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 (www.fitbackeurope.eu). 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.

Alliance for Research in Exercise Nutrition and Activity UniSA Allied Health and Human Performance University of South Australia Adelaide South Australia Australia

Center of Sport and Health Sciences School of Education University of Iceland Reykjavik Iceland

Confederation of Italian Associations of Physical Education Teachers Venezia Italy

Department of Biological and Environmental Sciences and Technologies University of Salento Lecce Italy

Department of Biosciences and Nutrition Karolinska Institutet Huddinge Sweden

Department of Chronic Diseases National Institute for Health Development Tallinn Estonia

Department of Clinical Physiology and Nuclear Medicine Kuopio University Hospital Kuopio Finland

Department of Communication and Education Universidad Loyola Andalucía Dos Hermanas Spain

Department of Education and Social Work University of Luxembourg Esch sur Alzette Luxembourg

Department of Human and Social Sciences University of Bergamo Bergamo Italy

Department of Movement and Sports Sciences Faculty of Medicine and Health Sciences Ghent University Ghent Belgium

Department of Physical Education and Sport Faculty of Science Humanities and Education Technical University of Liberec Liberec Czech Republic

Department of Physical Education and Sport Sciences University of Limerick Limerick Ireland

Department of Physical Education Faculty of Primary and Pre School Education ELTE Eötvös Loránd University Budapest Hungary

Department of Physical Education Theory and Methodology Hungarian University of Sports Science Budapest Hungary

Department of Physiology and Pharmacology University of Cantabria Cantabria Spain

Department of Public and Occupational Health Amsterdam Public Health research institute Amsterdam UMC location Vrije Universiteit Amsterdam Amsterdam The Netherlands

Division of Sport Physical Activity and Health University of Education Upper Austria Linz Austria

Epidemiology Biostatistics and Prevention Institute University of Zurich Zurich Switzerland

EstiLIFE Research Group Department of Physical Education Sport and Human Movement Faculty of Teaching Training and Education Autonomous University of Madrid Madrid Spain

European Physical Education Association

Exercise and Health Laboratory CIPER Faculdade de Motricidade Humana Universidade de Lisboa Lisbon 1499 002 Cruz Quebrada Portugal

Faculty of Education Free University of Bozen Bolzano Brixen Italy

Faculty of Mathematics Natural Sciences and Information technologies University of Primorska Glagoljaška Slovenia

Faculty of Physical Education Sport and Health Ss Cyril and Methodius University Skopje Republic of North Macedonia

Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland

Faculty of Sport Sciences University of Granada Department of Physical and Sports Education; Sport and Health University Research Institute CIBERobn Physiopathology of Obesity and Nutrition Granada Spain

Faculty of Sport University of Ljubljana Ljubljana Slovenia

Faculty of Sports Studies Masaryk University Brno Czech Republic

Foundation for Research in Health Exercise and Nutrition Kuopio Research Institute of Exercise Medicine Kuopio Finland

GALENO Research Group Department of Physical Education Faculty of Education Sciences University of Cadiz Puerto Real Cadiz Spain

Galician Sport Foundation General Sport Secretariat Galician Government Santiago de Compostela Spain

Harokopio University Department of Nutrition and Dietetics Athens Greece

Hungarian School Sport Federation Budapest Hungary

Institute for Biostatistics and Medical Informatics Medical Faculty University of Ljubljana Ljubljana Slovenia

Institute of Active Lifestyle Faculty of Physical Culture Palacký University Olomouc Olomouc Czech Republic

Institute of Biomedicine School of Medicine University of Eastern Finland Kuopio Campus Finland

Institute of Psychology University of Tartu Tartu Estonia

Institute of Sport Sciences and Physiotherapy Faculty of Medicine University of Tartu Tartu Estonia

Institute of Sports and Sports Science Karlsruhe Institute of Technology Karlsruhe Germany

Instituto de Investigación Biosanitaria ibs Granada Granada Spain

Instituto de Investigación e Innovación Biomédica de Cádiz Cádiz Spain

JAMK University of Applied Sciences School of Health and Social Studies LIKES Jyväskylä Finland

Józef Piłsudski University of Physical Education in Warsaw Poland

Leibniz Institute for Prevention Research and Epidemiology BIPS Bremen Germany

Lithuanian Sports University Department of Physical and Social Education Kaunas Lithuania

Mediterranean Lifestyle Medicine Institute and Department of Kinesiology and Health Rutgers University New Brunswick USA

National and Kapodistrian University of Athens Department of Physical Education and Sport Science Athens Greece

Performance and Health Group Faculty of Sport Sciences and Physical Education Department of Physical Education and Sports University of A Coruña Coruña Spain

Recruitment and Examination Faculty of Science Masaryk University Brno Czech Republic

Research Institute for Innovation and Sustainable Food Chain Development Department of Health Sciences Public University of Navarra Pamplona Spain

School of Sport Rehabilitation and Exercise Science University of Essex Colchester UK

Sorbonne Paris Nord University Inserm U1153 Inrae U1125 Cnam Nutritional Epidemiology Research Team Bobigny France

Sport and Exercise Sciences Research Unit Department of Psychology Educational Science and Human Movement University of Palermo Palermo Italy

Tallinn University School of Natural Sciences and Health Tallinn Estonia

The Pediatric Research Unit Department of Clinical Research University of Southern Denmark Odense Denmark

Universidad de Castilla La Mancha Health and Social Research Center Cuenca Spain

Universidad de Castilla La Mancha School of Education Ciudad Real Spain

University of Belgrade Faculty of Sport and Physical Education Belgrade Serbia

University of Montenegro Faculty for Sport and Physical Education Niksic Montenegro

University of Zagreb The Faculty of Kinesiology Zagreb Croatia

Western Balkan Sport Innovation Lab Podgorica Montenegro

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