10 étapes pour concevoir un système de monitorage de la condition physique

Case Serbia: The mission and main aims of the Serbian physical fitness surveillance system

The mission of the Serbian physical fitness surveillance system is “to promote and raise awareness of the importance of lifelong physical activity and the value of healthconscious lifestyles among school-age students, their families and those in public education”.

The main aims for Serbia include the following statements:

• To enable regular testing of all schoolchildren and adolescents (in physical education classes) using a systemized and standardized testing approach.
• To provide age and gender-specific feedback to the teacher, the individual student, and his/her parents based on national centile values.
• To enable follow-up feedback of the individual student and class changes in fitness levels across the child's growth and development.
• To provide recommendations to students and their parents on how best to maintain or improve physical fitness levels.
• To educate students and their parents concerning the importance of lifelong physical activity and the value of maintaining a health-conscious lifestyle.

A further aim of the Serbian physical fitness surveillance system is:

• To support health-related scientific research in children and youngsters on various issues (biological, anthropometric, motor, physiological, etc), aiming to elucidate the importance and contribution of physical activity and fitness to the overall health.

Case Hungary: The mission and main aims of NETFIT®

The mission of the Hungarian National Student Fitness Test – so called NETFIT® - is “to promote and raise awareness of the significance of the physically active, healthconscious behaviour throughout a lifetime among school aged youth, their families, and the stakeholders of the public education system”.

The main aims for students include:

• Objectively inform students and their parents about health-related physical fitness and potential health-risk factors.
• Help track health-related physical fitness development of the students in different levels.
• Support the fitness education process in physical education and beyond
• Support physical activity and curricular intervention programmes on individual-, classroom-, school- and national level.

Case Portugal: Steps to involve stakeholders in Portugal

FITescola® is the name of the national fitness database in Portugal. Its initial goal was to increase the number of teachers and students utilizing the database within the Portuguese educational system. To achieve its objectives, FITescola® started by establishing a partnership between their main promoters, the Faculty of Human Kinetics (FMH) and the General Directorate of Education, which provided a direct access to the Portuguese educational system. The Faculty of Human Kinetics main roles were to develop, validate and integrate the software functionalities of the FITescola® platform, supervise from the scientific and technical point of view the training actions for physical education teachers, and perform the statistical analysis within an epidemiological scope.

The main steps were:

• Establish a partnership with the General Directorate of Education allowed the FITescola® program so that it became a mandatory component of the physical education curricular documents, whilst also providing access to the FITescola® platform to teachers and students data from the Portuguese public-school system. Since its launch in 2016/2017, the number of schools and teachers using the FITescola® platform has increased steadily, starting in its first year with an adherence rate of 38% and increasing to 49% for the 2018/2019 academic term.
• Through the General Directorate of Education, this collaboration was extended to include the national associations representing physical education teachers, (e.g. Portuguese Physical Education Society, SPEF, and National Council of Associations of Physical Education Teachers, CNAPEF), in order to increase the mobilization of teachers in this curricular area. A secondary aim was to develop training and dissemination initiatives for the FITescola® program. Through collaborations with SPEF and CNAPEF, (while under the supervision of the General Directorate of Education), there were several workshops promoted at the national and local level which covered 1612 physical education teachers across the current lifespan of the programme.
• Finally, stakeholders whose interests were aligned with those of the monitoring system, were invited to be involved in the conception of the FITescola platform (e.g. Portuguese Olympic Committee). The collaboration’s goal was to increase the importance given to physical fitness in the development of young athletes, and to promote new technologies associated with data collection and organization in this area of study.
• Throughout the conception of the FITescola® platform, several educational contents were built to bridge the gap between teachers, students, and their families. These contents concerned not only on the physical fitness reports, but also provided fact sheets and videos to emphasize learning and physical literacy in the context of maintaining healthy lifestyles that impact on modifiable behaviors such as sedentary behavior, physical activity, and diet.

