ALPHA-Fitness Test Manual For Children & Adolescents

TheALPHAHealthRelatedFitnessTestBatteryfor
ChildrenandAdolescents
TestManual
www.thealphaproject.eu
1

CONTENTS
1.WHATISHEALTHRELATEDFITNESS?............................................................................................4
2.THEALPHAFITNESSTESTBATTERYFORCHILDRENANDADOLESCENTS.....................................4
2.1.Developmentofthetestbattery.........................................................................................4
2.2.Descriptionofthetestbattery...........................................................................................4
3.HOWTOCONDUCTTHETESTS?....................................................................................................5
3.1.Generalinstructions............................................................................................................5
3.2.Standardization....................................................................................................................7
3.3.Recommendedsequence....................................................................................................7
3.4.Instructionsfortheparticipants..........................................................................................7
4.SAFETYMODEL...............................................................................................................................8
4.1.Pretestinghealthscreening................................................................................................8
4.2.Recommendationforsafetesting.......................................................................................8
5.TESTS...............................................................................................................................................9
5.1.Pubertaldevelopment.........................................................................................................9
5.1.1.Girls................................................................................................................................9
5.1.2.Boys..............................................................................................................................11
5.2.Bodycomposition..............................................................................................................13
5.2.1.BodyMassIndex(BMI)...............................................................................................13
5.2.2.Waistcircumference...................................................................................................14
5.2.3.Tricepsskinfoldthickness............................................................................................15
5.2.4.Subscapularskinfoldthickness...................................................................................16
5.3.Musculoskeletalfitness......................................................................................................17
5.3.1.Handgrip......................................................................................................................17
5.3.2.Standinglongjump......................................................................................................20
5.4.Motorfitness......................................................................................................................21
5.4.1.4x10shuttleruntest...................................................................................................21
5.5.Cardiorespiratoryfitness...................................................................................................23
6.REFERENCEVALUES......................................................................................................................24
7.MEASUREMENTSSHEET...............................................................................................................33
8.WORKINGGROUP.........................................................................................................................34
FOREWORD
ALPHAisthefirstletteroftheGreekalphabet.Asanadjective,thetermALPHAiscommonlyused
to designate the first in an order of precedence. In our case, ALPHA is the acronym of the first
European collaborative project designed to be the first European approach to provide a set of
evidencebasedinstrumentsforassessinglevelsofphysicalactivityandfitnessinacomparableway
within the EU. The acronym ALPHA corresponds to Assessing the Levels of Physical Activity and
Fitness,aprojectcoordinatedbyDr.MichaelSjstrmfromtheKarolinskaInstitutetandfundedby
the Directorate General for Health and Consumers Affairs (DG SANCO) of the EU. A part of the
result of the activity of the ALPHA Consortium, and its external advisors, is the ALPHA Fitness
(ALPHAFIT)TestBatteryforChildrenandAdolescentswhichagainisthefirstEuropeanapproach
to provide evidencebased recommendations and operating instructions to assess the health
relatedfitnessstatusinchildrenandadolescentsonapopulationbaseintheEU.Inthefollowing
pagesthisinformationisprovided.
The question now is whether the ALPHAFIT Test Battery applied to Children and Adolescents
should also appear within the first positions in an order of precedence in relation to health. My
answerisyes.
In fact, physical fitness refers to a physiologic state of wellbeing and functional capacity that
allows adequately meeting the multiple demands of daily living including those coming from a
physicaloverload,suchasexerciseordisease.Thehigherthefitnesslevelsofaperson,thehigher
his/her ability to meet the demands of a functional overload. This overload may come not only
from exercise but also from any other physical stress. Sensu strictu, physical fitness makes
referencetothefullrangeofphysicalqualities,i.e.,aerobiccapacity,strength,endurance,speed,
agility, coordination, flexibility Nevertheless, other qualities, such as body composition or
metabolism also play an important role in meeting the demands of any physical overload.
Consequently, they all can also be considered as components of physical fitness. Healthrelated
physicalfitnessincludesthosecomponentsofphysicalfitnessthathaveshowntobemoreclearly
related to health status and it could also relate to wellbeing and happiness although data are
lackinginthisregard.
Iencouragenotonlytoreadthefollowingpagesbuttoputthemintopracticeasafirstpriorityin
relation to health and wellbeing both at individual and population levels. ALPHAFIT individuals
andgroupscanbeahealthygoalforEurope.
Granada,December19th,2009
ManuelJCastilloGarzn,MD,PhD
ProfessorofMedicalPhysiology
SchoolofMedicine,UniversityofGranada
1.WHATISHEALTHRELATEDFITNESS?
Physicalfitnessistypicallydefinedwithfocusontwogoals:performanceorhealth.Healthrelated
physicalfitnesscanbedefinedastheabilityofapersontoperformdailyactivitieswithvigour,and
bytraitsandcapacitiesthatareassociatedwithalowriskforthedevelopmentofchronicdiseases
and premature death. Despite chronic diseases and cardiovascular disease events occur most
frequentlyduringorafterthefifthdecadeoflife,thereisevidenceindicatingthattheprecursorsof
cardiovasculardiseasehavetheirorigininchildhoodandadolescence.Therefore,theassessment
of healthrelated fitness at childhood and adolescence is of public health and clinical interest.
Healthrelatedfitnesscomponentsincludecardiorespiratoryfitness,musculoskeletalfitness,motor
fitnessandbodycomposition.
2.THEALPHAHEALTHRELATEDFITNESSTESTBATTERYFORCHILDRENAND
ADOLESCENTS
2.1.Developmentofthetestbattery
TheALPHAfitnesstestbatterywasdevelopedtoprovideasetofvalid,reliable,feasibleandsafe
fieldbased fitness tests for the assessment of healthrelated physical fitness in children and
adolescents, to be used in the public health monitoring system in a comparable way within the
EuropeanUnion.
2.2.Descriptionofthetestbattery
ALPHAfitnesstestbatteryistimeefficient,lowincostandequipmentrequirements,andcanbe
easilyadministeredtoalargenumberofpeoplesimultaneously.
We propose a valid, reliable, feasible and safe test battery for the assessment of healthrelated
physical fitness in children and adolescents to be used for health monitoring purposes at
populationlevel.
3.HOWTOCONDUCTTHETESTS?
3.1.Generalinstructions
TheALPHAhealthrelatedfitnesstestbatterypresentsthreeslightlydifferentversionsdepending
ontheavailabletimetoadministerthetests.
a) Evidencebased ALPHA healthrelated fitness test battery. This version of the battery
includes weight and height (BMI), waist circumference, skinfolds thickness (triceps and
subscapular), handgrip strength, standing long jump, and 20m shuttle run tests. All these
measurementshaveshowntobestronglyrelatedwiththecurrentandfuturehealthstatus
ofthechildren/adolescent.
The time needed to administer this battery to a group of 20 individuals by one tester is
around2hoursand30minutes.
Evidence Based Health-Related Fitness Test Battery

