Introduction - Fitness Measures and Health Outcomes in Youth - NCBI Bookshelf
The phrase outcomes-based wellness program may be confusing. Most employers . Go to the gym 4 times a month for 6 month. Meet with. The measurement of health-related fitness in youth is the focus of this report. and data management systems have emerged, the link between fitness tests and . Management of a Strategic Resource Mervat Abdelhak, Sara Grostick, Mary Alice Hanken Their goal tends to be outcomes management through profiling, guidelines, This ideal record is a complete, longitudinal picture of all health- related occupational, physical fitness, nutritional, and other relevant lifestyle data.
One research study that compared joggers to nonjoggers, completing as little as 1—2. Based on these results, the authors recommend modest jogging recommendations of 2—3 times per week for a total cumulative duration of 2.
While it seems counterintuitive, it does not take much physical activity to improve our chances at survival and longevity. If nothing else, some light cardiovascular activity can improve the time we spend alive, with friends and family.
Since the exercise recommendations are modest, it is important to spread the word to those who need help getting started on a regular activity program. Exercise and cardiovascular disease risk Cardiovascular disease CVD is prevalent across both genders and all backgrounds and nationalities. According to a recent report from the American Heart Association [ 72 ], one of every three deaths in the U.
Additionally, heart disease and stroke were the top two killers worldwide. Even cost is an issue with those afflicted with CVD—costs for each U. Damning evidence, but what can we do about it? Is exercise the answer to combat the risk of CVD? As we learned above, it can help improve our quality of life and decrease the risk of mortality.
As CVD claims nearly a million lives in the United States each year, it would be presumptive that exercise could work in a similar fashion. It has been repeatedly shown that an inverse relationship exists between physical activity and the occurrence of CVDs. This means that with an increase in physical activity, the relative risk of developing CVD is decreased [ 74 ]. Regular physical activity using large muscle groups quadriceps, hamstrings, as well as the muscles of the chest, back, and upper armslike walking, running, or swimming, produces cardiovascular adaptations that increase exercise capacity, endurance, and skeletal muscle strength.
Routine physical activity also prevents the development of coronary artery disease CAD and reduces symptoms in patients with established cardiovascular disease [ 75 ]. Thus, it has been proven that we can reduce the likelihood of CVD with regular exercise.
How much mitigation or prevention remains to be seen, but we know through numerous studies that there is a positive relationship that exists. In areas of middle and low-income, diabetes prevalence is trending upwards, and contributes to blindness, kidney failure, heart attacks, stroke, and lower limb amputation [ 76 ]. The World Health Organization projects that diabetes will be the 7th leading cause of death by [ 77 ], a staggering thought considering the relative stranglehold that cancer and heart disease have on mortality.
A great deal of evidence has been collected that supports physical activity, among other therapies, may be useful in preventing or delaying the onset of type 2 diabetes T2D. There are now three published trials documenting that, with lifestyle modification weight loss and regular moderate physical activitydiabetes can be delayed or prevented [ 78 — 81 ].
Additionally, other research has proven that long-term interventions, using both diet and exercise, leads to substantial metabolic improvement that may contribute to prevent or postpone manifest diabetes [ 82 ]. In the case of T2D, exercise is truly medicine. Exercise and obesity While increased caloric intake is often blamed for rising rates of obesity, no association between these two variables was found in a recent study, which looked at data from the National Health and Nutrition Examination Survey NHANES from to More importantly, and in the interest of this particular chapter, an association was found between the trends over time for lack of physical activity and high BMI numbers [ 84 ].
Researchers from this study noted that such a dramatic reduction in daily calorie burn from our jobs alone, extrapolated over the course of a year, could explain the steady rise in weight gain [ 3 ]. This weight gain is not limited to adults alone. A recent study found that roughly a third of obese preschool children were obese as adults, and about half of obese school-age children were obese as adults. Across all conditions, the risk of adult obesity was at least twice as high for obese children as for non-obese children.
The risk of adult obesity was greater for children who were at higher levels of obesity and for children who were obese at older ages [ 85 ]. Children or adults alike, when individuals increase physical activity, there is a positive relationship with reductions in total adiposity [ 86 ].