Case Hungary: Understanding the Scientific rationale for the NETFIT® System

The main objectives of NETFIT® were to build a new physical fitness test battery for physical education that would be health-related, based on criterion-referenced standards, and accepted throughout the whole country from the 2014/2015 academic school year. The test battery also had to be scientifically well-founded and be based on the nationally representative data from Hungarian youth aged 11-19-years-old. To meet these objectives, the Hungarian School Sport Federation (HSSF) requested direct assistance from the Cooper Institute to assist in building an infrastructure for full deployment of their national student fitness assessment program.

In order to ensure a strong scientific foundation for the Hungarian schoolchildren, we first planned a representative study with the following aims:

• Determine the levels of health-related physical fitness in a random sample of Hungarian youth.
• Use the laboratory data to evaluate the utility of the existing FITNESSGRAM® standards for detecting health risks in a subset of Hungarian youth.
• Directly evaluate the validity of the FITNESSGRAM® test items in Hungarian youth.
• A combination of lab and field-based evaluations were used to test these aims and these were designed to ensure a strong scientific basis for the continued use of these test items in Hungary as part of the Hungarian National Student Fitness Test (NETFIT®). These data also provided valuable benchmark values of fitness that could serve as baseline data for future comparisons. Details of the study are summarized in a supplement of Research Quarterly for exercise and sport with 10 scientific papers.

Case Hungary: Establishing the Legal background of NETFIT®

In the case of Hungary, one of the points of the Hungarian Government’s program for 2010 was the need to introduce a nationally-standardized fitness monitoring system. In accordance with the provisions of the government’s program, the Hungarian School Sport Federation became the designated organization that planned, discussed, developed, and operated the standardized and mandatory test battery that has been implemented in schools since 2015.

• In the research and development work, there were continuous consultations with both the professional organizations of physical education, as well as with the Ministry of Education and the Educational Authority. As a result of the cooperation and consultations, the legal conditions were developed that ensure the obligation of the measurement, the measurement methodology and the regulations related to data management.
• The Hungarian legal background regulates school measurements on several levels, including the fitness assessment. At the highest level, the 2011. CXC act on National Public Education (§80) disposes the matter. An important regulation is the Decree 20/2012 (VIII. 31.) on the operation of educational institutions and the use of names of public educational institutions published by the Ministry of Human Capacities on 27th of October 2014, which appraised NETFIT® as the nationally standardized fitness assessment system and requires the measurement data to be uploaded to the online IT system of NETFIT®. From then on, a ministerial decree prescribes the information on the assessments for a given school year annually.
• It is therefore important to consider that the introduction of a national fitness assessment system is preceded by a high-level policy decision.

Case Slovenia: Regulation should promptly follow legal changes

According to the school legislation in Slovenia, all primary and secondary schools (i.e. grades 1-13) must follow the somatic and motor development of their students, and are obligated to provide them feedback on their fitness progress. Until 1996, participation in the national system SLOfit was obligatory for all students. However, when a new Data Protection Law was enacted, informed parental consent was introduced to the system. The introduction of parental consent did not affect participation rates in the programme, which have remained over 94% participation rates in the primary school population (6- to 14-year-olds) and above 75% in the secondary school population (15- to 19-year-olds). One of the important factors contributing to these high participation rates is that the national physical education curriculum obligates teachers to survey somatic and motor development of students and teach them how to monitor and influence their own developmental progress.

However, in the 2000’s, some school legislation changed in some sections (but not necessarily in a uniform way) which did impact the regulatory acts of the SLOfit measurements. The situation became more and more complicated as the years continued, especially as the key stakeholder (Ministry of Education) did not express/ accumulate enough political will to solve the compounding confusions. With the introduction of the privacy legislation GDPR, some secondary schools’ data protection officers advised principals not to participate in SLOfit. SLOfit devised an alternate legal solution (i.e. contracts with each school) within existing legislation framework, however, due to unknown reasons, the Ministry did not endorse this solution, and in effect, many of secondary schools did not participate in SLOfit for the 2020 academic year. These continuing issues mean that the SLOfit team must keep a vigilant watch over evolving legislation and provide continuous pressure on Ministry officials in order to ensure the smooth running of the national fitness surveillance system.