for Children and Adolescents
Cardiorespiratory
fitness
Musculoskeletal
fitness
Body composition
20m shuttle run test
Handgrip strength
Weight & Height (BMI)
Standing long jump
Waist circumference
Triceps & Subscapular

skinfold thickness
Figure1.EvidencebasedHealthRelatedFitnessTestBatteryforChildrenandAdolescents.BMI
indicatesbodymassindex(weightinkgdividedbyheightinmeterssquared,kg/m2).
b) High priority ALPHA healthrelated fitness test battery (Figure 2). When there are time
constraints, as it can be the case in the school setting, we recommend omitting the
assessmentoftheskinfoldthickness.Thismeasurementisthemostskilldemanding,soin
thesecasesBMIandwaistcircumferencecanbeenoughtoassessbodycomposition.
The time required to administer this battery to a group of 20 children by one trained
physical education (PE) teacher or a healthprofessional is less than 2 hours (i.e. 2 PE
sessionsof~55minutes).
5
High Priority ALPHA Health-Related Fitness Test Battery

Cardiorespiratory
fitness
Musculoskeletal
fitness
Body composition
Handgrip strength
Standing long jump
Waist circumference
Figure 2. High priority ALPHA HealthRelated Fitness Test Battery for Children and Adolescents.
BMIindicatesbodymassindex(weightinkgdividedbyheightinmeterssquared,kg/m2).
c) Extended ALPHA healthrelated fitness test battery (Figure 3). In those cases where there
arenotimelimitations,werecommendusingallthetestsincludedintheevidencebased
batterytogetherwithoneadditionaltest(4x10mshuttlerun)toassessmotorfitness.This
test has shown a poorer health and criterionrelated validity, but only because of a low
numberofstudies.
Extended ALPHA Health-Related Fitness Test Battery

Cardiorespiratory
fitness
Musculoskeletal
fitness
Body composition
Handgrip strength
Standing long jump
Waist circumference
Triceps & Subscapular

