A tutorial on health-related physical fitness testing in school settings Acknowledgments • Supported by: – The Joe Decker Children's Health-Related Fitness Research Award L. D. Erdmann C. S. McMillan Department of Kinesiology 8th Annual Illinois School Wellness Conference: Every Kid Healthyᵀᴹ 2015 Let’s Start With The Obesity Epidemic Body Mass Index in Children • Overweight: BMI (kg.m-2) for age and sex > the 85th percentile (CDC, 2000) • Obesity: BMI (kg.m-2) for age and sex > the 95th percentile (CDC, 2000). U.S. Prevalence of Overweight and Obese Children using CDC Growth Charts Overweight ( BMI > 85th %tile) 2-5y All (%) 23 Boys (%) 24 Girls (%) 22 Obese ( BMI > 95th %tile) All (%) 8 Boys (%) 10 Girls (%) 7 6-11y 34 33 35 12-19y 35 35 34 18 16 19 21 20 21 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014:311(8):806-14. 1 Trends in U.S. Prevalence (%) of Obese Children: Ages 6-11 yrs A History of Youth Fitness Testing The “go to” article: National Health and Nutrition Examination Survey (NHANES) Morrow JR Jr, Zhu W, Franks BD et al. 1958-2008: 50 years of youth fitness tests in the United States. Res Q Exerc Sport 2008; 80: 1-11. 20 15 10 5 0 1963-65 1971-74 1976-80 1988-94 1999-02 2003-04 2011-12 AAHPERD Youth Fitness Test – 1976 Ages 10 – 18 yrs Physical Fitness Component Aerobic Capacity Body Composition Muscular Strength/Endurance Agility Power Speed Flexibility Test Item 600-yard run, (optional: 1-mile or 9min run optional for ages <13 yrs and 1 ½ mile or 12-min run for ages 13 and older) None 1-min timed bent-knee sit-up (hands behind head), boys’ pull-up, girls’ flexed-arm hang (hands pronated for both) Shuttle run (3X10 yd, carry blocks) Standing long jump 50-yd dash None National samples used to establish norms – National Children and Youth Fitness Study I • Ages 10 – 18 yrs [1985, JOPERD: 56(1)] – National Children and Youth Fitness Study II • Ages 6 – 9 yrs [1987, JOPERD: 58(9)] AAHPERD HRPF Test – 1980 Ages 5 – 18 yrs Health-related Physical Fitness Components Test Items Aerobic Capacity 1-mile or 9-min run (1 ½ or 12-min run is optional for ages 13 and older) Body Composition Triceps+subscapular (triceps only is optional) Muscular Strength/Endurance 1-min timed bent-knee sit-up (arms crossed) & Flexibility Sit-and-reach (double leg) NCYFS I HRPF Test – 1985 Ages 10 – 18 yrs Health-related Physical Fitness Components Test Items Aerobic Capacity 1-mile run/walk Body Composition Triceps & subscapular (triceps only is optional) Muscular Strength/Endurance 1-min timed bent-knee sit-up (arms crossed) Pull-up (supinated grip) & Flexibility Sit-and-reach (double leg) 2 NCYFS II HRPF Test – 1987 Ages 6 – 9 yrs Health-related Physical Fitness Components FITNESSGRAM HRPF Test – 2010 Test Items Ages 5 - >17 Health-related Physical Fitness Components Test Items Aerobic Capacity 1-mile run/walk (ages 8 & 9) Half-mile run/walk (ages 6 & 7) Aerobic Capacity Body Composition Triceps+subscapular+calf (any 1 site or triceps+calf is optional) PACER, 1-mile run/walk, 1-mile walk Body Composition BMI or %BF (triceps+calf) Muscular Strength/Endurance Muscular Strength/Endurance Curl-up, Trunk lift, Push-up, Modified pull-up, flexed arm hang, [Pull-up in older software] & 1-min timed bent-knee sit-up (arms crossed) Modified pull-up (pronated grip) Flexibility Sit-and-reach (double leg) The Macomb Children’s Health-Related Physical Fitness Testing Project & Flexibility Sit-and-reach (single leg), Shoulder stretch, Trunk lift Project Overview • The Macomb Children’s Health-related Physical Fitness Testing Program was piloted in the fall of 1987 and began in the spring of 1988 as a requirement of the regular elementary physical education curriculum of the Macomb Illinois Community Unit School District # 185. • Children in grades kindergarten through five, inclusive, were tested annually (spring) at the McDonough County YMCA from 1988 - 2005. Project Overview (cont.) Measured Variables – Height and Weight – Skinfolds – 1-mile run/walk – Sit-up – Pull-up – Sit-and-reach body mass index (kg.m-2) triceps + calf (% body fat) time in min, 13-lap/mile, indoor # in 1-min, knees bent, heels on mat, ankles held, arms folded, elbows to thighs grip pronated, chin over bar, swing controlled double leg Project Overview (cont.) • The tests were administered through a collaborative effort by university kinesiology department faculty and majors; school district physical educators and classroom teachers; and YMCA staff. • Testing was completed in circuit fashion during a single session, with the 1-mile run/walk test completed last. 3 Project Overview (cont.) • A component of the project was longitudinal surveillance of adiposity and health-related physical fitness test performances in elementary-aged children of the school district. • Individual reports were provided to parents. How well do adiposity and healthrelated physical fitness track in children? McMillan CS, Erdmann LD. Tracking adiposity and healthrelated physical fitness test performances from early childhood through elementary school. Pediatric Exercise Science. 