, different diseases, in habilitation or rehabilitation after injuries.
Objective: The aim of the survey was to obtain reference data on physical performance in Swedish children and adolescents aged 10, 13 and 16 years. In addition, height and body mass were assessed and body mass index (BMI) was calculated.
Design: In total, 2118 children and adolescents in 48 randomly selected schools in Sweden were invited and 1737 subjects participated. Testing procedures were similar to the Eurofit tests, but with some modifications.
Results: Results show generally better performance in boys than in girls and increasing performance with age. BMI increased with age with only small differences between genders. Large variations were found within age and gender groups.
Conclusions: The present study provides reference data on physical performance and body size in Swedish children and adolescents. The results from the present study may be used to compare performance and anthropometric data over time or between countries, to evaluate performance in different patient groups or to set goals for athletes.
Introduction
Physical fitness is a frequently used diagnostic tool when evaluating the physical status of different paediatric patient groups Citation1Citation2Citation3 or healthy children Citation4Citation5, or in different types of intervention studies. Reference data concerning body size [height, body mass and body mass index (BMI)] in children or adolescents may be used in similar situations. Although relevant, earlier studies exist Citation6Citation7Citation8, recent reference data on healthy Swedish children are currently lacking, making comparisons and evaluations difficult.
To be useful, levels of fitness in a population should either be linked to some form of endpoints (such as health-related outcomes) or be compared with other populations (geographically or over time). In children, however, health complications of overweight or low levels of physical fitness are delayed for many years. Therefore, comparisons are more interesting. Some reference data on physical fitness from other Scandinavian samples are available, for example in a large sample of Norwegian men aged 18–19 years Citation9 and in Danish children Citation10. In Sweden, regional data are available on children, but not from nationwide samples. Physicians, physiotherapists, physical education teachers and sport coaches are groups potentially interested in such reference data.
Test batteries for physical fitness have been in use for many years, in studies such as the Leuven Longitudinal Study on Lifestyle, Fitness and Health Citation11Citation12 and the Amsterdam Growth and Health Longitudinal Study Citation13Citation14.
The aim of the study was to assess physical performance data in a representative sample of Swedish children and adolescents, using tests similar to the Eurofit test battery Citation15.
Methods
The selection process of the Swedish School-Sports-Health (SIH) study has been described in detail elsewhere Citation16. In brief, in 2001 48 schools were randomly selected from a national register of schools. Unlike the earlier study Citation16, data are presented here from the entire survey. All children in the third, sixth and ninth grades in the selected schools were invited to participate in the study, giving a total of 2118 invited children. The mean age of the subjects was 9.8, 12.8 and 15.8 years, for grades 3, 6 and 9, respectively. They are hereafter referred to as 10, 13 and 16 years old, respectively. Of these, 1737 subjects participated. Reasons for not participating were illness (82 children), holiday (16 children), no parental permission (six children) or other causes, such as religious concerns or disability (eight children). The remaining 269 children were either not interested or absent without known reason. Measurements took place at three specially arranged test centres, with the same trained staff performing the tests. Before the data collection, a parent of each participating child gave written consent. The ethics committee at Karolinska Hospital approved the study (KS 00-416).
Anthropometric measurements
Height and body mass were recorded with subjects dressed in light clothing, without shoes, using calibrated a standard scale and stadiometer. Height was recorded in centimetres, with one decimal. Body mass was recorded in kilograms, with one decimal. BMI was calculated as body mass in kilograms divided by height in metres squared (kg×m−2).
Flexed arm hang
This was performed with a supinated handgrip (palms towards the chest) with chin clear of the bar (the “correct” position). Subjects were helped into the correct position. The bar used had a diameter of approximately 3 cm. Results were recorded as time (seconds, with one decimal) in the correct position. To compensate for differences in body mass, results are given in seconds multiplied by body mass1/3 according to dimension analysis Citation17Citation18Citation19
Sit-ups
The test was performed with a knee angle of 90° and the feet fixed to the floor. The number of completed sit-ups (from a complete horizontal position on the floor to the position where the elbows touched the knees) during a 30 s period was recorded.
Vertical jump
Hands were held on the hips during the jump test. Jump height was measured as the vertical movement of the hip. A measuring tape was attached to a belt running around the subject’s waist. The measuring tape then ran under a plastic profile attached to the floor. Subjects were asked to jump vertically. Jump height was calculated as the difference in reading on the measuring tape before and after the jump, to the nearest 0.5 cm. The best out of three tests was recorded. Vertical jump height was multiplied by body mass, thus measuring the maximal functional work capacity, in kilojoules (kJ).