Case Portugal: The articulation between different partners and government structures

The articulation of the different strategic partners requires a clear explanation of the responsibilities that each one must assume in the development of the program. With a higher number of partners involved other problems may arise such as addressing the agendas of each institution creating possible issues on how quickly problems can be addressed. The solutions involve greater effectiveness centralized at the government level by the Secretary of State for Education.

Case Portugal: Funding strategy of the FITescola platform in Portugal

The main phases related to securing funding were:

• In the early stages of the development of the FITescola® platform, the Faculty of Human Kinetics (FMH) relied on the financial funding of the private sector. Once the collaboration protocol with the General Education Directorate (DGE) was established and the FITescola® program was mandatory in the physical education curriculum, the financial support for maintenance and technological development of the platform was assumed by two entities (DGE and FMH). DGE is responsible for maintaining the platform through a service contract with a specialized IT company (25 000€ per year) and FMH takes on the financing to develop of new features and applications for the FITescola program in partnership with the specialized IT company. The contract between the DGE and the IT company allows the correction of small computer bugs and the development of some additional features (e.g. direct email service to youth’s parents).
• Additional financing was obtained through the Portuguese Olympic Committee to develop technological features within the platform that allowed the system to identify students with a high physical fitness levels for a given sports practice.
• The establishment of strategic partnerships with foundations associated with the business sector is being studied, due to the need to increase the training rates of the entities involved (i.e. teachers), as well as the development of new gadgets associated with the App FITescola®.
• Local authorities (Municipal Chambers) are also being considered, due to the need to develop a similar platform / program for pre-schoolers (i.e. PREFITescola®).
• In the event of a failed attempt to raise additional funding, the FITescola® program built a proposal meant to signal children and adolescents associated with extreme body composition phenotypes, such as obesity and underweight, based on WHO BMI cut points. This add on to the IT platform would allow the physical education teacher, to share this information with the youth’s parents, who would be advised to get an appointment with their family’s doctor. This proposal was rejected by the Portuguese health care system, hence compromising the opportunity to bridge the gap between physical fitness testing within the physical education discipline and the healthcare system.

Case Slovenia: Data management plan in SLOfit

Data flow, data insight and data anonymization

• Parents or students always access their personal and/or children’s personal information with a username and password. They have the right to change their personal data, add new data or change the data they had put in before, but they cannot change the physical fitness data that was inputted by the school. All the data in the SLOfit database is automatically anonymised one year after an individual finishes their education. All the users are notified before anonymisation; they are given the option to permanently store and access the data in the application. Anonymised SLOfit data are used afterwards for statistical and scientific research, in accordance with the agreement of the Commission on Ethical Issues in Sport.

Personal data protection

• To provide meaningful feedback from physical fitness monitoring, identification of students is required. Therefore, all personal data treatment should be in accordance with data protection regulation (e.g. GDPR in Europe). If physical fitness monitoring is not mandatory by law for students, their parents, or students by themselves (if they are old enough according to local regulation) should give written consent for collecting and treating personal data included in monitoring system. If possible, physical fitness data treatment should be regulated by a special national legislation that defines the data treatment provider, i.e. the organisation which analyses fitness data and gives feedback to individuals and schools. If this is not the case, schools may enter into bilateral contracts with the fitness data processor which will process the data of their students. Schools and the data processor must take all necessary data protection measures to prevent unauthorised use of personal data. Moreover, Data Protection Officers from the schools and the data processor should double-check all personal data procedures.

