Protocol - Integrated Fitness - Child

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Protocol Name from Source:

FITNESSGRAM®/ACTIVITYGRAM Test Administration Manual


Publicly available


This is a series of fitness tests used to assess a child’s fitness level. Tests include the Progressive Aerobic Cardiovascular Endurance Run (PACER) test (similar to shuttle run); curl-up, which is often referred to as a sit-up; trunk lift; push-up (or modified push-up); and back-saver sit and reach. Optional tests include a 1 mile run/walk, modified pull-up or flexed arm hang (for muscular strength and endurance), and a shoulder stretch (for flexibility). Tests should be performed with the assistance of a partner who counts and/or times the activity.


The following descriptions are paraphrased. Complete protocols are available in the FITNESSGRAM®/ACTIVITYGRAM Test Administration Manual, which is available from Human Kinetics.

Progressive Aerobic Cardiovascular Endurance Run (PACER) - aerobic capacity

The child runs back and forth between two points 20 meters* apart. The pace of the run is progressive and timed according to beeps and background music on an audio CD (available from Human Kinetics). The objective is to reach the other point before the next beep sounds. The child must increase the pace of the run to keep up with the beeps. The tester counts the number of laps the child completes within the timed beeps. Document the number of laps completed and refer to the [link[www.phenxtoolkit.org/toolkit_content/supplemental_info/physical/additional_info/PACER_Perf_Eval_Chart.doc|PACER Performance Evaluation Chart]] **. The chart includes the child’s age, sex, PACER laps completed, and corresponding VO2 max range. Use the chart to determine if the number of laps completed corresponds to the Healthy Fitness Zone® Standards for the child’s sex and age. Note that the algorithm used to estimate VO2 max for young girls aged 10 to 11 years is not as accurate as the estimate for boys. Alternatively, the FITNESSGRAM® software, available from Human Kinetics, can be used to convert the number of laps to VO2 max. Contact the Cooper Institute for further updates on this protocol and scoring.

* A 15 meter PACER is an option for those who do not have room for a 20 meter test. Results should be converted using a conversion chart in the FITNESSGRAM®/ACTIVITYGRAM Test Administration Manual.

** Note that the PACER Performance Evaluation Chart includes a revised version for new Healthy Fitness Zone® Standards to be released in August 2010. Also note that the chart only applies to the 20 meter protocol.

Option - 1 Mile Run/Walk (aerobic capacity)

The child runs or walks as fast as possible on a 1 mile flat course. The child is timed from start to finish and the results are recorded. The mile time, age, gender, height, and body mass index values are inserted into a prediction equation developed by Cureton et al. (1995), which is fully described in the online Reference Guide available at the Cooper Institute website.

Alternatively, the child can walk 1 mile as quickly as possible. If the child walks rather than runs, aerobic capacity is estimated from age, gender, weight, mile walk time, and heart rate at the end of the walk using the Kline et al. (1987) equation. The heart rate should be measured by a heart rate monitor (e.g., Polar® heart rate monitor). The walk test has been validated for adolescents ages 13 years and older. See the PhenX measure called Cardiorespiratory Fitness-Exercise Test Estimate for the complete protocol for the 1 mile walk.

Curl-up (abdominal strength)

The child sits on a mat with knees up and slightly bent and feet flat on the mat. Arms are extended with hands flat on the mat. With back and head flat on the mat, the child lifts his upper body and "curls up" toward the knees and moves the hands (palms down) to the end of the measuring strip. The objective is to do as many curl-ups as possible (up to 75) to a specified cadence (3 seconds per repetition).

Trunk Lift (strength and flexibility of the back)

The child lies flat with stomach on mat and legs extended with hands placed under the legs. The child lifts the head up as far as possible but keeps the remainder of body in the same position. The distance from the floor to the child’s chin (with head up) is measured, in inches.

Push-up (upper body strength)

The child assumes a prone position with hands flat on the mat, arms slightly wider than shoulder, fingers stretched out, legs extended, and toes tucked under. The child lifts body with arms extended and back and legs straight and lowers the body so arms are bent at 90°. At this lowest position, the shoulders are parallel to the floor. The child repeats this motion (lifting and lowering body with back and legs straight) as many times as possible. Like the other tests, a cadence (one push-up every 3 seconds) should be used.

Option - Flexed Arm Hang

The instructor helps the child grasp the bar with palms facing outwards and lifts the child so the child is positioned with his or her chin above the bar. Then the child will hang independently in this position for as long as possible. Once the child is in position with chin above the bar, a stopwatch is used to determine how long the child retains the position.

Option - Modified Pull-up

The child grasps the modified pull-up bar with an overhand grip (palms facing inward) and gets into position. The child’s legs are extended with heels touching the ground so that the body is inclined. The child lifts body until the chin is above the elastic band and then returns to the starting position to lift again. The goal is to complete as many modified pull-ups as possible.

Back-saver Sit and Reach (flexibility of upper legs)

This test requires a box and yardstick. The yardstick is taped to the top of the box with the 9 inch mark at the edge of the box where the child’s feet will be placed. The child sits on the floor with left leg extended and foot resting on the edge of the box. The other leg remains bent. The child extends arms toward the box with left arm on bottom and right arm on top. Palms face the floor as child reaches as far as possible toward the extended yardstick. This distance is measured in inches. Make certain that the child does not allow one hand to reach farther than the other and that hips are kept square to the box.

