Submitted 20 June 2017Accepted 19 October 2017Published 30 November 2017

Corresponding authorMarco Antonio Cossio-Bolantildeosmcossio1972hotmailcom

Academic editorDaniel Loacutepez Loacutepez

Additional Information andDeclarations can be found onpage 12

DOI 107717peerj4032

Copyright2017 Hobold et al

Distributed underCreative Commons CC-BY 40

OPEN ACCESS

Reference standards to assess physicalfitness of children and adolescents ofBrazil an approach to the students ofthe Lake Itaipuacute regionmdashBrazilEdilson Hobold1 Vitor Pires-Lopes2 Rossana Goacutemez-Campos34Miguel de Arruda4 Cynthia Lee Andruske5 Jaime Pacheco-Carrillo6 andMarco Antonio Cossio-Bolantildeos478

1Universidade Estadual do Oeste do Paranaacute Parana Brazil2Research Center in Sports Sciences Health Sciences and Human Development (CIDESD) and Department ofSports Science of Polytechnic Institute of Braganca Braganca Portugal

3Universidad Autonoma de Chile Talca Chile4 Faculty of Physical Education State University of Campinas Campinas Brazil5 Faculty of Educational Sciences Universidad de Talca Linares Chile6Universidad del Bio Bio Chillan Chile7Universidad Catoacutelica del Maule Talca Chile8 Instituto del Deporte Universitario IDUNSA Universidad Nacional de San Agustiacuten Arequipa ArequipaPeruacute

ABSTRACTBackground The importance of assessing body fat variables and physical fitness testsplays an important role in monitoring the level of activity and physical fitness of thegeneral population The objective of this study was to develop reference norms toevaluate the physical fitness aptitudes of children and adolescents based on age andsex from the lake region of Itaipuacute BrazilMethods A descriptive cross-sectional study was carried out with 5962 students (2938males and 3024 females) with an age range of 60 and 179 years Weight (kg) height(cm) and triceps (mm) and sub-scapular skinfolds (mm) were measured Body MassIndex (BMI kgm2) was calculated To evaluate the four physical fitness aptitudedimensions (morphological muscular strength flexibility and cardio-respiratory) thefollowing physical education tests were given to the students sit-and-reach (cm) push-ups (rep) standing long jump (cm) and 20-m shuttle run (m)Results and Discussion Females showed greater flexibility in the sit-and-reach test andgreater body fat than the males No differences were found in BMI Percentiles werecreated for the four components for the physical fitness aptitudes BMI and skinfoldsby using the LMS method based on age and sex The proposed reference values may beused for detecting talents and promoting health in children and adolescents

Subjects Global Health Health Policy Kinesiology Pediatrics Public HealthKeywords Reference Children Adolescents Physical fitness

How to cite this article Hobold et al (2017) Reference standards to assess physical fitness of children and adolescents of Brazil an ap-proach to the students of the Lake Itaipuacute regionmdashBrazil PeerJ 5e4032 DOI 107717peerj4032

INTRODUCTIONPhysical fitness is a strong indicator of health in childhood years as well as in adulthood(Blaes et al 2011 Ortega et al 2008) It is associated with the decrease in the risk ofcardiovascular diseases (Soares-Miranda et al 2015) and the development of a healthybody weight (Lu et al 2014) among other aspects

In general physical fitness tests within the school educational system are an importanttool to measure the achievements of the learning standards associated with physicaleducation (Tremblay amp Lloyd 2010a) These standards are set by the results of field physicaltests (Golle et al 2015) These are commonly used by international schemes to assess thelevels of physical wellbeing of children and adolescents in schools (Catley amp Tomkinson2013 De Miguel-Etayo et al 2014 Meredith Welk amp the Cooper Institute 2007 Ruiz et al2011 Tremblay et al 2010b)

In Brazil reference standards to evaluate physical fitness associated with health arecurrently missing These standards are necessary to rank children and to monitor physicalfitness of the school community (De Miguel-Etayo et al 2014)

Currently the test models used nationally and internationally allow us to analyze theresults using the morphological muscular strenght flexibility and cardiovascular factorsNonetheless to our knowledge no recent studies exist that are capable of assessing the widerange of factors associated with the physical fitness of Brazilian children and adolescentsThis is due to the fact that it is generally known that todayrsquos children and adolescents havea variety of paces and patterns of physical development throughout the world In additionthe multiple protocols developed by countries to measure the components of physicalaptitude and the indicator values for human development are not adequate for comparingthe references for levels of physical aptitude between regions This forces the countries andtheir administrative regions to establish their own models to measure the general wellbeingof their populations with all physical fitness factors included