Schools and data management

• Based on previous activities with schools, the Faculty of Sport is the manager of the SLOfit national system. Schools use the system free of charge, based on the SLOfit service agreement, and appoint a school administrator who is responsible for the communication between the SLOfit national team and the school. Every school administrator is responsible for managing the users in their school (e.g. students, teachers, parents, doctors). They are the ones who acquire parental consent for involvement into SLOfit, import the lists of children and parental e-mail addresses, input the results of testing, verify the submitted school data, and communicate feedback to the school principal, other teachers, parents, and municipalities. All school administrators are required to attend an annual free training course at the Faculty of Sport, which is a prerequisite for schools to start using the My SLOfit application.

Quality of the data

• The my SLOfit application provides school administrators the ability to enter physical fitness testing data directly into app or via an Excel document. When entering the data, there are simultaneously cleaning procedures which are initiated based on so-called smart algorithms. These algorithms compare entered values according to age and sex, previous fitness data, and other fitness data entered in current period to ensure the entered data make sense for that variable. For example, certain data cannot be entered out of a predetermined range (e.g. height greater than 180 cm at age 7) and alert the user that the data should be immediately corrected, while for other doubtful data, the school administrator is notified to check these data again. If the administrator confirms doubtful data has been entered, a communication tool within the application allows him/her to describe specific inconsistencies and communicate this to the primary SLOfit administrator who confirms that the school data entered into the central SLOfit database is correct. Once this condition is met, all users can immediately generate their feedback reports, otherwise the data is corrected at the level of the school, checked by central SLOfit administrators, and so on until accurate data is verified.

Case Hungary: Data administration procedures of NETFIT®

In Hungary, a standardized, mandatory, criterion-referenced, health-related, annual fitness assessment has been in force since 2015 (NETFIT®)22. Based on the experience of the last 5 years, an optimal administration path follows the following logic:

1. In Hungary, every student has a so-called measurement identification number from the moment they enter school, which is provided by the Educational Authority and which accompanies the students’ studies until they leave high school. Identification based on the measurement ID can only be done by the student’s teacher, who can pair the name and the measurement ID. The measurement IDs are transferred into the NETFIT® system via a software connection with the Educational Authority. Measurement IDs are transferred and managed by the authorized administrator of the schools. Once a year, the measurement IDs need to be transferred to the NETFIT® system.
2. The administrator then assigns the measurement IDs to classes and teachers.
3. Teachers are responsible for the steps taken following the administrative steps
   • They check and validate the assigned classes (all students are assigned to the right class) by matching the measurement IDs to the name of the students.
   • If necessary, they adapt the test system to students with special educational needs (select individually relevant, alternative tests).
4. Tests are then assessed in the appropriate testing environment in physical education lessons.
5. Followingly, the task of the teachers is to administer the results in the NETFIT® software, which can either be done online, or by uploading a predesigned, locked Excel sheet.
6. The system then sends an e-mail notification to the student and parents about the data entered.

Case Slovenia: Feedback and procedures in SLOfit

Registered users of SLOfit, consist of physical education teachers, parents, children, and physicians, are able to use the on-line application My SLOfit. This application provides schools and individuals with administrative and analytical support in collecting, storing, and displaying the data.

• Users can access their results and receive feedback reports immediately after data has been entered and checked (i.e. few days after testing), for example: the change rate in one year, the trends of their somatic and motor development throughout the years of their schooling, comparison of their scores with the population (expressed in percentiles), and in which group of physical performance or health risk individual results are classified based on the existing scientific evidence.
• The presentation of physical fitness results also points out development trends and highlights the areas where elevated risk is emerging.
• Parents can contribute to information on their own, and they can also obtain additional information from the child’s teacher.
• Physical education teachers are trained in the correct interpretation of the physical fitness data and use this data to plan, implement and monitor the effectiveness of their work.
• Additionally, My SLOfit improves cooperation and enables communication between the school, parents, and healthcare system. SLOfit data enable physicians to get a better insight into children’s development as a basis for writing recommendations for individualization in PE class, or inclusion in any other intervention program. Kinesiologists, as members of the healthcare team, can construct individual exercise programs in collaboration with the physical education teachers for every child with diagnosed increased risks. In the case of inclusion of a child in the treatment within health-care system, this information also enables the physicians to monitor the effects of the intervention. Algorithms of cooperation between the healthcare and school teams, and diagnostics for physicians using My SLOfit are constructed and the treatment is conducted to improve exercise capacity and nutritional status of children.
• Moreover, My SLOfit enables reports for policy makers. Schools can create the School SLOfit report, while national administrator prepares annual regional and national SLOfit reports which are the backbone for possible interventions and their evaluation.

