Feasibility, safety and responsiveness of health-related field-based physical fitness tests in adults: the adult-fit project
Physical fitness is recognised as an important indicator of health in all age groups, such as children, adolescents, adults and the elderly. Research has indicated an inverse relation between cardiorespiratory, muscular fitness and motor fitness, whith various diseases, morbidity and all-cause mortality. Therefore, the assessment of physical fitness is of substantial value as a means of prevention and identification. Although laboratory tests are accurate reference points for measuring fitness, their feasibility is restricted due to high costs, complexity of equipment, need for skilled personnel and time constraints, especially in studies of larger populations. Conducting field-based physical fitness tests offers a practical substitute, as these tests are simple to administer, require minimal equipment, are cost-effective and allow the assessment of numerous participants in a relatively short-term and simultaneous period of time. It is crucial that any assessment tool maintains qualities such as validity, reliability, feasibility, safety and responsiveness. Recent studies have added some of these qualities to existing health-related fitness field test batteries for preschoolers (PREFIT study) and children and adolescents (ALPHA study). However, there is no evidence-based field test battery that assesses physical fitness in adults. It is possible to find studies that include some of the mentioned qualities in various field tests, but not a complete battery. This background exposes the need to propose a valid, reliable, feasible, safe and responsive health-related field-based physical fitness test battery in adults to be used in a consensual way. This is how the proposal for the ADULT-FIT Project [Plan nacional I+D +i 2017-2020, (ref.: DEP2017-88043-R)] was born, whose general aim was: to propose a field-based test battery to assess health-related physical fitness in adults based on scientific evidence, valid, reliable, feasible, safe and responsive, according to sex, age and level of physical fitness. This International Doctoral Thesis is part of the ADULT-FIT project and its general aim was: to propose a battery of field-based test to assess health-related physical fitness in adults based on scientific evidence, feasible, safe and responsive, according to sex, age and physical activity level. Likewise, the specific aims were: (i) to comprehensively analyze the feasibility and safety of the existing health-related field-based physical fitness tests in adults, trough a systematic review of the literature (study I); (ii) develop methodological feasibility and safety studies of those field-based physical fitness tests identified in the reviews that do not present sufficient or strong scientific evidence on their feasibility and safety in adults, according to sex, age, and physical activity level (study II); and (iii) to determine the responsiveness of the health-related field-based physical fitness tests used in adults (study III). The main results showed that there is strong evidence indicated that i) the 2-km walk and that 20-m shuttle run tests were feasible to assess cardiorespiratory fitness in adults and children and adolescents, respectively; ii) the handgrip strength test was feasible to assess isometric muscular strength in children and adolescents; iii) the standing long jump test was feasible to assess lower body explosive strength in children and adolescents; iv) only the 2-km walk test have shown strong evidence on safety in adults (study I). v) Feasibility items presented a successful answer of 100% in all tests (i.e., body composition (i.e., weight, height, neck, waist, and hip circumferences and triceps and subscapular skinfolds), cardiorespiratory fitness (i.e., 6-min walk, 2-km walk and 20-m shuttle run tests), muscular fitness (i.e., handgrip strength, standing long jump, 30-s sit-to-stand and front plank tests) and, motor fitness (i.e., 6-m gait speed, 2.45-m time up & go, 4x10 shuttle run and single-leg stand tests); vi) participants evaluated were the 100% of the sample, with an adequate ratio participants/evaluators and time of preparation (i.e., ~1 minute); vii) safety items presented a successful answer of 99% in all tests; viii) heart rate (HR) was evaluated only in cardiorespiratory fitness tests; the 97% of the participants reached the 85% HRmax in the 20-m shuttle run test; ix) for rate of perceived exertion, the 51% and 88% of the participants reported a moderate and hard to maximum effort in the 30-s sit-to-stand and the front plank tests, respectively; x) for tibial pain, the 32% of the participants reported pain in the 2-km walk test and; xi) for delayed-onset muscle soreness, the 45% of the participants expressed some degree of muscle soreness, with the 95% of them reporting that cardiorespiratory fitness tests could be the cause (study II). xii) All tests were found to be responsive (all P<0.01) after the exercise program, except the waist circumference measurement (P=0.09); with an effects size of moderate to large (Cohens d>0.50), except to the weight, body mass index, waist circumference and handgrip tests with trivial effect sizes (P>0.05, Cohens d<0.20); xiii) the highest proportion of individual responders based on the standard deviation was observed in the 4 10-m shuttle run, 30-s sit-to-stand, 6-m gait speed and 2.45-m time up & go tests and; xiv) the proportion of the population that was expected to respond to the intervention was higher than 85% in most of the field-based physical fitness tests evaluated, but 33% in the weight, body mass index, waist circumference and handgrip strength tests (study III). This International Doctoral Thesis provides scientific and methodological evidence to propose a battery of health-related field-based physical fitness tests in adults based on feasibility, safety and responsiveness, according to sex, age, and physical activity level. Previous systematic reviews and methodological studies developed in an International Doctoral Thesis, have provided scientific evidence on the validity (predictive and criterion-related) and reliability of health-related field-based physical fitness tests in adults according to sex, age and physical activity level.
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