Consequently the regulatory data from field tests represents the possibility for analyzingand studying health promotion and sports skills Therefore this would provide objectiverecommendations for assessing physical fitness during physical education classes (Golle etal 2015) Furthermore in the past few years the increasing number of publications aboutobesity cardiovascular diseases and metabolic problems (American Diabetes Association2000) show the emergence and the importance of these health problems that todayrsquossociety faces

In that context studying physical fitness using its four factors and the chronologicalage as starting points could provide a way towards achieving relevant data and reaching acommon references to describe physical fitness patterns of students of the Itaipuacute (Brazil)This is particularly feasible since physical education classes are held for 50 min two to threetimes a week

Thus the goal of this study was to develop reference standards that allow us to assessthe physical fitness factors of children and adolescents based on age and gender in the LakeItaipuacute region-Brazil

Hobold et al (2017) PeerJ DOI 107717peerj4032 215

Figure 1 Flowchart outlined to select the study sampleFull-size DOI 107717peerj4032fig-1

MATERIALSThe researcher team designed a cross-sectional descriptive study that included 5962students (2938 men and 3024 females) from the Lake Itaipuacute region in Paranaacute (Brazil)The age range ranged from 60 to 179 years old Sample selection was probabilistic(stratified) Age and sex was used to randomly select the sample from the total availablepopulation of students The sample selection process is illustrated in the flowchart ofFig 1 The educational system for the state of Paranaacute (Brazil) provides physical educationfor elementary education in the development of sports games gymnastics boxing anddance (DCEBEF 2008) Physical education classes are 50 min a day three times a week forelementary (6ndash14 years old) and two times a week for high school students (15ndash18 yearsold) The study was conducted in accordance with the guidelines established by the EthicsCommittee of the School of Medical Sciences of the University of Campinas (Satildeo PauloBrazil)- 2012-785

There were 34 public education schools (elementary and high school education) includedin the study These schools are located in 11 counties that are part of the Lake Itaipuacute regionin the state of Paranaacute (Brazil) This region is located in the west of Paranaacute 627 km from thecapital of Curitiba It is bordered and contained by the neighboring country of ParaguayAccording to the United Nations Program (PNUD 2010) the Human Development Index(HDI) of this region in 2010 was between 0700 and 0799

Hobold et al (2017) PeerJ DOI 107717peerj4032 315

Figure 2 Organization of physical fitness dimensions BMI BodyMass Index TR Triceps SE Sub-scapular

Full-size DOI 107717peerj4032fig-2

Students with physical or mental limitations and subjects with a Body Mass Index(IBMI) greater than the p97 percentile based on cut off points from the Centers for DiseaseControl and Prevention were not included in the study (Kuczmarski et al 2000) Writteninformed consent was obtained from the parents or guardians and students The studywas approved by the ethical committee of the Medical School of the State University ofCampinas SP (Brazil)

METHODSThe anthropometric evaluation and the physical fitness testing were conducted from Aprilto November 2012 The data collection was done fromMonday to Friday during morningsand afternoons (8 am to 12 pm and 1 pm to 5 pm) inside the facilities of the respectiveschools

Anthropometric measuresAll of the anthropometric measurements were carried out by five experiencedanthropometrists The technical measurement error was below 15 A standardanthropometric measurement protocol was adopted as described by Ross amp Marfell-Jones(1991)

Body weight and height were measured with the students in bare feet and with asfew clothes on as possible A digital scale (model BC601 Tanita Manchester UK) and aportable stadiometer (model 217 Seca Gmbh amp Co KG Hamburg Germany) were usedto take all respective measurements Body Mass Index (BMI) was calculated using thestandard equation weight (kg)height squared (m2) Triceps and subscapular skinfoldswere measured with a Harpenden skinfold caliper (Harpenden England)

Physical fitnessThe test battery was designed from four dimensions of physical fitness (morphologicalmuscular strength flexibility and cardio-respiratory) Figure 2 illustrates the organizationof the tests for each dimension