Case Finland: Feedback for policymakers

An open database and online service of physical activity indicators of children and adolescents aged 7 to 16 years in Finland has been designed especially for policymakers and published in 2018.

• The service includes key indicators of physical activity level and functional capacity as well as the status of physical activity promotion in schools across municipalities.
• The data from different registers, research centres and institutes, including several nationwide surveys and monitoring systems (such as the national Move! – monitoring system for physical functional capacity), have been combined
• Data are presented in simple figures through an interactive online user interface tool on the webpage of Ministry of Education and Culture (www.liikuntaindikaattorit.fi).
• Data can be seen at national, regional, and local levels and can be used in municipalities and provinces in their welfare reports that describe the status and development of physical activity promotion and outcomes, and in further knowledge-based policy-making

Case Finland: The selection of the fitness measurements included in the Move! – monitoring system for functional capacity

Pilot testing was conducted three times, including test and system level experiments, during the development process of the Move! - monitoring system for physical functional capacity.

• Initially, a review of the possible physical fitness measurements and testing batteries for children and adolescents was conducted. Also new measurements were developed for such fitness characteristics where limited number of tests were available (e.g. flexibility and fundamental movement skills).
• In the first phase, 15 different test items were selected as candidates for the monitoring system. These tests included 2-3 tests from each fitness characteristic aimed to be evaluated (foundations of daily functional capacity: aerobic fitness, muscular endurance, power, flexibility, and fundamental movement skills). Out of those 15 tests, six items with limited prior information, including the novel test items, were selected for pilot testing conducted in two different schools and with 60 students to evaluate their reliability. The evaluations showed that all items were eligible for further assessments.
• The second phase pilot testing included evaluation of 12 tests out of the 15 preliminary selected fitness tests (three tests evaluating cardiorespiratory fitness were excluded, as prior literature showed sufficient information). Pilot study included 310 students from 6 schools, and the feasibility and the reliability of the tests and the test material and equipment were evaluated. The measurements were conducted by educated professionals. Based on the findings, 9 test items were excluded, and the test battery was reduced to 6 measurements suitable for assessing physical fitness in physical education.
• In the third pilot phase the feasibility and the reliability of the six selected fitness measurements were assessed. The final six measurements are presented in the description of Move! – monitoring system for physical functional capacity. A total of 156 students from two different schools participated to the third pilot study. The measurements were conducted by trained physical education teachers for their own students during school day. The findings were used to build the final test battery and instructions.
• The first phase of pilot testing started during 2010, six years prior launching the national monitoring system. The three pilot testing phases lasted in total of 1.5 years. Procedures of pilot testing and development process related to the Move! monitoring system for functional capacity are described in detail in the final report of the project (in Finnish).

Case Slovenia: Lessons learned

The first national monitoring system, called the Physical Education Chart, was developed in 1969 and it was implemented on the population level. However, this system proved to be too ambitious for its time, due to time consuming testing, low awareness about importance of testing and no feedback provided because of analytical difficulties in the period when computer support was only in its beginnings. It ceased to operate in its original format by the end of the 1970s, but a simplified version called Sports Educational Chart was launched in the school year 1981/82. After a six-year piloting period (involving 37,000 students each year and a slight revision), the system was introduced to all Slovenian primary and high schools in the school year 1986/87. Every year thereafter, all schools perform testing every April. Each student spends approximately two hours on testing: one hour for tests within gym and one hour allotted for running outdoors.

