Article Text

European fitness landscape for children and adolescents: updated reference values, fitness maps and country rankings based on nearly 8 million test results from 34 countries gathered by the FitBack network
  1. Francisco B Ortega1,2,3,
  2. Bojan Leskošek4,
  3. Rok Blagus4,5,6,
  4. José J Gil-Cosano1,7,
  5. Jarek Mäestu8,
  6. Grant R Tomkinson9,
  7. Jonatan R Ruiz1,3,10,
  8. Evelin Mäestu8,
  9. Gregor Starc4,
  10. Ivana Milanovic11,
  11. Tuija H Tammelin12,
  12. Maroje Sorić4,13,
  13. Claude Scheuer14,15,
  14. Attilio Carraro16,
  15. Mónika Kaj17,
  16. Tamás Csányi17,18,19,
  17. Luis B Sardinha20,
  18. Matthieu Lenoir21,
  19. Arunas Emeljanovas22,
  20. Brigita Mieziene22,
  21. Labros S Sidossis23,
  22. Maret Pihu8,
  23. Nicola Lovecchio24,25,
  24. Kenn Konstabel26,27,
  25. Konstantinos D Tambalis28,29,
  26. Lovro Štefan13,30,31,
  27. Clemens Drenowatz32,
  28. Lukáš Rubín33,34,
  29. Seryozha Gontarev35,
  30. José Castro-Piñero36,37,
  31. Jérémy Vanhelst38,
  32. Brendan O’Keeffe39,
  33. Oscar L Veiga40,
  34. Thordis Gisladottir41,
  35. Gavin Sandercock42,
  36. Marjeta Misigoj-Durakovic13,
  37. Claudia Niessner43,
  38. Eva-Maria Riso8,
  39. Stevo Popovic44,45,
  40. Saima Kuu46,
  41. Mai Chinapaw47,
  42. Iván Clavel48,49,
  43. Idoia Labayen50,
  44. Janusz Dobosz51,
  45. Dario Colella52,
  46. Susi Kriemler53,
  47. Sanja Salaj13,
  48. Maria Jose Noriega54,
  49. Klaus Bös43,
  50. Mairena Sánchez-López55,56,
  51. Timo A Lakka57,58,59,
  52. Garden Tabacchi60,
  53. Dario Novak13,
  54. Wolfgang Ahrens61,
  55. Niels Wedderkopp62,
  56. Gregor Jurak4
  57. the FitBack, HELENA and IDEFICS consortia
  1. 1 Faculty of Sport Sciences, University of Granada, Department of Physical and Sports Education; Sport and Health University Research Institute (iMUDS), CIBERobn Physiopathology of Obesity and Nutrition, Granada, Spain
  2. 2 Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
  3. 3 Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
  4. 4 Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
  5. 5 Institute for Biostatistics and Medical Informatics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
  6. 6 Faculty of Mathematics, Natural Sciences and Information technologies, University of Primorska, Glagoljaška, Slovenia
  7. 7 Department of Communication and Education, Universidad Loyola Andalucía, Dos Hermanas, Spain
  8. 8 Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
  9. 9 Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
  10. 10 Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain
  11. 11 University of Belgrade, Faculty of Sport and Physical Education, Belgrade, Serbia
  12. 12 JAMK University of Applied Sciences, School of Health and Social Studies, LIKES, Jyväskylä, Finland
  13. 13 University of Zagreb, The Faculty of Kinesiology, Zagreb, Croatia
  14. 14 European Physical Education Association (EUPEA)
  15. 15 Department of Education and Social Work, University of Luxembourg, Esch-sur-Alzette, Luxembourg
  16. 16 Faculty of Education, Free University of Bozen-Bolzano, Brixen, Italy
  17. 17 Hungarian School Sport Federation, Budapest, Hungary
  18. 18 Department of Physical Education Theory and Methodology, Hungarian University of Sports Science, Budapest, Hungary
  19. 19 Department of Physical Education, Faculty of Primary and Pre-School Education, ELTE, Eötvös Loránd University, Budapest, Hungary
  20. 20 Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, 1499-002 Cruz-Quebrada, Portugal
  21. 21 Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
  22. 22 Lithuanian Sports University, Department of Physical and Social Education, Kaunas, Lithuania
  23. 23 Mediterranean Lifestyle Medicine Institute and Department of Kinesiology and Health, Rutgers University, New Brunswick, USA
  24. 24 Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
  25. 25 Confederation of Italian Associations of Physical Education Teachers (Capdi & LSM), Venezia, Italy
  26. 26 Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia
  27. 27 Institute of Psychology, University of Tartu, Tartu, Estonia
  28. 28 Harokopio University, Department of Nutrition and Dietetics, Athens, Greece
  29. 29 National and Kapodistrian University of Athens, Department of Physical Education and Sport Science, Athens, Greece
  30. 30 Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
  31. 31 Recruitment and Examination (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic
  32. 32 Division of Sport, Physical Activity and Health, University of Education Upper Austria, Linz, Austria
  33. 33 Institute of Active Lifestyle, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
  34. 34 Department of Physical Education and Sport, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
  35. 35 Faculty of Physical Education, Sport and Health. Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
  36. 36 GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, Cadiz, Spain
  37. 37 Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
  38. 38 Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Centre of Research in Epidemiology and Statistics - University of Paris Cité (CRESS), Bobigny, France
  39. 39 Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
  40. 40 EstiLIFE Research Group. Department of Physical Education, Sport and Human Movement, Faculty of Teaching Training and Education, Autonomous University of Madrid, Madrid, Spain
  41. 41 Center of Sport and Health Sciences, School of Education, University of Iceland, Reykjavik Iceland
  42. 42 School of Sport Rehabilitation and Exercise Science, University of Essex, Colchester, UK
  43. 43 Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
  44. 44 University of Montenegro, Faculty for Sport and Physical Education, Niksic, Montenegro
  45. 45 Western Balkan Sport Innovation Lab, Podgorica, Montenegro
  46. 46 Tallinn University, School of Natural Sciences and Health, Tallinn, Estonia
  47. 47 Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  48. 48 Galician Sport Foundation, General Sport Secretariat, Galician Government, Santiago de Compostela, Spain
  49. 49 Performance and Health Group, Faculty of Sport Sciences and Physical Education, Department of Physical Education and Sports, University of A Coruña, Coruña, Spain
  50. 50 Research Institute for Innovation & Sustainable Food Chain Development, Department of Health Sciences, Public University of Navarra, Pamplona, Spain
  51. 51 Józef Piłsudski University of Physical Education in Warsaw, Poland
  52. 52 Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
  53. 53 Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
  54. 54 Department of Physiology & Pharmacology University of Cantabria, Cantabria, Spain
  55. 55 Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
  56. 56 Universidad de Castilla-La Mancha, School of Education, Ciudad Real, Spain
  57. 57 Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, Finland
  58. 58 Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
  59. 59 Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
  60. 60 Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
  61. 61 Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
  62. 62 The Pediatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
  1. Correspondence to Francisco B Ortega; ortegaf{at}; Gregor Jurak; Gregor.Jurak{at}