2010:22:231-44. Tracking Body Composition in Boys What is tracking? • The stability of a characteristic • The maintenance of relative rank or position in a group, over a period of time • Tracking requires longitudinal observations of the same individual. Inter-period correlations (Spearman’s) at five grades with baseline: kindergarten Tracking Body Composition in Girls 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 %BF 2nd 3rd 4th %BF 2nd 3rd 4th 5th Tracking Fitness Measures in Boys BMI 1st BMI 1st • There is limited knowledge about how well HRPF tracks in young children. Inter-period correlations (Spearman’s) at five grades with baseline: kindergarten 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 Inter-period correlations (Spearman’s) at five grades with baseline: kindergarten 5th 4 Tracking Fitness Measures in Girls What are the strengths of the relationships between fatness and fitness in children, from a longitudinal perspective? Inter-period correlations (Spearman’s) at five grades with baseline: kindergarten Erdmann LD, McMillan CS. Longitudinal relations of body composition field measures to healthrelated physical fitness components in children. International Journal of Body Composition Research. 2011:9(1):11-8. Relations of %BF to Fitness Measures in Boys Inter-period correlations (Spearman’s) at six grades with %BF Relations of BMI to Fitness Measures in Boys 1 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 mile sit-up pull-up reach Inter-period correlations (Spearman’s) at six grades with %BF 0.8 0.7 mile 0.6 sit-up 0.5 pull-up 0.4 reach 0.3 0.2 0.1 0 K 1st 2nd 3rd 4th K 5th Relations of %BF to Fitness Measures in Girls 1st 2nd 3rd 4th 5th Relations of BMI to Fitness Measures in Girls 1 Inter-period correlations (Spearman’s) at six grades with %BF 0.9 1 0.9 0.8 0.7 mile 0.6 sit-up 0.5 pull-up 0.4 reach 0.3 Inter-period correlations (Spearman’s) at six grades with %BF 0.9 0.8 0.7 sit-up 0.5 pull-up 0.4 reach 0.3 0.2 0.2 0.1 0.1 0 mile 0.6 0 K 1st 2nd 3rd 4th 5th K 1st 2nd 3rd 4th 5th 5 METHODS How do fitness levels of children with persistently high body fat compare with those of children with healthy body fat? What are the implications? Erdmann LD, McMillan CS. A comparison of FITNESSGRAM aerobic capacity estimates in children of persistently healthy body fat levels compared to children of persistently high-risk body fat levels. Illinois Journal for Health, Physical Education, Recreation and Dance. (In Press). FITNESSGRAM® & ACTIVITYGRAM® Test Administration Manual, Updated Fourth Edition cut-points, identifying healthy and high-risk body fat (BF) by age-and-sex. Age (years) 8 Healthy BF (%) Boys: 8.4 – 18.8 Girls: 10.5 – 20.8 High-risk BF (%) Boys: > 27.0 Girls: > 28.4 n Boys: 269 Girls: 248 BMI (kg.m-2) Boys: 19.6+4.2 Girls: 20.2+4.4 BF (%) Boys: 26.0+11.1 Girls: 27.8+8.8 We retained data for analyses from 85 boys and 58 girls, with %BF in the FITNESSGRAM® & ACTIVITYGRAM® Test Administration Manual, Updated Fourth Edition healthy fitness zone (HFZ) at each of the four ages, whom we considered to have long-term healthy BF. We also considered 26 boys and 31 girls, with highrisk %BF at each of the four ages, to have long-term high-risk BF. Descriptive statistics (m+sd) and comparisons of height and mass in 11-year-olds by sex-and-body fat classification. All Strata BF 9 10 11 8.7 – 20.6 11.0 – 22.6 8.9 – 22.4 11.6 – 24.3 8.8 – 23.6 12.2 – 25.7 > 30.1 > 30.8 > 33.2 > 33.0 > 35.4 > 34.5 Descriptive statistics (m+sd) and comparisons of BMI and %BF in 11-year-olds by sex-and-body fat classification. All Strata of BF Initially reviewed were school-based health-related physical fitness test data from 269 boys and 248 girls with body mass index (BMI, kg.m-2) and %BF (estimated from medial calf and triceps skinfolds) values at ages 8, 9, 10, and 11 years, and 1-mile run/walk elapsed time at age 11 years. Long-term Healthy BF Long-term High-risk BF 85 58 26 31 16.6+1.3 16.7+1.6 27.9+4.2 27.9+3.5 13.59 <0.001 16.84 <0.001 16.4+3.0 19.2+2.7 48.1+10.3 43.1+5.1 15.59 <0.001 24.23 <0.001 n Boys: 269 Girls: 248 Ht (m) Boys: 1.50+0.08 Girls: 1.49+0.08 Mass (kg) Boys 44.2+12.3 Girls 