It has also been shown that physical activity is associated with reduction in abdominal and visceral fat, both of which can contribute to other diseases within the body, particularly the cardiovascular system [ 8788 ].
More specifically, the more exercise and activity one gets, the less fat an individual has. We need to be physically active to burn more calories and, in turn, see reductions in body composition.
Exercise and cancer prevention Cancer and exercise have a tricky relationship. A recent meta-analysis found an inverse association between physical activity and colon cancer. Individuals can likely reduce their risk of colon cancer with the addition of physical activity [ 89 ].
Breast cancer seems to be just as responsive, as there is reasonably clear evidence that physically active women have about nearly a third of the risk when compared to inactive women. Like the previously mentioned mortality rates, it does not take much to reduce the likelihood of such a terrible disease like cancer.
In addition to risk reduction, there is also the benefit of exercise and cancer survivorship. Participants with higher levels of physical activity following a cancer diagnosis were less likely to have a cancer recurrence and had increased survival [ 90 ].
Over 20 studies have examined the impact of physical activity on the risk of lung cancer. Overall, this wealth of data suggests an inverse association between physical activity and lung cancer risk. A theme is recurring—exercise is medicine [ 91 ]. Exercise and hypertension Exercise is advocated for the prevention, treatment, and control of high blood pressure or hypertension HTN [ 92 ]. When left uncontrolled, high blood pressure can lead to stroke by damaging and weakening blood vessels in the brain, causing them to narrow, rupture, or leak.
High blood pressure can also cause blood clots to form in the arteries leading to the brain, blocking blood flow, and potentially causing a stroke.
It can also cause arterial and kidney complications, in addition to the eyes, bones, and sleep [ 93 ]. Exercise intervention studies have shown that regular aerobic exercise significantly lowers blood pressure in hypertensive individuals. As exercise intensity moves from moderate to vigorous, it may be even more effective in lowering blood pressure. Most importantly, they can allow folks with HTN to come off medications, see fewer medication-related side-effects, and, as has been repeated, improve quality of life [ 95 ].
High blood pressure is not a terminal diagnosis, but it can lead to further complications that can be quite deleterious if left uncontrolled. It is important to begin stressing exercise as a modifier in order to eliminate the stress that HTN places on the cardiovascular system.
Exercise and osteoporosis Often thought of as a disease that only impacts older women, osteoporosis is characterized by low bone mineral density BMDcoupled with deterioration of bone tissue. These two factors contribute to an increase in bone fragility, leaving those afflicted with this systemic skeletal disease more susceptible to fracture. While fractures might not seem like a big deal, as we age, it becomes more and more important to avoid them at all costs.
A recent meta-analysis revealed that women sustaining a hip fracture were five times as likely and men nearly eight times as likely to die within the first 3 months as compared with age- and sex-matched controls [ 97 ].
Given the fragility of the skeletal system for those with osteoporosis, it is important to know how to prevent fractures and preserve bone strength. Osteoporosis is a silent disease that does not cause pain or outward signs of an underlying cause or condition.
It has become the most common bone disease worldwide, thus making it a major health problem. One of the contributing factors to maintaining bone health is regular weight-bearing exercise throughout the life span. Moderate exercise protects against osteoporosis, but too little or extremely prolonged bouts of exercise may cause osteoporosis [ 98 ]. Unfortunately, as we age, we progressively become sedentary [ 99 ]. This is largely attributed to a lack of energy, muscle mass, adequate caloric intake, and fear of injuring oneself and becoming less independent.
Outcomes management and its relationship to fitness
Disuse and inactivity can cause bone loss, whereas weight-bearing exercises may maintain or improve bone mineral density. There is a significant correlation between muscle strength and bone mineral density, as well as enough evidence to support strengthening exercises leading to an increase in BMD. A well-rounded exercise program, incorporating cardiovascular and resistance training, as well as balance exercises, may prove to be effective for retarding age-related bone loss [ ].