skinfold thickness
Motor fitness
4x10m shuttle run test
Figure 3. Extended ALPHA HealthRelated Fitness Test Battery for Children andAdolescents. BMI
indicatesbodymassindex(weightinkgdividedbyheightinmeterssquared,kg/m2).
3.2.Standardization
A strict standardization of the field work precludes to a great extent the confounding bias that
often interferes when comparing results from isolated studies. This manual, which includes not
onlythedescriptionofthetestsbutalsothemostappropriatesequence,andtheinstructionsfor
thetesterandparticipants,willenableahigheraccuracyintheassessmentofphysicalfitnessand
itsrelationshipwithhealthinyoungpeople.
3.3.Therecommendedsequence
Therecommendedsequencetoadministerthisbatterywouldbe:
1. Pubertalstatus.
2. Weightandheight(BMI).
3. Waistcircumference.
4. Skinfoldthickness(tricepsandsubscapular).
5. Handgripstrength,standinglongjumpand4x10mshuttleruntest.Thesecouldbecarried
outalternativelyorsimultaneitywhentherearetwoormoretesters.
6. 20mshuttleruntest.
3.4.Instructionsfortheparticipants
Childmustbeinstructedtoabstainfromstrenuousexerciseinthe48hprecedingthetesting.To
wearcomfortablesportclothesandshoesisvitalfortheappropriateadministrationofthebattery.
A notable and constant level of encouragement is recommended to guarantee the maximum
performancefromtheparticipantsthroughoutthetests.
4.SAFETYMODEL
4.1.Pretestinghealthscreening
Knowledgeofthecurrentandformerhealthstatusofthechildrenandadolescentsisimportantin
order to enhance safe testing. A pretesting screening should identify young people at high risk,
andshouldbesimilartotheonetypicallyusedtoallowthechildrenandadolescentstotakeactive
partinthePElessons. Forthispurpose,inmost/manyEuropeancountries,childrenhaveannual
physical examinations by the schooldoctors who provide detailed information regarding the
skeletomuscular, cardiorespiratory, haematocirculatory, psychoneurological and endocrine
metabolic systems. When this service is not available, it is recommendable that the parents or
guardians complete at least a pretesting/preparticipation screening questionnaire before the
childstartswiththePElessonsand/orthefitnesstesting.Agoodexampleofsuchquestionnaireis
theExerciseandPhysicalActivityReadinessAssessmentquestionnaire.Inanycase,itisimportant
to be alert to the subjective symptoms such as skin pallor, dizziness, syncope and dyspnea. The
tests should be immediately interrupted if there is any sign of problem or risk (see the standard
operatingprocedureforspecification).Anychildabletotakepartinphysicaleducationclassescan
performtheALPHAhealthrelatedfitnesstestbattery.
4.2.Recommendationforsafetesting
A small and comfortable chamber, but warm and ventilated at the same time, is highly
recommendedforthebodycompositionmeasurements.Ideally,nobodyelseapartfromthetester,
anassistant,andamaximumof2participantsshouldbepresentinthechamberatthesametime.
Anonslipperysurfaceisnecessaryforthestandinglongjumpand4x10mshuttleruntests.Finally,
aspaceofatleast25mlengthisrequiredforasafeadministrationofthe20mshuttleruntest.
Immediately after the body composition measurements (BMI, waist circumference and skinfold
thickness),andbeforecontinuingwiththerestofthetests(handgripstrength,standinglongjump,
4x10m shuttle run, and 20m shuttle run), it is necessary to carry out a 510 minutes warm up
composedofjoggingandstretchingexercises.
5.TESTS
5.1.Pubertalstatus(Tannerstage)
Anevaluationofthepubertalstatusofchildrenandadolescentsisofimportanceduetothefact
that childhood and adolescence is a period of life where many changes occur. Though pubertal
development should be ideally evaluated by a paediatrician or trained physician through direct
observation,thisisnotfeasibleinmostsettings.Instead,trainedinterviewerscanaskthechildren
and adolescents to classify themselves in one of the five stages of pubertal maturity defined by
TannerandWhitehouse.
5.1.1.Girls
In girls, Tanner Stage should be assessed by the stage of breast development and public hair
distributionasdenotedintable1.
Table1.GirlsTannerStagesbybreastdevelopment,andbyhairdistribution.
Stage BreastDevelopment
Hairdistribution
1
The infantile stage persists from the immediate Nohair.
postnatal period until the onset of puberty. The
breast has no glandular tissue and the areola and
papillaconformtothechestline.
2
This is the bud stage, during which the breast and Smallamountoflong,slightly
papilla are elevated as a small mound, and the pigmented,downyhair.
diameter of the areola is increased. The
developmentofthebreast.
The breast and areola are further enlarged and Moderate amounts of more
present an appearance rather like that of a small curly, pigmented hair: more
adult mammary gland with a continuous rounded lateral.
contour.
The areola and papilla are further enlarged and Resembles adult public hair
form a secondary mound projecting above the in coarseness and curliness,
corpusofthebreast.
but does not extend to the
medialsurfacesofthethighs.
This is the typical adult stage with a smooth Adultpatter.

rounded contour, the secondary mound present in
Stage4havingdisappeared.
Images.
Stage
Breastdevelopment
Hairdistribution
10

5.1.2.Boys
In boys, Tanner Stage should be assessed by the stage of genitalia development (penis size and
testicularvolume)andpubichairdistributionasdenotedintable2.
Table2.BoysTannerStagesbypenisandscrotumdevelopment,andbyhairdistribution.
Stage PenisandScrotumDevelopment
HairDistribution
1
During this time the genitalia increase in overall Nohair.

size, but there is little change in general
appearance. Testes volume 1.5 cc. Phallus is
childlike.
The scrotum has begun to enlarge, and there is Smallamountoflong,slightly

some reddening and change in texture of the pigmented,downyhair,along
scrotalskin.Testesvolume1.66cc.Thescrotumis thebaseofthescrotum.
reddened, thinner and lager. The phallus is
childlike.
The penis has increased in length, and there is a Moderate amount of more
small increase in breadth. There has been further curly,pigmented,andcoarser
growthofthescrotum.Testesvolume6to12cc.
hair;morelateralextension.
The length and breadth of the penis has increased

further and the glands have developed. The
scrotumisfurtherenlarged,andthescrotalskinhas
becomedarker.Testesvolume12to20cc.
The genitalia are adult in size and shape. Tests Adultpatter.

volume20cc.
Resembles adult hair in

coarseness and curliness, but
does not extend to the
medialsurfacesofthethighs.
11

Images.
Stage
PenisandScrotumDevelopment
Hairdistribution
12
5.2.Bodycomposition
5.2.1.BodyMassIndex(BMI)
Purpose
Tomeasurebodysize.
Healthrelation
HigherBMIisassociatedwithaworsecardiovascularprofile.
Equipment
Anelectronicscaleandatelescopicheightmeasuringinstrument.
Performance
Bodyweightinkilogramsdividedbythesquareofheightinmeters(kg/m2).