45.5+12.2 Long-term Healthy BF Long-term High-risk BF t test results t P 85 58 26 31 1.46+0.07 1.44+0.07 1.54+0.07 1.53+0.08 5.18 5.30 35.6+4.8 34.9+5.7 66.9+13.8 65.8+11.0 11.33 <0.001 14.62 <0.001 <0.001 <0.001 1-mile run/walk results (mean in min) in 11-year-olds by sex-and-body fat classifications. t test results t p 6 Finding the 1-mile finish line: Comparing 11-yr-olds with long-term health and high-risk body fat The average high-risk BF boy finished 520 m (or 569 yds) behind the average healthy BF boy (124 v. 183 m/min). The average high-risk BF girl finished 350 m (or 383 yds) behind the average healthy BF girl (125 v. 159 m/min). Illinois Learning Standards • ILLearningStandardsGoal20PE.pdf • http://www.isbe.net/ils/pdh/pdf/goal20.pdf Inclusion Challenges for Obese Children As school- and community-based physical activity and sports programs typically include running, children with long-term high-risk BF may find themselves struggling to “keep up” with their long-term healthy BF peers. Consequently, to ensure exercise is appropriate and tolerable, modifications in activity mode, intensity, and/or duration may be warranted for elementary-aged children with long-term high-risk BF. State of Illinois Public Act 098-0859 The School Code is amended by adding Section 27-6.5 as follows: (105 ILCS 5/27-6.5 new) • State Goal 20: Achieve and maintain a healthenhancing level of physical fitness based upon continual self assessment. Sec. 27-6.5. Physical fitness assessments in schools. (a) As used in this Section, “Physical fitness assessment” means a series of assessments to measure aerobic capacity, body composition, muscular strength, muscular endurance, and flexibility. State of Illinois Public Act 098-0859 State of Illinois Public Act 098-0859 (b) To measure the effectiveness of State Goal 20 of the Illinois Learning Standards for Physical Development and Health, beginning with the 2016-2017 school year and every year thereafter, the State Board of Education shall require all public schools to use scientifically-based, healthrelated physical fitness assessment for grades 3 through 12 and periodically report fitness information to the State Board of Education, as set forth in subsections (c) and (e) of this section, to assess student fitness indicators. Public schools shall integrate health-related fitness testing into the curriculum as an instructional tool, except in grades before the 3rd grade. Fitness tests must be appropriate to students’ developmental levels and physical abilities. The testing must be used to teach students how to assess their fitness levels, set goals for improvement, and monitor progress in reaching their goals. Fitness scores shall not be used for grading students or evaluating teachers. 7 State of Illinois Public Act 098-0859 (c) [paraphrased] The State Superintendent of Education appointed a 15-member stakeholder and expert task force, who submitted recommendations on physical fitness (on or before April 1, 2015) concerning: (1) Methods for ensuring the validity and uniformity of reported physical fitness assessment scores, including assessment administration protocols and professional development approaches for physical education teachers; State of Illinois Public Act 098-0859 (5) the demographic information that should accompany scores, including, but not limited to, grade and gender; (6) the development of protocols regarding the protection of students’ confidentiality and individual information and identifiers; and (7) How physical fitness assessment data should be reported by the State Board of Education to the public, including potential correlations with student academic achievement, attendance, and discipline data and other recommended uses of the reported data. State of Illinois Public Act 098-0859 (f) School districts may report the aggregate findings of physical fitness assessments by grade level and school to parents and members of the community through typical communication channels, such as Internet websites, school newsletters, school board reports, and presentations. Districts may also provide individual fitness assessment reports to students’ parents. (g) Nothing in this Section precludes schools from implementing a physical fitness assessment before the 20162017 school year or from implementing more robust forms of physical fitness assessment. State of Illinois Public Act 098-0859 (2) How often physical fitness assessment scores should be reported to the State Board of Education (3) the grade levels within elementary, middle, and high school categories for which physical education assessment scores should