Protocol - Integrated Fitness - Child

Add to My Toolkit

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.

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 Progressive Aerobic Cardiovascular Endurance Run (PACER) test are found in Physical Activity and Physical Fitness - Additional Information.




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 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
Major equipment Yes
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Physical Measurement


Child, Adolescent


Ages 5-17 years

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.


Chinese, English

Logical Observation Identifiers Names and Codes (LOINC) Integrated fitness child proto 62819-8 LOINC
Human Phenotype Ontology Postexertional malaise HP:0030973 HPO
Human Phenotype Ontology Exercise-induced muscle stiffness HP:0008967 HPO
Human Phenotype Ontology Exercise intolerance HP:0003546 HPO
caDSR Form PhenX PX150203 - Integrated Fitness Child Protocol 6170241 caDSR Form
Derived Variables


Process and Review

The 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)

Protocol Name from Source

FITNESSGRAM®/ACTIVITYGRAM® Test Administration Manual, 2007


Cureton, K. J., Sloniger, M. A., OBannon, 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 Name Variable IDVariable DescriptiondbGaP Mapping
PX150203020000 Participant's age Variable Mapping
PX150203110000 Distance from the floor to the child's chin N/A
PX150203130000 Length of time child retains position N/A
PX150203010000 Participant's gender Variable Mapping
PX150203080000 Participant's heart rate immediately after more
the walk show less
Variable Mapping
PX150203040100 Participant's height Variable Mapping
PX150203040200 Participant's height N/A
PX150203050000 Length of laps N/A
PX150203160000 Fingertips touch with left arm behind the more
back and right arm behind the head show less
PX150203140000 Number of modified pull-ups completed N/A
PX150203100000 Number of curl-ups N/A
PX150203060000 Number of laps Variable Mapping
PX150203120000 Number of push-ups N/A
PX150203170000 Fingertips touch with left arm behind the more
back and right arm behind the head show less
PX150203150000 Distance reached N/A
PX150203070100 Time to complete entire 1 mile run N/A
PX150203070200 Time to complete entire 1 mile run N/A
PX150203090100 Time to complete entire 1 mile walk Variable Mapping
PX150203090200 Time to complete entire 1 mile walk N/A
PX150203030000 Participant's weight Variable Mapping
Physical Activity and Physical Fitness
Measure Name

Integrated Fitness

Release Date

May 10, 2010


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.


Physical Activity and Physical Fitness, muscle, exercise, endurance, flexibility, balance, strength, VO2 max, PACER, FITNESSGRAM

Measure Protocols
Protocol ID Protocol Name
150201 Integrated Fitness - Adult
150202 Integrated Fitness - Older Adult
150203 Integrated Fitness - Child

There are no publications listed for this protocol.