Hobold et al (2017) PeerJ DOI 107717peerj4032 415

In all of the cases the highest points obtained were interpreted as indicators of betterphysical performance During the physical tests carried out in each of the schools a nursewas always present The nurse was to assist in case of an emergency during the physical testsAll of the tests except for the 20-m Shuttle Run Test were conducted twice (n= 596) Thepurpose was to verify the Technical Error of Measurement (TEM) of 10 of the sample inthe research study The values varied from 08 to 27

Physical fitness evaluation included the following test items(1) Sit-and-reach to measure flexibility of the hamstrings muscles and lower back The

procedures followed the YMCA of the USA (2000) suggestions Three trials were conductedand the best performance was recorded

(2) Push-ups test to measure muscle endurance For girls the push-up test was modifiedby resting on the knees (as opposed to toes) The number of push-ups was registered(Canadian Association of Sport Sciences 1986)

(3) Standing long jump to measure power muscular fitness of leg muscles Three trialswere carried out and the best performance was recorded (Castro-Pintildeero et al 2010)

(4) A 20-m shuttle run to measure aerobic fitness (Leger et al 1998) The runningpace was imposed by a sound signal The initial speed was 85 kmh-1 and it increasedin 05 kmh in 1 min intervals The testing finished when the student stopped due tofatigue or when heshe did not reach the line at the same time as the audio signal on twoconsecutive occasions This test was performed only once A group of 6ndash8 students weretested simultaneously

The evaluation of physical testing was performed in the facilities of each schoolPreviously a warm up of about 10 to 15min was carried out to familiarize the students withthe procedures Afterwards the tests were carried out in the following order sit-and-reachpush-ups standing long jump and Shuttle Run test

StatisticsThe normal distribution of the data was verified by using the KolmogorovndashSmirnovTest Descriptive statistics of the arithmetic average standard deviation frequencies andpercentages The differences between both sexes were determined by a t -test of independentsamples Smoothed percentile curves were created for physical fitness for each sex based onthe LMS method (Cole et al 2000) LMS Chart Maker Pro Version 23 software (Pan Coleamp Chartmaker 2006) was used The final percentile curves were the result of smoothingthree age-specific curves L (lambda skewness) M (Mu median) and S (sigma coefficientof variation) P10 P50 and P85 to BMI and to the sum of skinfolds P15 P50 and P85 tothe physical tests

RESULTSTable 1 shows the descriptive statistics (mean and standard-deviation) for all variablesmeasured

In general male subjects showed greater weight and stature and better performancein push-ups standing long jump and 20-m shuttle run (plt 0001) On the contraryfemale students demonstrated better performance in the sit-and-reach test No significate

Hobold et al (2017) PeerJ DOI 107717peerj4032 515

Table 1 Descriptive statistics (meanplusmn standard-deviation) for somatic variables and physical fitnessiacutetems for males and females And results for difference between males and females

Males (n= 2938)Xplusmn SD

Females (n= 3024)Xplusmn SD

p

Age (years) 117plusmn 32 121plusmn 32Somatic measuresWeight (kg) 454plusmn 178 439plusmn 147

Height (cm) 1511plusmn 188 1491plusmn 151

Sitting height (cm) 779plusmn 93 783plusmn 81BMI (kgm2) 191plusmn 40 192plusmn 406 skinfolds (TR+SB) 205plusmn 124 268plusmn 129

Physical fitnessSit-and-reach (cm) 242plusmn 70 258plusmn 70

Push-ups ( Reps) 113plusmn 83 98plusmn 71

Standing long jump (cm) 1422plusmn 338 1139plusmn 230

20-m Shutle Run (m) 8158plusmn 3827 4451plusmn 1993

NotesBMI body mass indexFor age [(F(df 5960)= 1839) plt 0001)]

significant for plt 0001

differences were observed in the BMI (p= 03345) However females showed a greatersum of skinfolds than males

The physical fitness dimension norms distributed in percentiles by age and sex areillustrated in Tables 2 and 3 For the morphological dimension (BMI and skinfolds) theP10 P50 and P85 percentiles have been used and for the other dimensions in P15 P50 andP85 Smoothed curves are also shown through the LMS method for the four dimensionsof physical fitness by age and sex (Figs 3 and 4)