be reported to the State Board of Education; (4) the minimum fitness indicators that should be reported to the State Board of Education, including, but not limited to, a score for aerobic capacity (for grades 4 through 12); muscular strength; endurance; and flexibility; State of Illinois Public Act 098-0859 (d) On or before December 31, 2015, the State Board of Education shall use the recommendations of the task force under subsection (c) of this Section to adopt rules for the implementation of physical fitness assessment by each public school for the 2016-2017 school year and every school year thereafter. (e) On or before September 1, 2016, The State Board of Education shall adopt rules for data submission by school districts and develop a system for collecting and reporting the aggregated fitness information from the physical fitness assessments. This system shall also support the collection of data from school districts that use a fitness testing software program. FITNESSGRAM • With the establishment of the Presidential Youth Fitness Program in 2012, it became the recognized health-related physical fitness test in the U.S. • It is used in more than 67,000 schools in all 50 states. • The standards are criterion-referenced, rather than norm-referenced , based on how fit children need to be for good health. 8 Healthy Fitness Zone • Test items are scored using criterion-referenced standards. • Criterion-referenced standards are established based on the level of fitness needed for good health. • There are separate standards by sex and age. • Most students who perform regular physical activity will be able to achieve a score placing them in or above the HFZ. Presidential Youth Fitness Program • http://www.pyfp.org/ FITNESSGRAM resources • http://www.fitnessgram.net/ • The Cooper Institute. (2010). FITNESSGRAM® & ACTIVTYGRAM®: Test Administration Manual (updated 4th ed.). Champaign, IL: Human Kinetics. Stakeholder and Task Force on Physical Education: Health-related Physical Fitness Assessment Recommendations • ILFitnessTest-report-040115.pdf • http://www.isbe.net/EPE/pdf/setfpe-report040115.pdf Testing Recommendation (1) Testing Recommendation (2) The Illinois State Board of Education (ISBE) require schools to administer annual fitness testing for the following fitness components for all grades 3-12, and to report to ISBE aggregate results for grades 5, 7 and 10 each year: Aerobic capacity (Grades 4-12 only; Recommended test: PACER test, Alternate test: Mile Run test), Flexibility (Recommended test: BackSaver Sit and Reach test, Alternate test: Trunk lift test), Muscular endurance (Test: Curl-up test) and Muscular strength (Test: Push-up test). Schools should use the Brockport fitness testing methodologies, when appropriate as determined by an Individualized Education Program (IEP) team, for students with disabilities. 9 Testing Recommendation (3) ISBE require schools to use the fitness testing protocols that were developed by Fitnessgram. Testing Recommendation (3b) All schools should follow the Fitnessgram protocols for identifying when a student has completed the fitness test. On form breaks, the first form break should be counted in the total number of repetitions/cycles for each test, e.g. PACER laps, push-ups, etc. The second form break signals the end of the test (no matter when the second form break occurs). Testing Recommendation (3a) Prior to administering aerobic capacity tests, schools should measure out the 15 or 20-meter or 1 mile mark-off point and have another staff member check the measurement for accuracy. Going forward, the school need only re-measure if the space changes or the markings deteriorate. Testing Recommendation (4) ISBE suggest that schools integrate fitness testing into physical education classes when covering content related to Illinois State Learning Standard 20. Education about the importance of the five components of fitness (aerobic capacity, muscular strength, muscular endurance, flexibility and body composition) should be included. Teachers should follow the Illinois Learning Standard 20 performance descriptors to identify appropriate times to integrate fitness testing into class. Reporting Recommendation (5) Reporting Recommendation (6) ISBE require schools report the number of students tested (using recommended tests or Brockport alternatives) and the number meeting the "healthy fitness zone" and "needs improvement" categories for each of the required fitness testing components for grades 5, 7 and 10 at the end of each academic year. Each school will submit its aggregate data to its district administrator and he/she will submit that aggregate data for each school and the district as a whole to ISBE yearly via the ISBE Web Application Security (IWAS) system. ISBE should not require any demographic information accompany the scores when reported in aggregate to ISBE. However, ISBE should explore the feasibility and utility of collecting demographic and achievement information in conjunction with fitness scores for potential longer-term enhancements to the fitness testing and reporting requirement. To that end, ISBE should undertake a pilot data collection program with school districts that volunteer to participate. 