Case Finland: Implementation strategies of the Move! monitoring system for functional capacity

Training, and education

• National educational tours and training were conducted in 2014-2016, while the national system was launched in 2016. Conducting the measurements are also taught during the physical education training in the University of Jyväskylä. Additional online educational materials (webinars) are provided. These webinars address the good practises related to the monitoring system and are directed for teachers, health-care professionals, and policy makers. Training has been organized on how to adapt the Move! measurements for children with special needs.

Webpages

• Resources are available in the system’s webpages. The main philosophy behind the monitoring system is described in the webpages, with tailored instructions for different stakeholders. Additionally, a Teacher’s manual, a quick guide and videos of the measurements, feedback, and the utilization of the feedback can be found from the webpages. Only measurements requiring typical physical educational equipment were selected to ease the implementation.

Communication channel

• The system manager (Ministry of Education and Culture) has an e-mail contact list including all the schools in Finland. Newsletters and other information related to the annual measurements, e.g. organizing the measurements during the COVID-19 pandemic, are distributed via this channel.

Help desk

• Despite of the training and available materials, thousands of contacts were made by the teachers and principals in the launching phase for system manager. A help desk was established as a solution which operated for two weeks, and provided technical support related to the data administration and organizing the measurements.

Incentives

• Once weekly physical educational lessons were added to the school curriculum in upper secondary school for one grade (45 min). Implementation of the Move! system was not the only driving force, but supported this decision. As teachers were at that time paid by teaching hours, this implementation of the national monitoring system did not only increase their working hours but also salary.

Feedback

• Feedback was asked after the first round of national measurements. The most common limitations were listed, and an expert panel was asked to provide solutions for these issues. Steps towards addressing these most common limitations are being taken.

Case Hungary: Implementation strategies of the NETFIT®

Training, and education

• A National, free of charge, 30-lessons-long CPD programme was conducted in 2013-2015, where 2-3 teachers could be trained per school on average. Free of charge, online and offline test procedure materials (handbook and DVD) were available for the teachers and schools. National and regional conferences helped to familiarise the system among different stakeholders – like teacher trainers, health-care professionals, sport professional, scientific community, and policy makers (including the ministry of education and the government). Educational materials (animation and how to use films) has been made for the parents.

Scientific updates

• In recent years HSSF has been developed a module for adapted testing of the children with special educational needs25. Furthermore, the system developer group are consulting every year about the updates of the system (including technical and scientific issues.) From 2019 for example the grip strength standards have been updated.

Webpages

• All resources are available free of charge in the system’s webpage.

Support

• HSSF has a helpdesk including free of charge phone line, and e-mail channel. This is available for all the stakeholders. Newsletter for the schools and teachers also available 3-4 times per year, where we are communicating some important news and developments of the system directly via e-mail.

Case Slovenia: Examples from SLOfit

• The on-line reports in My SLOfit application have links that lead students and their parents to tips for improving individual components of physical fitness and other important information related to physical fitness and physical development of the students, published on SLOfit web platform. Additionally, parents can directly communicate with teachers via My SLOfit app while teachers can involve the SLOfit team from Faculty of Sport into this communication when a higher level of expertise is required.
• Teachers, parents, and general public can follow the professionally moderated SLOfit Facebook page with up-to date information on different aspects of physical activity, physical fitness and healthy lifestyles. Additionally, posts promote short evidence-based but lay writing advices published on SLOfit web page as well as on SLOfit YouTube channel.
• When special public attention is required (e.g. extraordinary decrease of fitness levels after corona-virus measures), SLOfit team with support of Slovenian Press Agency organises media face-to-face and web event to present findings and suggested measures. Such event is usually covered by several mainstream media contributions and public debate.

Case Hungary: Public Relations in NETFIT®

HSSF is organising a broadcast message every year what contain the main results and conclusions of the national dataset of NETFIT®. Based on this initiative, 60-80 online and offline media news, radio interviews and television reports born every year, what is very important for the accountability and maintenance of the system.