Option - Shoulder Stretch

The child stands up straight, puts left arm behind back with elbow down, and twists the arm up as far as possible up the back with palm facing outward. Retain the position. The right arm goes back behind the head and as far as possible toward the left hand on back. The stretch is done to determine if the child can touch the tips of the other hand behind the back or not. Once the exercise is finished, alternate arms. To meet Health Fitness Zone® Standards, the child must touch fingertips together behind the back in both positions.

Compare the test results with Healthy Fitness Zone® Standards for the age of the child. These standards are found in the FITNESSGRAM®/ACTIVITYGRAM Test Administration Manual.

FITNESSGRAM® and Healthy Fitness Zone® are trademarks of The Cooper Institute, Dallas, Texas.

Polar® is a trademark of Polar Electro Oy.

Personnel and Training Required

Adults should read the FITNESSGRAM Manual and watch the video prior to administering FITNESSGRAM youth tests.

Equipment Needs

Progressive Aerobic Cardiovascular Endurance Run (PACER) test audio CD
Box for back-saver sit and reach test
Exercise mat
Pull-up bar and elastic band for flexed arm hang and modified pull-up
Heart rate monitor for one-mile walk


Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentYes
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration


Life Stage:

Child, Adolescent

Specific Instructions:

Tests should be performed with the assistance of an adult who counts and records repetitions and times the activity. See each test protocol for additional tips and rules.

Note that look-up tables used to score the [link[www.phenxtoolkit.org/toolkit_content/supplemental_info/physical/additional_info/PACER_Perf_Eval_Chart.doc|Progressive Aerobic Cardiovascular Endurance Run (PACER) test]] are found in Physical Activity and Physical Fitness - Additional Information.

Research Domain Information

Release Date:

October 1, 2015


A measure to assess muscle strength, endurance, flexibility, and agility or balance.


An assessment or score used to indicate a person’s overall level of fitness. Different fitness tests are used to assess differing age groups. If results are low, interventions may improve a person’s fitness and health.

Selection Rationale

The FITNESSGRAM® is used to measure youth fitness in schools across the United States. The FITNESSGRAM® tests have been evaluated and provide criterion-based standards. FITNESSGRAM® is a trademark of the Cooper Institute.




Common Data Elements (CDE)Child Integrated Fitness Assessment Description Text3107315CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Integrated fitness child proto62819-8LOINC

Process and Review

The [link[phenx.org/node/62|Expert Review Panel #1]] reviewed the measures in the Anthropometrics, Diabetes, Physical Activity and Physical Fitness, and Nutrition and Dietary Supplements domains.

Guidance from the ERP includes:

• Revised descriptions of measure

Back-compatible: no changes to Data Dictionary

Previous version in Toolkit archive ([link[www.phenxtoolkit.org/index.php?pageLink=browse.archive.protocols&id=150000|link]])


Cureton, K. J., Sloniger, M. A., O’Bannon, J. P., Black, D. N., & McCormack, W. P. (1995). A generalized equation for prediction of VO2 peak from one-mile run/walk performance in youth. Medicine and Science in Sports and Exercise, 27, 445-451.

Kline, G., Porcari, J., Hintermeister, R., Freedson, P. S., Ward, A., McCarron, R. F., Ross, J., & Rippe, J.M. (1987). Estimation of VO2 max from a one-mile track walk, gender, age, and body weight. Medicine and Science in Sports and Exercise, 19, 253-259.

Welk, G. J., & Meredith, M. D. (Eds.). (2007). FITNESSGRAM/ACTIVITYGRAM Test Administration Manual. Champaign, IL: Human Kinetics.

General References


Protocol ID:



Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX150203_GenderPX150203010000Participant's gender4N/A
PX150203_AgePX150203020000Participant's age4N/A
PX150203_WeightPX150203030000Participant's weight4Variable Mapping
PX150203_Height_FeetPX150203040100Participant's height4N/A
PX150203_Height_InchesPX150203040200Participant's height4N/A
PX150203_Lap_LengthPX150203050000Length of laps4N/A
PX150203_Number_LapsPX150203060000Number of laps4Variable Mapping
PX150203_Time_To_Complete_Run_MinutesPX150203070100Time to complete entire 1 mile run4N/A
PX150203_Time_To_Complete_Run_SecondsPX150203070200Time to complete entire 1 mile run4N/A
PX150203_Heart_RatePX150203080000Participant's heart rate immediately after the walk4N/A
PX150203_Time_To_Complete_Walk_MinutesPX150203090100Time to complete entire 1 mile walk4Variable Mapping
PX150203_Time_To_Complete_Walk_SecondsPX150203090200Time to complete entire 1 mile walk4Variable Mapping
PX150203_Number_Curl_UpsPX150203100000Number of curl-ups4N/A
PX150203_Distance_To_ChinPX150203110000Distance from the floor to the child's chin4N/A
PX150203_Number_Push_UpsPX150203120000Number of push-ups4N/A
PX150203_Flexed_Arm_HangPX150203130000Length of time child retains position4N/A
PX150203_Modified_Pull_UpsPX150203140000Number of modified pull-ups completed4N/A
PX150203_Sit_And_ReachPX150203150000Distance reached4N/A
PX150203_Left_Shoulder_StretchPX150203160000Fingertips touch with left arm behind the back and right arm behind the head4N/A
PX150203_Right_Shoulder_StretchPX150203170000Fingertips touch with left arm behind the back and right arm behind the head4N/A