Bodyweight
Thechildmuststandontheplatformofthescalewithoutsupport.Thechild
stands still over the centre of the platform with the body weight evenly
distributed between both feet. Light underclothes can be worn, excluding
shoes,longtrousersandsweater.
Bodyheight
Hair ornaments must be removed and braids must be undone. The child
standsonthestadiometerwithbarefeetplacedslightlyapartandtheback
of the head, shoulder blades, buttocks, calves, and heels touching the
verticalboard.Legsmustbekeptstraightandthefeetflat.Thetestermust
positionthechildsheadsothatahorizontallinedrawnfromtheearcanalto
the lower edge of the eye socket runs parallel to the baseboard (i.e., the
Frankfortplanepositionshorizontally).Theheadboardmustbepulleddown
torestfirmlyontopoftheheadandcompresshair.
Practiceandnumberoftesttrials:Twomeasurementsofbothbodyweight
andbodyheightareperformedandthemeanofeachoneisretained.
Measurement
Itstartswhenthechildhasreachedthecorrecttestposition.
Scoring
Weight is recorded to the nearest 100 g. Example: a result of 58 kg scores
58.0. In height the reading must be taken to the last completed 1 mm.
Example:aresultof157.3cmscores157.3.
13
5.2.2.Waistcircumference
Purpose
Toestimatecentralbodyfat.
Healthrelation
Ahigherwaistcircumferenceisariskfactorforcardiovasculardisease.
Equipment
Nonelastictape.
Performance
Thechildwearslittleclothingsothatthetapemaybecorrectlypositioned.
Thechildstandserectwiththeabdomenrelaxed,thearmsatthesidesand
the feet together. The tester faces the child and places an inelastic tape
aroundhim/her,inahorizontalplane,atthelevelofthenaturalwaist,which
isthenarrowestpartofthetorso,asseenfromtheanterioraspect.Insome
obese children, it may be difficult to identify a waist narrowing. In such
cases,thesmallesthorizontalcircumferenceshouldbemeasuredinthearea
betweenthespinailiacasuperiorandthecostaledgeinthemidaxillaryline.
Practice and number of test trials: Two measurements are performed not
consecutivelyandthemeanisusedintheanalyses.
It starts when the child has reached the correct test position. The
Measurement
measurementshouldnotbemadeoverclothing,shouldbetakenattheend
of a normal expiration without the tape compressing the skin and with
childsarmsattheside.
Scoring
Itisrecordedtothenearest0.1cm.Example:aresultof60.7cmscores60.7.
14
5.2.3.Tricepsskinfoldthickness
Purpose
Tomeasuresubcutaneousfatandtoestimatepercentagebodyfat.
Healthrelation
Ahigheradiposityisariskfactorforcardiovasculardisease.
Equipment
Skinfoldcalliper,nonelastictapeandpen.
Performance
Themidupperarmpointishalfthedistancebetweentheacromionprocess
(the most lateral bony protuberance of the back of the shoulder) and the
olecranon(thebonystructurethatstandsoutwhentheelbowisbent).The
tester stands behind the child and picks up the skinfold about 1 cm above
themidpointmarkoverthebicepsmuscle,withthefoldrunningdownward
alongthemidlineofthebackupperarm.Thecaliperjawsmustbeappliedat
rightanglestotheneckofthefoldjustbelowthefingerandthumbover
the midpoint mark. While maintaining a grip on the skinfold, the tester
gently releases the caliper handles and allows the jaws to close on the fat
foldfortwosecondsbeforetakingthereading.
Measurement
Child starts when he/she has reached the correct test position. Skinfolds
must be measured not on the dominant side of the adolescent (it means
that,whensomeoneisrighthandedthanskinfoldsmustbemeasuredonthe
lefthandside).Themeasurementshouldnotbemadeoverclothing.
Scoring
It is recorded to the nearest 0.1 mm. Example: a result of 21.2 mm scores
21.2.
15
5.2.4.Subscapularskinfoldthickness
Purpose
Tomeasuresubcutaneousfatandtoestimatepercentagebodyfat.
Healthrelation
Ahigheradiposityisariskfactorforcardiovasculardisease.
Equipment
Skinfoldcalliper,nonelastictapeandpen.
Performance
Thesubscapularskinfoldispickeduponadiagonal,inclinedinferolaterally
approximately45tothehorizontalplaneinthenaturalcleavagelinesofthe
skin. The site is just inferior to the lower angle of the scapula. The child
standscomfortablyerect,withtheupperextremitiesrelaxedatthesidesof
the body. To locate the site, the tester palpates the scapula, running the
fingers inferiorly and laterally, along its vertebral border until the inferior
angleisidentified.Forsomechildren,especiallytheobese,gentleplacement
of the childs arm behind the back aids in identifying the site. The caliper
jawsareapplied1cminferolateraltothethumbandfingerraisingthefold.
Measurement
Child starts when he/she has reached the correct test position. Skinfolds
must be measured not on the dominant side of the adolescent (it means
that,whensomeoneisrighthandedthanskinfoldsmustbemeasuredonthe
lefthandside).Themeasurementshouldnotbemadeoverclothing.
Scoring
It is recorded to the nearest 0.1 mm. Example: a result of 33.4 mm scores
33.4.
16
5.3.Musculoskeletalfitness
5.3.1.Handgripstrength
Purpose
Tomeasureupperbodyisometricstrength.
Healthrelation
Musculoskeletalfitnessisinverselyassociatedwithestablishedandemerging
cardiovasculardiseaseriskfactors,backpainandwithbonemineralcontent
and density. Musculoskeletal improvements from childhood to adolescence
arenegativelyassociatedwithchangesinoveralladiposity.
Equipment
A hand dynamometer with adjustable grip (TKK 5101 Grip D; Takey, Tokio
Japan)andatablerule.
Performance
Childsqueezesgraduallyandcontinuouslyforatleast2seconds,performing
the test twice (alternately with both hands) with the optimal gripspan
(previously calculated, according to the hand size) and allowing short rest
betweenmeasures.Foreachmeasure,thehandtobetestedfirstlyischosen
randomly.Theelbowmustbeinfullextensionandavoidingcontactingwith
any other part of the body with the dynamometer, except the hand being
measured.
Instructions:"Takethedynamometerwithonehand.Squeezeitforcefullyas
you can while holding the dynamometer away from your body. Don't let it
touchyouduringthetest.Squeezegraduallyandcontinuouslyforatleast2
seconds.Dothetesttwiceperhand:thebestresultscores."
Practiceandnumberoftesttrials:Thetestershowstherightperformance.
Bothhandsaretobetestedtwice,andthebestresult(ofeachhand)scored.
Adjustthehandgripspanaccordingtothehandsize(seenextpage).
Measurement
The maximal duration of the test is 35 seconds. Hand size should be
measured in right hand at maximal width and by measuring the distance
separating distal extremes of the first and fifth digits. The precision of the
measureis0.5cm.Theresultsofhandsizeshouldberoundedtothenearest
whole centimetre. If you prefer, you can put the childrens hand over the
rulertable to see the optimal grip span according to hand size (see ruler
table).Duringthetest,thearmandhandholdingthedynamometershould