10 Reporting Recommendation (7) At a minimum, ISBE report the "healthy fitness zone" results for each fitness component at each school and district on the ISBE website, annually, for grades 5, 7, and 10. Confidentiality Recommendation (9) ISBE require that schools have procedures for protecting student data and confidentiality that comply with all related state and federal laws. Testing Suggestion (11) ISBE suggest that schools include all students in annual fitness testing, whether or not they are enrolled in physical education. Reporting Recommendation (8) ISBE include "healthy fitness zone" results on the School Report Card. Professional Development Recommendation (10) Every person administering fitness testing in Illinois must receive in-person or web-based Fitnessgram instruction related to administering and scoring the fitness tests for the required fitness components. ISBE shall create a compliance oversight mechanism to ensure everyone required has completed the training. Testing Suggestion (12) ISBE suggest schools do pre-and post-fitness tests with students each year (or semester, as applicable). Post-test results shall be used for reporting scores to ISBE. 11 Reporting Suggestion (13) Professional Development Suggestion (14) ISBE work with universities to develop methodologies and tools to correlate fitness scores with other available data, like attendance, academic performance, behavior, etc. Local school districts can use the methodologies and tools to track progress at a local level and determine a plan of action for improving P.E. programs in order to create the most benefits for academics, behavior, and health. Recommend that ISBE and other organizations offer professional development opportunities to administrators to understand fitness testing and how to effectively evaluate P.E. teachers without using student fitness scores as a measure of student growth (which is prohibited by Public Act 98-0859). Professional Development Suggestion (15) Professional Development Suggestion (16) ISBE should work with P.E. supporting organizations, universities, and associations to develop professional development opportunities for integrating fitness testing into the P.E. curriculum as an instructional tool and work with stakeholders to disseminate the professional development opportunities across the state. Other Suggestion (17) ISBE should convene a committee of stakeholders to look for additional funding and resources to support implementation of fitness testing, with a focus on Fitnessgram software, professional development, and general support to schools and districts for implementing the recommendations and suggestions from the Task Force. ISBE should work to compile all available free and paid resources and trainings related to fitness testing, and post the compendium, with links to other resources, on its website. Other Suggestion (18) ISBE should engage an outside evaluator to evaluate the impact of the implementation of fitness testing in Illinois and track changes in aggregate fitness data over time. 12 Other Suggestion (19) ISBE should work with Presidential Youth Fitness Program and/or Fitnessgram to modify the Microsoft Excel reporting spreadsheet to meet the specific needs/requirements of Illinois. FITNESSGRAM TEST ITEMS • Aerobic Capacity – PACER (recommended IL aerobic capacity test) – 1-mile run/walk (alternate IL aerobic capacity test) – 1-mile walk FITNESSGRAM TEST ITEMS • Muscular Strength/Muscular Endurance – Curl-up (recommended IL muscular endurance test) – Trunk lift – Push-up (recommended IL muscular strength test) – Modified pull-up – Flexed arm hang – Pull-up (in older software) FITNESSGRAM TEST ITEMS FITNESSGRAM TEST ITEMS • Flexibility – Sit and reach (recommended IL flexibility test) • Back-Saver (single leg) – Trunk lift (alternate IL flexibility test) – Shoulder stretch Appropriate and Inappropriate Uses of FITNESSGRAM • Appropriate • Body Composition – Body mass index (BMI) – Percent body fat The Stakeholder and Expert