Quiet stand
The task in the quiet stand test was to balance for 60 s on one leg standing on a 3 cm wide steel profile. The subjects were instructed that the free foot must not touch the other foot, but could otherwise move freely. A brief test (3–5 s) was done to decide which leg to use, whereafter the test began. If the subject lost their balance, the clock was stopped and started again when the subject did the next ascent. The number of ascents was recorded.
Sit-and-reach
During the sit-and-reach test subjects sat with straight legs performing a maximal trunk flexion, aiming to reach as far forward as possible. Ankles were kept at a 90° angle. Reaching distance was recorded as centimetres past the toes, where the value “0” denoted having just reached the toes.
Grip strength
Subjects were asked to compress maximally the handles of the grip dynamometer (Cardionics AB, Bromma, Sweden) for 2–3 s, using their preferred hand. Grip size was adjusted to fit the subjects’ hand size, using the middle phalanx on the index finger of the preferred hand. The test was performed with the arm straight down and the dynamometer not touching the body. Three attempts were given and results were recorded in kiloponds (kp) with one decimal [CE1]. The best trial was used for analysis.
Cycle ergometry
Heart-rate response to a submaximal work rate on a Monark ergometer was used to estimate cardiovascular fitness. Cadence was set to 50 rpm. The heart rate was measured and noted after 5 min of work. If it was found to be stable (i.e. varied by less than 5 bpm) at the end of the sixth minute, the last of the two readings was considered as the heart-rate response to this work rate. If not, the test was prolonged by 1 min. Heart rate was recorded using telemetry (Polar Electro Oy, Kempele, Finland). Heart-rate response to the work rate was converted into estimated maximal oxygen uptake, expressed as litres O2×min−1, using the Åstrand-Ryhming nomogram Citation20. Data are presented as absolute values (l×min−1), as ml O2×min−1×kg−1 and as ml O2×min−1×kg−2/3, the latter according to dimension analysis Citation17.
Statistics
Descriptions of data are given as arithmetic mean, its 95% confidence interval (CI), standard deviation, and the 5th, 25th, median including its 95% CI, 75th and 95th percentiles. Since some of the distributions were found to have skew distributions, the 95% CI for the median was used throughout the study to describe differences between groups. Data were processed in SPSS, version 10.1 (SPSS, Chicago, IL, USA).
Results
The height, body mass and BMI of the subjects are given in and . At the age of 10 years, medians did not differ and the distributions of height and weight were almost identical between genders. At the age of 13 years, girls were taller and at 16 years boys were both taller and heavier. BMI increased in both genders with increasing age. No difference in BMI between genders was found at the ages of 10 years and 13 years. At 16 years, girls had higher values than boys.
Table 1. Height, body mass and body mass index (BMI) for girls in the Swedish School-Sports-Health (SIH) sample
Table 2. Height, body mass and body mass index (BMI) for boys in the Swedish School-Sports-Health (SIH) sample
and present data on neuromuscular performance in the six tests in the SIH battery.
Table 3. Reference values for girls on the six tests on neuromuscular performance used in the Swedish School-Sports-Health (SIH) study
Table 4. Reference values for boys on the six tests on neuromuscular performance used in the Swedish School-Sports-Health (SIH) study
Data from the cycle ergometer test are given in and . Absolute values for maximal oxygen uptake increased with age. Relative oxygen uptake decreased with age, in both genders when expressed as ml×min−1×kg−1 and in girls when expressed as ml×min−1×kg−2/3.
Table 5. Reference values for girls on the cycle ergometer test for aerobic fitness in the Swedish School-Sports-Health (SIH) study
Table 6. Reference values for boys on the cycle ergometer test for aerobic fitness in the Swedish School-Sports-Health (SIH) study
Gender differences in physical performance are present in most tests and at most ages. In 10-year-olds, performance on the flexed arm hang and the grip strength tests were better in boys than in girls. Girls aged 10 years performed better on the sit-and-reach test, compared with boys. The quiet stand, the vertical jump and cycle ergometry (relative oxygen uptake, ml×min−1×kg−1 and ml×min−1×kg−2/3) did not differ between genders. Among 13- and 16-year-olds, boys performed better in all tests, except the for quiet stand test, where no difference was found, and the sit-and-reach test, where girls performed better.
Discussion
This study gives reference values on body mass, body height, BMI and some physical performance tests in Swedish children and adolescents aged 10, 13 and 16 years. Although the participation rate was fairly high, it is reasonable to assume that those who were absent differed from the investigated sample, concerning fitness and anthropometry, in that the studied children probably performed better and were leaner (lower BMI).