not touch the body. The instrument is held in line with the forearm and
hangs down at the side. After a short rest, a second attempt is made. The
indicatorneedstobereturnedtozeroafterthefirstattempt.
Scoring
Theresultisexpressedinkilograms,accurateto0.1kg.Example:aresultof
24kgscores24.0.
17
Rulertable.Optimalgripspanforchildren(612years)accordingtohandsize.ThegripspaniscalculatedfromtheequationbyEspaaRomeroetal.
(JHandSurgery[Am],2008Mar;33(3):37884.):y=x/4+0.44forboysandy=0.3x0.52forgirls,wherexisthehandsize,andyisthegripspan.
GRIP SPAN (cm) for FEMALES (Mark it with a circle)
3
.
5
3
.
7
3
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8
4
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0
4
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1
4
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1
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4
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5
6
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7
6
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8
7
.
1
GRIP SPAN (cm) for MALES (Mark it with a circle)
3
.
8
3
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9
4
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1
4
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2
4
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3
4
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4
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5
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5
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5
2
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2
5
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5
HAND SIZE (real cm)
18
Rulertable.Optimalgripspanforadolescents(1318years)accordingtohandsize.ThegripspaniscalculatedfromtheequationbyRuizetal.(J
HandSurg,[Am].2006Oct;31(8):136772):y=x/7.2+3.1formalesandy=x/4+1.1forfemales,wherexisthehandsize,andyisthegripspan.
GRIP SPAN (cm) for FEMALES (Mark it with a circle)
3
.
6
3
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7
3
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9
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0
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1
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GRIP SPAN (cm) for MALES (Mark it with a circle)
4
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6
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HAND SIZE (real cm)
1
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2
1
2
1
.
5
2
2
2
2
.
5
2
3
2
3
.
5
2
4
2
4
.
5
2
5
19
5.3.2.Standinglongjump
Purpose
Tomeasurelowerbodyexplosivestrength.
Healthrelation
Musculoskeletalfitnessisinverselyassociatedwithestablishedandemerging
cardiovasculardiseaseriskfactors,backpainandwithbonemineralcontent
anddensity.Musculoskeletalimprovementsfromchildhoodtoadolescence
arenegativelyassociatedwithchangesinoveralladiposity.
Equipment
Nonslipperyhardsurface,stick,tapemeasure,adhesivetape,andcones.
Performance
Jumpingfordistancefromastandingstartandwithfeettogether.
Instructions: Stand with your feet at the shoulders width, and toes just
behindtheline.Bendyourkneeswithyourarmsinfrontofyou,parallelto
theground.Asyouswingbotharms,pushoffvigorouslyandjumpasfaras
possible.Trytolandwithyourfeettogetherandtostayupright.Thetestis
donetwiceandthebestattemptisrecorded.
Twotrialsarecarriedoutandthebestresultisscored.
Measurement
Horizontallinesaredrawnonthelandingregion10cmapart,paralleltoand
starting 1 m from the takeoff line. A tape measure perpendicular to these
lines gives accurate measurements. Stand on one side and record the
distances jumped. The distance is measured from the takeoff line to the
point where the back of the heel nearest to the takeoff line lands on the
ground.Afurtherattemptisallowedifthechildfallsbackwardsortouches
thematwithanotherpartofthebody.
Scoring
Theresultisgivenincm.
Example:ajumpof1m56cmscores156.
20
ALPHAFitnessTestBatteryforChildrenandAdolescents
5.4.Motorfitness
5.4.1.4x10mshuttleruntest
Purpose
Tomeasurespeedofmovement,agilityandcoordination.
Healthrelation
Improvements in speed/agility seem to have a positive effect on skeletal
health.
Equipment
Clean, nonslippery floor. Stopwatch, adhesive tape, tape measure, three
spongesofdifferentcoloursandfourcones.
Performance
A running and turning (shuttle) test at maximum speed (4x10 m). Two
parallellinesaredrawnonthefloor(withtape)10mapart.Inthestartline
thereisonesponge(B)andintheoppositelinetherearetwosponges(A,C).
Whenthestartisgiven,thechild(withoutsponge)runsasfastaspossibleto
theotherlineandreturnstothestartinglinewiththesponge(A),crossing
both lines with both feet. The sponge (A) is changed by the sponge B in
starting line. Then go back running as fast as possible to the opposite line
andchangethespongeBbytheConeandrunbacktothestartingline(see
figure,nextpage).
Instructions:Getreadybehindtheline.Onefootshouldbejustbehindthe
line.Whenthestartisgiven,runasfastaspossibletotheotherlinewithout
spongeandreturntothestartinglinewiththespongeA,crossingbothlines
with both feet. Thereafter, change the sponge A by sponge B and go back
runningasfastaspossibletotheoppositeline,wherethespongeBmustbe
changed bythe C one. Finally, runback to thestarting line without getting
down speed before crossing it. Do the test twice: the best result is the
score.
Twotrialsareperformedandthebesttimescored.
Measurement
Makesurethatbothfeetcrossthelineeachtime,thathe/sheremainsinthe
requiredpathandthattheturnsaremadeasquicklyaspossible.Calloutthe
number of cycles completed after each one. The test stops when the child
crosses the finishing line with one foot. The child should not slip or slide
duringthetest,soaslipprooffloorisnecessary.
Scoring
Theresultisscoredinsecondswithonedecimal.Example:atimeof21.6sec
isexpressedas21.6.
21
Graphicdescription.
1m
10 m
Sponge A
Sponge B
Sponge C
22
5.5.Cardiorespiratoryfitness
5.5.1.20mshuttleruntest
Purpose
Toassesscardiorespiratoryfitness.
Healthrelation
High cardiorespiratory fitness during childhood and adolescence is strongly
associatedwithahealthiercurrentandfuturecardiovascularhealth.
Equipment
A gymnasium or space large enough to mark out a 20m track, four cones,
tapemeasure,CDplayerandaprerecordedCDofthetestprotocol.
Performance
Childrenarerequiredtorunbetween2lines20mapartintimewithanaudio
signal. The initial speed of the signal is 8.5 km/h and is increased by 0.5
km/h/min(1minuteequalto1step).Thetestfinisheswhenthechildfailsto
reach the end lines concurrent with the audio signals on 2 consecutive
occasions.Otherwise,thetestendswhenthechildstopsbecauseoffatigue.
Thistestisdoneonce.
Instructions: The shuttle run test gives an indication of your maximal