DISCUSSION AND CONCLUSIONSThis study developed percentiles based on the LMS method to evaluate the physical fitnessof children and adolescents of both sexes and ages 60 to 179 The battery of the tests givenin the study evaluated four dimensions For example the morphological dimensions weredetermined by BMI and the sum of two skinfolds (tricipital+ subescapular) the musculardimension by the Push-up Test and standing long jump and flexibility the Sit-and-reachTest and the cardio-respiratory dimension by the Shuttle Run Test (20 m)

Therefore to date no general consensus exists about the definition of the keycomponents andor dimensions of physical fitness However the majority of the studiesare in agreement about two defined objectives health and sports achievements (CvejićPejović amp Ostojić 2013)

In general independent of the objectives both depend on the level of physical fitnessperformed inside and outside of the school system The percentile values proposed in thisstudy may be useful for identifying children and adolescents with high health risks as wellas identifying individuals with moderate and elevated levels of physical fitness

Hobold et al (2017) PeerJ DOI 107717peerj4032 615

Table 2 Smooth centile scores for body mass index (BMI) Skinfolds sit-and-reach push-ups test standing long jump and 20-m shuttle run by chronological age inmales

Age n L M S P10 p50 P85 L M S P15 p50 P85 L M S P15 p50 P85

BMI (kgm2) Sit-and-reach test (cm) Standing long jump (cm)60ndash69 284 minus203 1496 013 129 150 175 142 2517 023 189 252 309 132 10175 018 824 1017 120070ndash79 222 minus191 1544 014 132 154 183 140 2432 024 179 243 302 129 11090 017 905 1109 130280ndash89 210 minus179 1599 015 135 160 192 137 2362 026 17 236 296 126 11928 017 981 1193 139590ndash99 227 minus167 1653 016 139 165 201 134 2313 027 164 231 293 124 12626 016 1044 1263 1472100ndash109 236 minus156 1708 017 142 171 208 130 2295 028 16 229 293 121 13226 016 1099 1323 1539110ndash119 244 minus146 1766 017 146 177 216 124 2302 028 159 23 296 117 13855 016 1155 1385 1610120ndash129 297 minus143 1828 017 151 183 223 118 2342 029 161 234 303 114 14608 016 1220 1461 1696130ndash139 354 minus147 1885 017 157 189 230 110 2414 030 166 241 315 112 15485 016 1295 1549 1797140ndash149 326 minus157 1936 016 162 194 235 101 2482 030 17 248 326 114 16354 016 1367 1635 1898150ndash159 241 minus170 1987 016 167 199 241 091 2541 031 174 254 336 118 17138 016 1430 1714 1990160ndash169 167 minus183 2037 015 172 204 246 080 2584 031 178 258 344 123 17845 016 1486 1785 2072170ndash179 130 minus196 2085 015 177 208 251 069 2614 032 18 261 351 130 18535 016 1539 1854 2153

6 skinfolds (TR+SB) Push-ups ( Reps) 20-m Shuttle run (m)60ndash69 284 minus078 469 039 31 47 76 033 480 065 2 5 970ndash79 222 minus074 508 044 32 51 89 035 624 067 3 6 1280ndash89 210 minus073 572 049 34 57 108 036 738 068 3 7 1490ndash99 227 minus062 633 052 36 63 123 039 814 070 4 8 15100ndash109 236 minus060 681 054 38 68 135 041 853 071 4 9 16 023 51579 047 3081 5158 8174110ndash119 244 minus063 721 054 41 72 144 044 884 072 4 9 17 033 56585 047 3312 5659 8925120ndash129 297 minus067 757 052 44 76 148 047 952 072 4 10 18 043 64275 047 3708 6428 10030130ndash139 354 minus073 767 049 46 77 144 049 1073 071 4 11 20 054 73981 046 4246 7398 11336140ndash149 326 minus073 754 046 46 75 135 050 1227 070 5 12 23 064 83525 044 4844 8352 12490150ndash159 241 minus067 762 043 48 76 130 049 1397 069 6 14 26 073 91546 042 5430 9155 13342160ndash169 167 minus075 807 041 52 81 135 048 1570 067 7 16 29 081 101066 039 6177 10107 14363170ndash179 130 minus082 868 040 57 87 144 047 1741 066 8 17 32 087 113105 036 7154 11310 15679