Task Force did not recommend that body composition assessment be an IL state requirement but suggests including it in the education content, along with the other four healthrelated physical fitness components. – Personal testing to help students evaluate their healthrelated physical fitness levels – Provide group data for teachers to use in curriculum development – Teach students about the types of activity needed to reach criterion-referenced health standards • Inappropriate – Grading students – Evaluating teacher effectiveness – Evaluating overall physical education program quality 13 Test Validity and Reliability Solutions/Best Practices • Validity – The degree to which a test item measures what it is supposed to measure – The most important characteristic of testing • Test organization and administration • Enhancement of physical activity time • Reliability – A measure of the degree of consistency or repeatability of a test – Measurement error can result from the following: • • • • Intrasubject (within subjects) variability Lack of interrater (between raters) agreement Intrarater (within raters) variability Failure of the test itself to provide consistent results Key Objectives for Testing Success Components & Process Students enjoy physical activity Students are involved in MVPA for 50% of class time All students are provided with many opportunities to participate and practice skills Students are encouraged to participate in physical activity outside of class • Components – Physical Education – Physical Activity during School (Recess/Classroom) – Physical Activity before and after school – Staff involvements – Family and community involvement • Process – Establish/Develop – Implement – Evaluate Fitness testing – linked to the curriculm Goals • To provide a variety of school-based physical activities to enable all students to participate in 60 minutes of moderate-to-vigorous physical activity each day. • To provide coordination among the components to maximize understanding, application, and practice of the knowledge and skills learned in physical education so that all students will be fully physically educated and well-equipped for a lifetime of physical activity. Physical Activity During School • This includes classroom activity and recess: • Classroom activity – Even 5-10 minutes in duration contributes to cognitive health – Can be preK-12 • Recess – Minimum 20 minutes per day – Activity zones, active supervision, equipment and multiple approaches – “Drop-in” physical activity in secondary schools 14 Physical Activity Before & After School • School or community sponsored activities/clubs/programs before and after school – Active commuting to school • Walk and bike to school • Walking school bus – Physical activity walking and running clubs – Intramurals (voluntary, student-centered, and all students) – Joint use agreements with community centers/buildings Physical Education Physical Education • Must implement quality Physical Education – Adequate instructional time & well designed lessons – Classes taught by qualified PE specialist – Proper equipment and facilities – Adaptions for students with disabilities – Opportunities for students to be active most of class time Steps Before Testing • Must implement quality PE (continued): – Not using physical activity as punishment – Appropriate use of fitness assessment tools – Ongoing opportunities for students to conduct self-assessments and practice self monitoring of physical activity – Well-developed, planned, and sequential curricula for PE – Aligns with your State and National Standards for PE Procedures/Activities Peer teaching Teacher assisted MVPA of 50% Provide PA outside of class Practice the tests Procedures/Activities Test administration 40 students 40 minutes Games/examples Trusted partner 15 Barriers Benefits to Students • Teaching knowledge & values • Enjoyable Participation Large class sizes (multiple classes) Limited space Not enough equipment Not enough time • All students can be successful Psychological Implications Benefits to Students Promote testing as enjoyable Practice in fun game like conditions Self- responsibility Non-competitive Self-improvement • INDIVIDUALIZED – Students compete only with themselves! – Results/printouts – Intrinsic motivation Philosophy… for Students Enjoyable Realistic Fair The Stairway to Lifetime Fitness C.B. Corbin and R.P. Pangrazi, 1989 Participate in Regular Exercise 2. Achieve Physical Fitness 3. Personal Exercise Patterns 4. Evaluate Own Fitness Levels 5. Problem Solve/Decision Making 1. 16 17
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