At the very least, with more weight-bearing movement e. Exercise and lipid disorders Physical activity, which involves working major muscle groups like the quadriceps and hamstrings, is vital when controlling lipid metabolism and preventing lipid disorders. Increased physical activity induces a number of positive changes in the metabolism of lipoproteins—serum triglycerides are lowered and the high density lipoprotein HDL production is increased [ ].
The prediction equations for maturity offset require age, height, weight, sitting height, and estimated leg length height minus sitting height, technically subischial length Mirwald et al. Limitations of this measure are that it requires an additional measurement and a flat sitting surface and the fact that ethnic variation is a potential confounder Hamill et al.
It should also be noted that leg length has its adolescent growth spurt before sitting height Malina et al. Although the above measures have been used to assess various populations of athletes Cumming et al. Motor Skill The association between motor skill i. However, a growing body of cross-sectional and longitudinal evidence demonstrates positive relationships between motor skill competence levels and multiple aspects of health-related fitness in youth.
Given the lack of experimental data, the literature does not provide adequate support for a recommendation to include a motor skill measure in a national youth fitness test battery.
Further research is needed to examine the relationships between the development of motor skill and health-related fitness performance and health outcomes. Motor Skill and Health-Related Fitness Performance Children do not develop motor skill through maturation alone, but also through context-specific engagement in physical activity Logan et al.
Without intervention or formal instruction, such as physical education, youth with lower levels of motor coordination and control i. However, the use of multiple types of motor skill assessments i. Additionally, issues related to a lack of developmental validity, the sensitivity and skill-level discrimination capabilities of various assessments, and a lack of consensus on how motor skill versus health-related fitness is defined need to be addressed in future research Fisher et al.
Using multivariate regression, explained variance in either individual or composite measures of fitness by multiple individual or composite motor skill assessments has ranged from 0 to 79 percent Barnett et al. With the exception of one quasi-experimental study Matvienko and Ahrabi-Fard, and three longitudinal studies Barnett et al.
Sample sizes varied from to 2, in all studies except those of Matvienko and Ahrabi-Fard and Hands and colleagueswhich included only 90 and 19 subjects, respectively. It is important to note that the strength of relationships generally increases across age in both males and females. Results of recent cross-sectional and longitudinal research examining associations between motor skill competence levels and body weight status i.
As body weight status may influence both motor skill and health-related fitness performance, it is difficult to identify a causal pathway for these relationships.
These data indirectly support the hypothesis of Stodden and colleagues that the development of motor skills may promote improvements in body weight status, physical activity, and health-related physical fitness through the dynamic and reciprocal relationships that occur among these variables across childhood.
As mentioned previously, there is a need for long-term experimental studies to better understand the impact of motor skill development on body weight status and various aspects of health-related fitness. It has been suggested that associations between cardiorespiratory endurance and fundamental motor skills are indirectly related to developmental trajectories of motor skill development, are reciprocal in nature Barnett et al. Associations between motor skill i.
This link supports the notion that motor skill development influences these variables Myer et al. Although most of the data reported above were derived from correlational or prospective longitudinal studies, the increasing relationship strength trajectories between motor skill and fitness levels across ages suggest the need for additional research on the relationship trajectories between motor skill development and health outcomes. The committee could identify only a few studies examining the relationship between motor skill and any health outcomes.
Motor Skill and Health Outcomes A small body of research cross-sectional and longitudinal studies indicates that low motor skill competence is associated with poor bone health in youth Anliker et al. However, these relationships also can be attributed to lean mass Anliker et al. Weaker associations have been demonstrated with other skill-related tests Page 64 Share Cite Suggested Citation: Overall, the proposed synergistic relationships and mechanisms involving skill development and muscle strength, power, and endurance make it difficult to delineate the contributions of skill, strength, and power to bone health see Chapter 6 for a discussion of the relationship between musculoskeletal fitness and bone mineral density.
Even fewer studies have examined the relationship between any aspect of motor skill and cardiovascular or metabolic health outcomes in youth.