aerobic capacity, i.e. the endurance, and involves running there and back
along a 20m track. Speed will be controlled by means of a tape emitting
buzzingsoundsatregularintervals.Paceyourselvessoastobeatoneendof
the20mtrackortheotherwhenyouhearasound.Accuracytowithinoneor
twometresisenough.Touchthelineattheendofthetrackwithyourfoot,
turnsharplyandrunintheoppositedirection.Atfirst,thespeedislowbutit
will increase slowly and steadily every minute. Your aim in the test is to
followthesetrhythmforaslongasyoucan.Youshouldthereforestopwhen
youcannolongerkeepupwiththesetrhythmorfeelunabletocomplete
theoneminuteperiod.Rememberthenumberannouncedbytherecording
whenyoustop,thatisyourscore.Thelengthofthetestvariesaccordingto
theindividual:thefitteryouare,thelongerthetestlasts.Tosumup,thetest
is maximal and progressive, in other words easy at the beginning and hard
towardstheend.GoodLuck!
Practiceandnumberoftesttrials:Onlyonetrialisperformed.
Measurement
Selecttestsite,preferablyina25mlonggym.Allowforaspaceofatleast
onemetreateitherendofthetrack.Thewidertheareaused,themorethe
number of children that can be tested simultaneously: one metre between
eachchildisrecommended.Thesurfaceshouldbeuniformbutthematerial
of which it is made is not specifically important. The two ends of the 20m
trackshouldbeclearlymarked.
Check the functioning of the sound track and CD player. Ensure that the
device is powerful enough for group testing. Listen to the contents of the
sound track. Note the numbers on the CD player timer so as to be able to
locatethekeysectionsofthetrackquickly.
Scoring
After the child has stopped, the last completed halfstep is retained.
Example:a score of 6.5 stages. If a higher precision is required (eg.
interventionstudiesaimingtodetectsmallchanges),thefinaltimespentin
thetestexpressedinseconds,insteadofhalfstages,canberetained.
23
6.REFERENCEVALUES
BodyMassIndex(weightinkg/heightinm2)
Verylow
Low
Average
High
Veryhigh
13y
16.7
16.818.0
18.122.2
22.325.7
25.8
14y
17.5
17.619.0
19.123.3
23.426.5
26.6
15y
17.9
18.119.5
19.623.8
23.926.7
26.8
16y
18.0
18.119.6
19.723.7
23.826.4
26.5
17y
19.0
19.120.5
20.624.6
24.727.5
27.6
Girls
13y
17.5
17.619.0
19.123.2
23.326.4
26.5
14y
17.6
17.718.9
19.022.8
22.925.6
25.7
15y
18.1
18.219.4
19.523.0
23.125.6
25.7
16y
18.3
18.419.6
19.723.1
23.225.8
25.9
17y
18.2
18.319.5
19.623.2
23.225.8
25.9
Boys
AdaptedfromMorenoetal.Anthropometricbodyfatcompositionreferencevalues
inSpanishadolescents.TheAVENAStudy.EurJClinNutr2006;60:191196.
24
Waistcircumference(cm)
Verylow
Low
Average
High
Veryhigh
13y
62
6366
6778
7987
88
14y
65
6669
7080
8188
89
15y
67
6771
7281
8289
90
16y
67
6871
7281
8288
88
17y
70
7173
7483
8491
92
Girls
13y
61
6265
6675
7683
84
14y
61
6264
6573
7480
81
15y
63
6466
6775
7681
82
16y
63
6466
6775
7681
82
17y
62
6365
6674
7580
81
Boys
AdaptedfromMorenoetal.BodyfatdistributionreferencestandardsinSpanish
adolescents:theAVENAStudy.IntJObes2007;31:17981805.
25
Tricepsskinfoldthickness(mm)
Verylow
Low
Average
High
Veryhigh
13y
78
915
16.23
24
14y
78
915
1621
22
15y
78
914
1519
20
16y
67
813
1318
19
17y
78
914
1519
20
Girls
13y
10
1112
1320
2125
26
14y
10
1112
1319
2023
24
15y
10
1112
1319
2023
24
16y
11
1213
1420
2124
25
17y
10
1113
1420
2125
26
Boys
26
Subscapularskinfoldthickness(mm)
Verylow
Low
Average
High
Veryhigh
13y
67
812
1319
20
14y
78
912
1319
20
15y
78
912
1317
18
16y
78
912
1316
17
17y
89
1013
1418
19
Girls
13y
89
1016
1722
23
14y
89
1014
1520
21
15y
910
1114
1519
20
16y
910
1115
1620
21
17y
910
1115
1621
22
Boys
27
Bodyfat(%)
Verylow
Low
Average
High
Veryhigh
13y
10.0
10.112.9
13.024.3
24.436.4
36.5
14y
10.1
10.213.0
13.124.0
24.135.1
35.2
15y
9.6
9.712.2
12.322.0
22.131.4
31.5
16y
9.9
10.112.5
12.621.8
21.930.4
30.5
17y
11.3
11.414.1
14.224.0
24.132.9
33.0
Girls
13y
17.8
17.921.0
21.129.5
29.635.3
35.4
14y
17.6
17.720.4
20.528.1
28.233.3
33.4
15y
18.3
18.421.0
21.128.1
28.232.9
33.0
16y
19.0
19.121.8
21.929.2
29.334.1
34.2
Boys
17y
18.721.7
21.829.7
29.835.1
35.2
18.6
AdaptedfromMorenoetal.Anthropometricbodyfatcompositionreferencevalues
inSpanishadolescents.TheAVENAStudy.EurJClinNutr2006;60:191196.
Equationstoestimatebodyfat(%)
Females:
Bodyfat(%)=1.33(tric+subsc)0.013(tric+subsc)22.5
Femaleswhentric+subsc>35mm:
Bodyfat(%)=0.546(tric+subsc)+9.7
Malesprepubertal(Tannerstage1):
Malespubertal(Tannerstage2,3y4):
Malespostpubertal(Tannerstage5):
Maleswhentric+subsc>35mm:
Bodyfat(%)=0.783(tric+subsc)+1.7
Bodyfat(%)estimatedfromequationsreportedbySlaughteretal.(HumBiol1988:
60:709723)usingtricepsandsubscapularskinfolds.
28
Cardiorespiratoryfitness:20mshuttleruntest(stages)
Verylow
Low
Average
High
Veryhigh
13y
3.0
3.54.5
5.06.0
6.57.5
8.0
14y
3.5
4.05.5
6.06.5
7.08.5
9.0
15y
4.0
4.55.5
6.07.0
7.58.5
9.0
16y
4.0
4.5.5.5
6.07.0
7.58.5
9.0
17y
4.5
5.06.0
6.57.5
8.09.0
9.5
Girls
13y
2.0
2.52.5
3.03.5
4.04.5
5.0
14y
2.0
2.53.0
3.54.0
4.55.0
5.5
15y
2.0
2.53.0
3.54.0
4.55.0
5.5
16y
2.0
2.53.0
3.54.0
4.55.0
5.5
17y
2.0
2.53.0
3.54.0
4.55.0
5.5
Boys
AdaptedfromOrtegaetal.PhysicalfitnesslevelsamongEuropeanadolescents:The
HELENAstudy.BrJSportsMed.2010Jun11.[Epubaheadofprint].
29
Upperlimbmaximalstrength:handgripstrengthtest(kg)
Verylow
Low
Average
High
Veryhigh
13y
21.4
21.524.7
24.827.8
27.931.8
31.9
14y
26.3
26.430.4
30.534.0
34.138.5
38.6
15y
31.3
31.435.7
35.839.7
39.844.3
44.4
16y
35.9
36.040.0
40.143.7
43.848.1
48.2
17y
39.9
40.043.5
43.646.7
46.850.6
50.7
Girls
13y
19.9
20.022.5
22.624.8
24.927.6
27.7
14y
21.5
21.624.1
24.226.4
26.529.2
29.3
15y
22.5
22.625.1
25.227.4
27.530.3
30.4
16y
22.9
23.025.4
25.527.8
27.930.8
30.9
17y
23.9
24.026.4
26.528.9
29.032.1
32.2
Boys
Valuesexpressedasaverageofrightandlefthands.
30
Lowerlimbexplosivestrength:standingbroadjumptest(cm)
Verylow
Low
Average
High
Veryhigh
13y
135
136152
153167
168184
185
14y
151
152169
170183
184200
201
15y
165
166182
183196
197212
213
16y
175
176192
193206
207221
222
17y
184
185201
202215
216229
230
Girls
13y
118
119133
134147
148163
164
14y
121
122137
138151
152167
168
15y
123
124138
139151
152167
168
16y
126
127141
142154
155169
170
17y
129
130144
145157
158172
173
Boys
31
Speed/agility:4x10mshuttleruntest(sec)
Verylow
Low
Average
High
Veryhigh
13y
13.0
12.312.9
11.812.2
11.211.7
11.1
14y
12.6
11.912.5
11.411.8
10.911.3
10.8
15y
12.1
11.512.0
11.011.4
10.510.9
10.4
16y
11.8
11.111.7
10.711.0
10.210.6
10.1
17y
11.8
11.111.7
10.711.0
10.210.6
10.1
Girls
13y
13.9
13.113.8
12.513.0
11.912.4
11.8
14y
13.8
13.013.7
12.412.9
11.812.3
11.7
15y
13.7
13.013.6
12.412.9
11.812.3
11.7
16y
13.6
12.913.5
12.312.8
11.712.2
11.6
Boys
17y
12.913.4
12.412.8
11.812.3
13.5
11.7
Lowerscoresindicatebetterperformance.
32
ALPHAHealthRelatedFitnessTestBattery
forChildrenandAdolescents
Measurements
Nameofthechild:
Sex:Male/Female
Dateofbirth:
Tannerstage
Breastdevelopment
Hairdistribution
Hairdistribution
PenisandScrotumDevelopment
Bodycomposition
Weight(kg)
Weight(kg)
Height(cm)
Height(cm)
Handgripstrengthrighthand(kg)
Handgripstrengthrighthand(kg)
Handgripstrengthlefthand(kg)
Handgripstrengthlefthand(kg)
Standinglongjump(cm)
Standinglongjump(cm)
Motorfitness
4x10mshuttleruntest(sec)
Musculoskeletalfitness
4x10mshuttleruntest(sec)
Cardiorespiratoryfitness
20mshuttleruntest(stage)