NotesBMI body mass index TR+SB triceps+ subscapular P percentile L skew M median S coefficient of variation

Hobold

etal(2017)PeerJDOI107717peerj4032

715

Table 3 Smooth centile scores for body mass index (BMI) Skinfolds sit-and-reach push-ups test standing long jump and 20-m shuttle run by chronological age infemales

Age n L M S P10 p50 P85 L M S P15 p50 P85 L M S P15 p50 P85

BMI (kgm2) Sit-and-reach test (cm) Standing long jump (cm)60ndash69 241 minus17 1505 0146 128 150 179 153 2612 021 199 261 316 043 8752 018 718 875 10570ndash79 203 minus158 1549 0154 131 155 186 145 2583 023 193 258 317 064 9609 018 785 961 114980ndash89 170 minus147 1592 0161 133 159 193 137 2541 024 186 254 316 084 10436 018 85 1044 124390ndash99 218 minus138 1641 0166 136 164 200 129 2508 026 181 251 315 101 11113 018 903 1111 1319100ndash109 276 minus131 1704 017 141 170 208 122 2507 027 179 251 318 113 11588 018 94 1159 1373110ndash119 323 minus124 1775 0172 146 177 217 118 254 027 181 254 324 119 11920 018 966 1192 1411120ndash129 311 minus117 1845 0172 152 184 225 116 2581 027 183 258 33 118 12103 018 981 121 1432130ndash139 337 minus112 1912 0171 157 191 233 118 2622 027 185 262 335 111 12140 018 986 1214 1438140ndash149 332 minus108 1967 0169 162 197 239 122 2664 027 188 266 34 101 12067 018 983 1207 143150ndash159 276 minus104 2006 0167 165 201 243 127 2693 027 19 269 343 086 11929 018 976 1193 1416160ndash169 198 minus100 2040 0164 169 204 246 133 2712 027 191 271 344 068 11793 018 97 1179 1402170ndash179 139 minus096 2077 0162 172 208 249 139 2738 027 193 274 346 048 11672 018 965 1167 139

6 skinfolds (TR+SB) Push-ups ( Reps) 20-m Shuttle run (m)60ndash69 241 minus059 1660 039 96 166 263 027 416 069 2 4 870ndash79 203 minus052 1792 040 101 179 287 029 538 069 2 5 1080ndash89 170 minus046 1917 042 106 192 310 030 645 069 3 6 1290ndash99 218 minus041 2041 042 110 204 332 032 733 07 3 7 14100ndash109 276 minus037 2158 043 115 216 351 034 806 071 4 8 16 036 39811 043 245 3981 6021110ndash119 323 minus033 2263 043 120 226 367 035 867 072 4 9 17 037 41497 044 2512 415 6332120ndash129 311 minus030 2377 043 126 238 382 036 909 073 4 9 18 039 4297 045 2566 4297 6606130ndash139 337 minus027 2532 042 135 253 402 038 948 074 4 10 19 039 41945 046 2488 4194 6478140ndash149 332 minus024 2684 041 144 268 420 039 983 074 4 10 19 037 41071 046 2429 4107 6369150ndash159 276 minus020 2793 040 151 279 430 041 1002 075 4 10 20 034 41087 046 2428 4109 6418160ndash169 198 minus017 2871 039 156 287 436 043 1018 075 4 10 20 028 41753 047 2476 4175 6588170ndash179 139 minus013 2944 038 162 294 441 044 1037 076 4 10 20 018 42836 047 2565 4284 6843

NotesBMI body mass index TR+SB triceps+ subscapular P percentile L skew M median S coefficient of variation

Hobold

etal(2017)PeerJDOI107717peerj4032

815

Figure 3 Smoothed centile curves for BMI and Skinfolds (P10 P50 and P85) and physical fitness tests(P15 P50 and P85) by chronological age in males

Full-size DOI 107717peerj4032fig-3

Various studies have proven that a low level of physical fitness during childhood andadolescence is associated with overweight and obesity as well as cardiovascular diseasesdeterioration of bone health and reduced quality of life (Vicente-Rodriguez et al 2008Moliner-Urdiales et al 2010 Morales et al 2013) among other ailments