Many of these studies, however, involved participants with mental or associated cognitive, motor, emotional, or behavioral developmental disorders Emck et al. Thus, these data may not be representative for normal populations of children. Influence of Amount of Practice Time on Fitness Testing Performance Evidence for the effects of practice on performance on specific health-related physical fitness tests i. The relevant literature on the relationship between motor learning and development and general skill learning indicates that adequate learning and completion of a fitness test depend on many factors, including experience, instruction, feedback, cognitive capabilities, motivation, and the complexity of the test Farpour-Lambert and Blimkie, ; Raudsepp and Pall, For example, although the committee found no evidence to support the influence of socioeconomic status on test selection, delivery, or interpretation, one could hypothesize possible limitations due to lack of equipment if a school had a suboptimal built environment e.
Previous youth fitness surveys in the United States have failed to consider these factors see Malina, Previous studies have used proxy measures to collect information on socioeconomic status from youth themselves, such as the number of books or cars the family owns, parental education or occupation, and the number of rooms in the household.
If collecting this information directly from parents is not feasible, it may be estimated from official school-level statistics, such as percentage of students eligible for free or reduced-price lunch Merola, Disability The information in this report is driven by the evidence for healthy study populations and directed to the general population. As is clear from the discussion throughout the report, studies that follow youth into adulthood are infrequent.
Since the s, moreover, organizations and relevant government agencies have focused their efforts on the health benefits of physical activity among youth rather than on fitness, which was the focus prior to the s. The lack of a recent focus on fitness has resulted in a less than ideal scientific literature base addressing questions of fitness and health.
Nevertheless, the knowledge base has increased sufficiently to support the conduct of a national fitness survey. The focus on health in youth is a unique feature of this report and one that presented many challenges given the inadequate amount and nature of the relevant literature. However, this focus is in tune with current thinking that factors related to health in adults cannot necessarily be extrapolated to youth, and therefore, health markers in youth need to be defined and reviewed.
While the committee provides guidance for developing cut-points cutoff scores for and interpreting performance on fitness tests, it did not develop specific cut-points for the recommended test items.
Rather, the committee suggests an ideal approach to establishing cut-points. Recognizing that all the data necessary to establish cut-points do not exist for all the recommended tests, the committee also provides alternative approaches for establishing interim cut-points when such data are unavailable.
Program Outcomes - Health & Fitness Management - Clayton State University
In addition, there are aspects of fitness testing that the committee did not address in depth, such as protocols for the recommended tests, specific training for test administrators, or the appropriateness of fitness components that were not included in the committee's statement of task.
Finally, the studies reviewed were designed to collect evidence on the relationship between fitness tests and health in healthy youth. Studies on overweight and obese youth were included in the review; however, studies in special populations, such as athletes or people with disabilities 1 or congenital diseases, were not reviewed.
Therefore, the committee's findings, conclusions, and recommendations do not target those special populations. Chapter 2 provides a historical perspective on the origins of youth fitness testing and the changes that have occurred over the years both in the tests and in their uses. This chapter includes a table describing fitness test batteries currently used around the world. Chapter 3 describes in detail the methodology used by the committee to identify test items, including the CDC's systematic review, which was the primary basis for the committee's conclusions and recommendations.
Chapters 456and 7 present the committee's rationale for recommending test items for the four fitness components, respectively—body composition, cardiorespiratory endurance, musculoskeletal fitness, and flexibility—highlighting the findings of the scientific literature. As noted earlier in this chapter, the primary purpose of this report was to make recommendations for a national survey. A secondary purpose was to make recommendations for the use of fitness tests in schools and other educational settings.
Chapter 8 presents the committee's recommendations for national surveys of youth fitness. Chapter 9 describes the importance of fitness in the context of education, details factors to consider when implementing fitness tests in schools and other educational settings, and presents the committee's recommendations for specific fitness tests for educational settings.
Finally, Chapter 10 includes the committee's recommendations for future research. Health related physical fitness test manual.
Activity Tracking and Improved Health Outcomes
Anti-aging therapy through fitness enhancement. Clinical Interventions in Aging. PMC ] [ PubMed: Standards for the development and use of tests: The standards for educational and psychological testing.
European Journal of Psychological Assessment.
- Outcomes-based Wellness Programs: An Example from the Real World
- Looking for other ways to read this?
- Quality Improvement