Notes:(e.g.reasonsforexclusion,problemsoccurringduringthetest)
Nameofthetester:
Date:
33
7.WORKINGGROUP
TheALPHAhealthrelatedfitnesstestbatterywasdevelopedundertheframeworkofthe
ALPHAstudythankstotheteamworkofthefollowinggroupofexperts:
1. JonatanRRuiz,UniversityofGranada,Spain,andKarolinskaInstitutet,Sweden
2. VanesaEspaaRomero,UniversityofGranada,Spain,andKarolinskaInstitutet,Sweden
3. JosCastroPiero,UniversityofCdiz,Spain
4. EnriqueGArtero,UniversityofGranada,Spain
5. FranciscoBOrtega,UniversityofGranada,Spain,andKarolinskaInstitutet,Sweden
6. DavidJimnezPavn,UniversityofGranada,Spain
7. MagdalenaCuenca,UniversityofGranada,Spain
8. PalmaChillnGarzn,UniversityofGranada,Spain
9. MJosGirelaRejn,UniversityofGranada,Spain
10. JessMora,UniversityofCdiz,Spain
11. ngelGutirrez,UniversityofGranada,Spain
12. JaanaSuni,UKKInsitute,Finland
13. MichaelSjstrm,KarolinskaInstitutet,Sweden
14. ManuelJCastillo,UniversityofGranada,Spain
We would like to thank our group of international experts Prof. Pekka Oja, Prof. Han CG
Kemper,Prof.JorgeMota,Prof.KariB,Prof.WillemvanMechelen,andProf.RobertM.Malina
fortheirvaluablecontributiontotheconceptionandstrategyofthedevelopmentoftheALPHA
healthrelatedfitnesstestbatteryforchildrenandadolescents.
E.U.DGSANCOfundedprojectintheframeworkofthePublicHealthProgramme,ref:2006120
34