For example increase in muscular strength from childhood to adolescences relatedinversely to changes in body fat (Ruiz et al 2011)Moreover it has been demonstrated thatstrength is positively associated with a better quality of bone health (Pitukcheewanont Pun-yasavatsut amp Feuille 2010) In addition an adequate level of aerobic conditioning increasesthe capacity to work efficiently and allow participation and enjoyment in physical activitiessuch as sports recreation and leisure (Carnethon Gulati amp Greenland 2005) Therefore

Hobold et al (2017) PeerJ DOI 107717peerj4032 915

Figure 4 Smoothed centile curves for BMI and Skinfolds (P10 P50 and P85) and physical fitness tests(P15 P50 and P85) by chronological age in females

Full-size DOI 107717peerj4032fig-4

these benefits are associated with adequate levels of flexibility reduced risks of lesionsprevent and reduce pain and improve motor coordination (Castro-Pintildeero et al 2010)

As a result the importance of evaluating body fat variables and physical fitnesstests plays an important role in monitoring the level s of physical activity and physicalfitness of populations in general According to the World Health Organization (2010)physical fitness should be considered a priority for public health Therefore schoolsshould play a central role in the provision and promotion of physical activity andphysical fitness of the young along with other healthy behaviors since children andadolescents spend a majority of their time in the school setting (Pate et al 2006)

Hobold et al (2017) PeerJ DOI 107717peerj4032 1015

This is an important opportunity to introduce physical activity programs for specific workgroups not only in schools but also in sports clubs andor physical sports rehabilitationcenters respectively

The accurate interpretation of physical fitness values requires the comparison of thescores obtained from one person in particular with the normative valuies for the generalpopulation of the same sex and age (Ortega et al 2011) In this context the normativevalues proposed here may be used for different purposes for example morphologicaldimensions (BMI and skinfolds) The interpretation of gtp85 may be considered excessivefat between 10 to p85 as normal and ltp10 as low levels of fat equal to the CDC-2000cut-off scores (Kuczmarski et al 2000) On the other hand for the physical fitness teststhe percentiles less than ltp15 may be interpreted as a low level or a warning sign betweenp15 to p85 as adequate and gtp85 as an elevated level of fitness

In essence to date no defined consensus exists about the cut-off points for dimensionsused in the tests for determining physical fitness in pediatric populations In spite of thissome population studies use scales consisting of two to five categories (Meredith Welk ampthe Cooper Institute 2007 Ortega et al 2011 Catley amp Tomkinson 2013 De Miguel-Etayoet al 2014)

This current study opts for three categories To do this we took into account the realityof the educational systems of the schools since the schools just importantly identifiedstudents with low levels of physical fitness as well as identifying those student athletes(Golle et al 2015)

Moreover the schools maintained and promoted adequate levels of physical activity(related to health) for the students throughout the school years Furthermore this is anobjective that should be maintained in the short medium and long term Thus theseobjectives should not be careless and of a permanent nature They should be developedwithin the curriculum programs in all of the educational systems

In summary taking into account the probabilistic sample selection the use of theLMS method to generate the percentiles and the proposed battery of tests with their fourdimensions this study has a number of advantages Based on its applicability to the LakeItaipuacute region of Brazil and the selected sample size the results from this research maybe generalized to other geographical regions of Brazil particularly those with similardemographic characteristics

This study has a few limitations For example the (cross-sectional) design of thestudy does not allow for changes to be described in physical fitness during growth anddevelopment Therefore future studies should be designed longitudinally since physicalfitness levels change over time Longitudinal research is better suited to track changesover time than are cross-sectional studies (Golle et al 2015) Furthermore biologicalmaturation could not be measured in this study Controlling for this variable would havediminished the range of variability between individuals of the same chronological ageduring adolescence

In conclusion the results of this study show regional reference values for evaluatingthe physical fitness of children and adolescents by chronological age and sex The findingsfrom this research can be used for the detection and monitoring of the four dimensions

Hobold et al (2017) PeerJ DOI 107717peerj4032 1115

of physical fitness (morphological flexibility muscle strength and cardiorespiratory) as aspecific tool for health in educational contexts Nevertheless to confirm these results it isnecessary to develop longitudinal studies