BMI showed a skew distribution, which is in line with other European data Citation21Citation22. In all children 20.1% were overweight or obese using standard definitions Citation23. These results are similar to recent Danish data Citation24, except in the oldest girls, where the Danish study showed a considerably higher prevalence (25% vs 17.5%)
For the sit-and-reach test, performance improved with age, for both genders, but girls performed better at all ages. This may be due to differences in the growth rate for connective tissue, muscles and bone, but also to the differences between genders in the hip joint and pelvic anatomy. For the quiet stand test, performances improved with age, but no differences were noted between genders. For the flexed arm hang test, performance increased steeply with age, especially in boys. Large gender differences were found in that test. At 16 years of age, more than 50% of the boys performed better than the top 5% of the girls. In the vertical jump test, performance increased with age in both groups and so did the difference between genders, with less than 5% of the 16-year-old girls performing better than the median results for boys. In the sit-ups test, performance differed between genders in 13 and 16-year-olds, but not in 10-year-olds. At the age of 10 years, the median for boys did not differ from the median for girls, at 13 years it was close to the 75th percentile for girls, and at 16 years it was close to the 95th percentile for girls. In the grip strength test, a steep increase in performance was noted, especially for boys. More than 75% of boys aged 16 years performed better than the top 5% of girls. In the cycle ergometry test no difference was found between genders at the age of 10 years, but at 13 and 16 years boys performed better. The results from the cycle ergometer test showed higher values with increasing age, when expressed in absolute values (l×min−1), whereas lower values was found with increasing age in both genders when expressed in ml×min−1×kg−1 and in girls when expressed in ml×min−1×kg−2/3. This implies that, with age, the increase in absolute oxygen uptake cannot compensate for the increase in body mass.
Compared with a recent Danish study, the levels of aerobic fitness were somewhat higher in Swedish girls but comparable in boys. In Danish children (aged approximately 9.5 years) studied in 1997–98 Citation22, the mean maximal oxygen uptake was 42 ml×min−1×kg−1 for girls and 47 ml×min−1×kg−1 for boys. Based on data given in the article, the present study found a higher fitness level in girls (mean difference 7.4 ml×min−1×kg−1, 95% CI 5.8 to 9.3 ml×min−1×kg−1). In boys the difference was only 2.0 ml×min−1×kg−1 (95% CI 0.2 to 3.7 ml×min−1×kg−1).
One possible explanation for the gender differences for 10-year-olds in these comparisons may be the difference in sampling year (1997–98 in the Danish study and 2001 in the present study), and that the genders have had differing secular trends.
However, it is possible that Swedish and Danish girls (but not boys) actually differ regarding aerobic fitness, since the samples also differ in other key aspects. For example, the Swedish girls were taller (mean difference 1.4 cm, 95% CI 0.4 to 2.4 cm) and heavier (mean difference 2.7 kg, 95% CI 1.5 to 3.9 kg) than their Danish peers. It is important to underline that these differences only concern 10-year-old children.
The lower levels of relative oxygen uptake (VO2 max) in 16-year-olds compared with in the present study may describe a natural development regarding relative oxygen uptake between the ages of 10 and 16 years. The latter has been shown previously Citation6 in girls, but not in boys. The decreasing levels across age groups could therefore be a consequence of a physically inactive lifestyle during adolescence and should therefore raise concern among health promoters and public health professionals.
An earlier study Citation16, showed that boys aged 16 years had lower levels of aerobic fitness in 2001 than in 1987. No such trend were found in girls aged 16 years. However, in another study, Jansson and Hedberg Citation25 showed values from 1991 on aerobic fitness in adolescents. In that study, mean absolute oxygen uptake were 2.1 and 2.7 l×min−1 for girls and boys, respectively. Relative oxygen uptake was 36.3 and 43.1 ml×min−1×kg−1 for girls and boys, respectively. These results are close to the results in the present study, for both boys and girls. Thus, no obvious trend seems to be present.
In the sit-and-reach test, girls had a superior performance to boys in all age groups. This is in line with earlier studies Citation26Citation27.
One potential confounder is level of maturity Citation28Citation29. Maturity data (such as Tanner status) were not collected from these subjects, for practical reasons. Data in the present study should therefore be considered as data on the general population at the ages of 10, 13 and 16 years in 2001. However, a slow secular trend towards earlier puberty has been reported Citation30, implicating that results from older studies may differ to those in the present study, partly owing to differences in maturation. If so, the older samples should be less mature and thereby be handicapped by a less developed physical capacity.
One important conclusion from this study was that gender and age differences are present, but that the differences in performance between individuals within an age or gender group are large. The common view that boys are physically superior to girls and that older children are better than younger can be complemented by the data shown in this study. The results show, for example, that there is a limited physiological rationale to divide children by gender in sports or activities where success is mainly based on balancing ability. However, when the results depend on upper body strength (as measured in the present study by the grip strength and flexed arm hang tests), only a few girls will perform better than the average boy, especially in children older than 13 years. Another practical use of the present data may be their use as reference data in comparisons with, for example, children with impairments or different diseases, or in habilitation or rehabilitation after injuries.
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