ALPHA-Fitness Test Manual For Children & Adolescents

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TheALPHAHealthRelatedFitnessTestBatteryfor

Evidence Based Health-Related Fitness Test Battery

20m shuttle run test

Weight & Height (BMI)

Standing long jump

Triceps & Subscapular

High Priority ALPHA Health-Related Fitness Test Battery

20m shuttle run test

Weight & Height (BMI)

Standing long jump

Extended ALPHA Health-Related Fitness Test Battery

20m shuttle run test

Weight & Height (BMI)

Standing long jump

Triceps & Subscapular

4x10m shuttle run test

This is the typical adult stage with a smooth Adultpatter.

During this time the genitalia increase in overall Nohair.

The scrotum has begun to enlarge, and there is Smallamountoflong,slightly

The length and breadth of the penis has increased

The genitalia are adult in size and shape. Tests Adultpatter.

Resembles adult hair in

GRIP SPAN (cm) for FEMALES (Mark it with a circle)

GRIP SPAN (cm) for MALES (Mark it with a circle)

HAND SIZE (real cm)

GRIP SPAN (cm) for FEMALES (Mark it with a circle)

GRIP SPAN (cm) for MALES (Mark it with a circle)

HAND SIZE (real cm)

Instructions: The shuttle run test gives an indication of your maximal

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