ADDITIONAL INFORMATION AND DECLARATIONS

FundingThe authors received no funding for this work

Competing InterestsThe authors declare there are no competing interests

Author Contributionsbull Edilson Hobold performed the experiments contributed reagentsmaterialsanalysistools reviewed drafts of the paperbull Vitor Pires-Lopes analyzed the data wrote the paper reviewed drafts of the paperbull Rossana Gomez-Campos and Marco Antonio Cossio-Bolantildeos conceived and designedthe experiments analyzed the data wrote the paper prepared figures andor tablesreviewed drafts of the paperbull Miguel Arruda conceived and designed the experiments wrote the paper revieweddrafts of the paperbull Cynthia Lee Andruske wrote the paper reviewed drafts of the paper grammar reviewbull Jaime Pacheco-Carrillo prepared figures andor tables reviewed drafts of the paper

Human EthicsThe following information was supplied relating to ethical approvals (ie approving bodyand any reference numbers)

The study was conducted in accordance with the guidelines established by the EthicsCommittee of the School of Medical Sciences of the University of Campinas (Satildeo PauloBrazil)

Data AvailabilityThe following information was supplied regarding data availability

Figshare DOI 106084m9figshare5388298

Supplemental InformationSupplemental information for this article can be found online at httpdxdoiorg107717peerj4032supplemental-information

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Hobold et al (2017) PeerJ DOI 107717peerj4032 1215

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CarnethonMR Gulati M Greenland P 2005 Prevalence and cardiovascular diseasecorrelates of low cardiorespiratory fitness in adolescents and adults Journal of theAmerican Medical Association 2942981ndash2988 DOI 101001jama294232981

Castro-Pintildeero J Ortega FB Artero EG Girela-RejoacutenMJ Mora J SjoumlstroumlmM Ruiz JR2010 Assessing muscular strength in youth usefulness of standing long jump as ageneral index of muscular fitness Journal Strength Condition Research 241810ndash1817DOI 101519JSC0b013e3181ddb03d

Catley MJ Tomkinson GR 2013 Normative health-related fitness values for childrenanalysis of 85347 test results on 9ndash17-year-old Australians since 1985 British Journalof Sports Medicine 4798ndash108 DOI 101136bjsports-2011-090218

Cole TJ Bellizzi MC Flegal KM DietzWH 2000 Establishing a standard definition forchild overweight and obesity worldwide international survey BMJ 3201240ndash1243DOI 101136bmj32072441240

Cvejić D Pejović T Ostojić S 2013 Assessment of physical fitness in children andadolescents Physical Education and Sport 11(2)135ndash145

Diretrizes Curriculares da Educacatildeo Baacutesica en Educacatildeo Fiacutesica (DCEBEF) 2008Gov-erno do Paranaacute secretaria de estado da Educacatildeo do Paranaacute Paranaacute Departamentode Educacatildeo baacutesica

DeMiguel-Etayo P Gracia-Marco L Ortega FB Intemann T Foraita R Lissner LOja L Barba G Michels N Tornaritis M Molnaacuter D Pitsiladis Y AhrensWMoreno LA on behalf of the IDEFICS consortium 2014 Physical fitness referencestandards in European children the IDEFICS study International Journal of Obesity38S57ndashS66 DOI 101038ijo2014136

Golle K Muehlbauer TWick D Granacher U 2015 Physical fitness percentiles ofGerman children aged 9ndash12 years findings from a longitudinal study PLOS ONE10(11)e0142393 DOI 101371journalpone0142393

Kuczmarski R Ogden C Grummer-Strawn L Flegal KM Guo SSWei R Mei Z CurtinLR Roche AF Johnson CL 2000 CDC growth charts United States Advance datafrom vital and health statistics Hyattsville US Department of Health and HumanServices

Leger LA Mercier D Gadoury C Lambert J 1998 The multistage 20 metre shuttle runtest for aerobic fitness Journal of Sports Science 693ndash101

Lu YJ Zheng XD Zhou FS Zuo XB 2014 BMI and physical fitness in Chinese adultstudents a large school-based analysis International Journal of Clinical and Experi-mental Medicine 7(10)3630ndash3636

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MeredithMWelk G the Cooper Institute 2007 FitnessgramActivitygram 2007 testadministration manual Updated 3rd edition Champaign Human Kinetics

Moliner-Urdiales D Ortega FB Vicente-Rodriguez G Rey-Lopez JP Gracia-MarcoLWidhalm K SjoumlstroumlmMMoreno LA Castillo MJ Ruiz JR 2010 Associationof physical activity with muscular strength and fat-free mass in adolescentsthe HELENA study European Journal of Applied Physiology 1091119ndash1127DOI 101007s00421-010-1457-z

