BACKGROUND: Physical fitness in childhood and adolescence is associated with a variety of health outcomes and is a powerful marker of current and future health. However, inconsistencies in tests and protocols limit international monitoring and surveillance. The objective of the study was to seek international consensus on a proposed, evidence-informed, Youth Fitness International Test (YFIT) battery and protocols for health monitoring and surveillance in children and adolescents aged 6-18 years. METHODS: We conducted an international modified Delphi study to evaluate the level of agreement with a proposed, evidence-based, YFIT of core health-related fitness tests and protocols to be used worldwide in 6- to 18-year-olds. This proposal was based on previous European and North American projects that systematically reviewed the existing evidence to identify the most valid, reliable, health-related, safe, and feasible fitness tests to be used in children and adolescents aged 6-18 years. We designed a single-panel modified Delphi study and invited 216 experts from all around the world to answer this Delphi survey, of whom one-third are from low-to-middle income countries and one-third are women. Four experts were involved in the piloting of the survey and did not participate in the main Delphi study to avoid bias. We pre-defined an agreement of ≥80% among the expert participants to achieve consensus. RESULTS: We obtained a high response rate (78%) with a total of 169 fitness experts from 50 countries and territories, including 63 women and 61 experts from low- or middle-income countries/territories. Consensus (>85% agreement) was achieved for all proposed tests and protocols, supporting the YFIT battery, which includes weight and height (to compute body mass index as a proxy of body size/composition), the 20-m shuttle run (cardiorespiratory fitness), handgrip strength, and standing long jump (muscular fitness). CONCLUSION: This study contributes to standardizing fitness tests and protocols used for research, monitoring, and surveillance across the world, which will allow for future data pooling and the development of international and regional sex- and age-specific reference values, health-related cut-points, and a global picture of fitness among children and adolescents.

Alliance for Research in Exercise Nutrition and Activity Allied Health and Human Performance University of South Australia Adelaide SA 5001 Australia

Alliance for Research in Exercise Nutrition and Activity Allied Health and Human Performance University of South Australia Adelaide SA 5001 Australia; Faculty of Sport Science Nippon Sport Science University Tokyo 158 8508 Japan

Alliance for Research in Exercise Nutrition and Activity Allied Health and Human Performance University of South Australia Adelaide SA 5001 Australia; Menzies Institute for Medical Research University of Tasmania Hobart Tasmania 7000 Australia

Centre for Surveillance and Applied Research Public Health Agency of Canada Ottawa ON K1A 0K9 Canada; School of Epidemiology and Public Health Faculty of Medicine University of Ottawa Ottawa ON K1H 8M5 Canada

Department of Epidemiology and Biostatistics College of Health Sciences Makerere University P O Box 7072 Kampala Uganda

Department of Exercise and Nutrition Sciences Milken Institute School of Public Health The George Washington University Washington DC 20052 USA

Department of Exercise Science Arnold School of Public Health University of South Carolina Columbia SC 29208 USA

Department of Medicine Huddinge Karolinska Institute 141 83 Huddinge Sweden

Department of Physical Education and Sports Faculty of Sport Sciences Sport and Health University Research Institute University of Granada; CIBEROBN Physiopathology of Obesity and Nutrition Granada ES18071 Spain; Department of Cardiology Stanford University Stanford CA 94305 USA; Veterans Affair Palo Alto Health Care System Palo Alto CA 94304 USA

Department of Physical Education and Sports Faculty of Sport Sciences Sport and Health University Research Institute University of Granada; CIBEROBN Physiopathology of Obesity and Nutrition Granada ES18071 Spain; Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä FI40014 Finland

Department of Physical Education and Sports Faculty of Sport Sciences Sport and Health University Research Institute University of Granada; CIBEROBN Physiopathology of Obesity and Nutrition Granada ES18071 Spain; Instituto de Investigación Biosanitaria ibs Granada Granada ES18012 Spain

Department of Physical Education Exercise and Sports Science School of Health Sciences Kenyatta University P O Box 43844 00100 Nairobi Kenya

Department of Physical Education Federal University of Sergipe São Cristóvão 49107 230 Brazil; Department of Physical Education and Sport Sciences Health Research Institute Physical Activity for Health Research cluster University of Limerick Limerick V94 T9PX Ireland

Department of Psychological Sciences and Health University of Strathclyde Glasgow G1 1QE UK

Department of Sports Science and Physical Education The Chinese University of Hong Kong Hong Kong China

Division of Research Innovation and Outreach KCA University P O Box 56808 00200 Nairobi Kenya

Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä FI40014 Finland; Centre for Active Living and Learning University of Newcastle Newcastle NSW 2308 Australia

Faculty of Sport University of Ljubljana 1000 Ljubljana Slovenia

Healthy Activity Living and Obesity Allied Health and Human Performance University of South Australia Adelaide SA 5001 Australia; Centre for Surveillance and Applied Research Public Health Agency of Canada Ottawa ON K1A 0K9 Canada; School of Epidemiology and Public Health Faculty of Medicine University of Ottawa Ottawa ON K1H 8M5 Canada

Healthy Activity Living and Obesity research group Children's Hospital of Eastern Ontario Research Institute Ottawa ON K1H 8L1 Canada; Department of Pediatrics University of Ottawa Ottawa ON K1H 8L1 Canada

Healthy Activity Living and Obesity research group Children's Hospital of Eastern Ontario Research Institute Ottawa ON K1H 8L1 Canada; School of Human Kinetics Faculty of Health Sciences University of Ottawa Ottawa ON K1N 6N5 Canada

Institute for Sports and Sports Science Karlsruhe Institute of Technology Karlsruhe 71631 Germany

Institute of Public Health College of Medicine National Yang Ming Chiao Tung University

IRyS Group Physical Education School Pontificia Universidad Católica de Valparaiso Valparaiso 2374631 Chile

School of Physical Education Shanghai University of Sport Shanghai 200438 China

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