Objectives (1) To develop reference values for health-related fitness in European children and adolescents aged 6–18 years that are the foundation for the web-based, open-access and multilanguage fitness platform (FitBack); (2) to provide comparisons across European countries.

Methods This study builds on a previous large fitness reference study in European youth by (1) widening the age demographic, (2) identifying the most recent and representative country-level data and (3) including national data from existing fitness surveillance and monitoring systems. We used the Assessing Levels of PHysical Activity and fitness at population level (ALPHA) test battery as it comprises tests with the highest test–retest reliability, criterion/construct validity and health-related predictive validity: the 20 m shuttle run (cardiorespiratory fitness); handgrip strength and standing long jump (muscular strength); and body height, body mass, body mass index and waist circumference (anthropometry). Percentile values were obtained using the generalised additive models for location, scale and shape method.

Results A total of 7 966 693 test results from 34 countries (106 datasets) were used to develop sex-specific and age-specific percentile values. In addition, country-level rankings based on mean percentiles are provided for each fitness test, as well as an overall fitness ranking. Finally, an interactive fitness platform, including individual and group reporting and European fitness maps, is provided and freely available online (

Conclusion This study discusses the major implications of fitness assessment in youth from health, educational and sport perspectives, and how the FitBack reference values and interactive web-based platform contribute to it. Fitness testing can be conducted in school and/or sport settings, and the interpreted results be integrated in the healthcare systems across Europe.

  • physical fitness
  • physical endurance

Data availability statement

Data may be obtained from a third party and are not publicly available. This article includes data from more than 100 datasets. Data sharing permission should be requested to the researchers of each individual dataset. References for each dataset can be found in online supplemental table 1.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data may be obtained from a third party and are not publicly available. This article includes data from more than 100 datasets. Data sharing permission should be requested to the researchers of each individual dataset. References for each dataset can be found in online supplemental table 1.

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    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


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  • Contributors Designed research, contributed to the conception and interpretation of the analyses: FBO, BL, RB, JJG-C, JM, GRT, JRR, EM, GS, IM, TT, MS, CS, AC, MK, TC, LBS and GJ. Statistical analysis: BL and RB. Drafted the manuscript. FBO. Participated/responsible for fitness data collection: FBO, JM, JRR, EM, GS, IM, MS, MK, TC, LBS, ML, AE, BM, LSS, MP, NL, KK, KDT, LS, CD, LR, SG, JC-P, JV, BOK, OLV, TG, GS, MM-D, CN, E-MR, SP, SKuu, MJMC, IC, IL, JD, DC, SK, SS, MJN, KB, MS-L, TAL, GT, DN, WA and NW. All authors critically revised the manuscript and approved the final version of the manuscript to be submitted. FBO and GJ are the guarantors of this article, and therefore accept full responsibility for the work and/or the conduct of the study, had access to the data and controlled the decision to publish.

  • Funding This research was co-funded by the Erasmus+ Sport Programme of the European Union within the project FitBack No 613010-EPP-1-2019-1-SI-SPO-SCP and Slovenian Research Agency within the Research programme Bio-psycho-social context of kinesiology (number P5-0142). FBO, JJG-C, JRR and IL are supported by the University of Granada, Plan Propio de Investigación, Visiting Scholar grants and Excellence actions: Units of Excellence; Unit of Excellence on Exercise, Nutrition and Health and by the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades and European Regional Development Fund (SOMM17/6107/UGR) and CIBERobn Physiopathology of Obesity and Nutrition.

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  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.