Morales PF Sanchez-LopezMMoya-Martinez P Garcia-Prieto JC Martinez-Andres M Garcia NL Martiacutenez-Vizcaiacuteno V 2013Health-related quality of lifeobesity and fitness in schoolchildren the Cuenca study Quality of Life Research221515ndash1523 DOI 101007s11136-012-0282-8

Ortega FB Labayen I Ruiz JR Kurvinen E Loit HM Harro J Veidebaum T SjoumlstroumlmM 2011 Improvements in fitness reduce the risk of becoming overweight acrosspubertyMedicine Science Sports Exercise 431891ndash1897

Ortega FB Ruiz JR Castillo MJ SjostromM 2008 Physical fitness in childhood andadolescence a powerful marker of health International Journal of Obesity 321ndash11DOI 101038sjijo0803774

Pan H Cole TJ Chartmaker LMS 2006Health For All ChildrenmdashlsquolsquoThe joint workingparty on child health surveillancersquorsquo Available at httpwwwhealthforallchildrencouk(accessed on 28 March 2015)

Pate RR Davis MG Robinson TN Stone EJ McKenzie TL Young JC 2006 Promotingphysical activity in children and youth a leadership role for schools a scientificstatement from the American Heart Association Council on Nutrition PhysicalActivity and Metabolism (Physical Activity Committee) in collaboration with theCouncils on Cardiovascular Disease in the Young and Cardiovascular NursingCirculation 114(11)1214ndash1224 DOI 101161CIRCULATIONAHA106177052

Pitukcheewanont P Punyasavatsut N Feuille M 2010 Physical activity and bone healthin children and adolescents Pediatric Endocrinology Reviews 7(3)275ndash282

Programa de las Naciones Unidas para el Desarrollo (PNUD) 2010 Informe SobreDesarrollo Humano 2010 Edicioacuten del Vigeacutesimo Aniversario New York Availableat httphdrundporg sitesdefault fileshdr_2010_es_complete_reprintpdf

RossWDMarfell-Jones MJ 1991 Kinanthropometry In MacDougall JD WengerHA Green HJ eds Physiological testing of the high-perfomance athlete ChampaignHuman Kinetics Books 223ndash308

Ruiz JR Espantildea Romero V Castro-Pintildeero J Artero EG Ortega FB Cuenca GarciacuteaM Jimeacutenez Pavoacuten D Chilloacuten P Girela-RejoacutenMJ Mora J Gutieacuterrez A Suni JSjoumlstromM Castillo MJ 2011 ALPHA-fitness test battery health-related field-based fitness tests assessment in children and adolescents Nutricion Hospitalaria26(6)1210ndash1214

Soares-Miranda L Imamura F Siscovick D Jenny NS Fitzapatrick AL MozaffarianD 2015 Physical activity physical fitness and leukocyte telomere length the car-diovascular health studyMedicine amp Science in Sports amp Exercise 47(12)2525ndash2534DOI 101249MSS0000000000000720

Hobold et al (2017) PeerJ DOI 107717peerj4032 1415

TremblayM LloydM 2010a Physical literacy measurement the missing piece Physicaland Health Education Journal 76(1)26ndash30

TremblayMS Shields M Laviolette M Craig CL Janssen I Connor Gorber S 2010bFitness of Canadian children and youth results from the 2007ndash2009 CanadianHealth Measures Survey Health Report 217ndash20

Vicente-Rodriguez G Urzanqui A MesanaMI Ortega FB Ruiz JR Ezquerra JCasajuacutes JA Blay G Blay VA Gonzalez-Gross M Moreno LA AVENA-ZaragozaStudy Group 2008 Physical fitness effect on bone mass is mediated by theindependent association between lean mass and bone mass through adoles-cence a cross-sectional study Journal of Bone Mineral Metabolims 26288ndash294DOI 101007s00774-007-0818-0

World Health Organization 2010Global recommendations on physical activityfor health WHO Geneva Available at httpswwwncbinlmnihgovbooksNBK305057

YMCA of the USA 2000 YMCA fitness testing and assessment manual 4th editionChampaign Human Kinetics

Hobold et al (2017) PeerJ DOI 107717peerj4032 1515