504502

2013
SJP0010.1177/1403494813504502T. Haugen et al.BMI and Physical Fitness in Adolescents

Scandinavian Journal of Public Health, 2014; 42: 67–73

Original Article

Normative data of BMI and physical fitness in a Norwegian

sample of early adolescents

Tommy Haugen, Rune Høigaard & Stephen SEILER

Faculty of Health and Sport, University of Agder, Kristiansand, Norway

Abstract
Aim: The purpose of the present study was to 1) provide normative data quantifying the physical fitness level and body mass
index of 13–15-year-old Norwegian adolescents using a multi-component fitness assessment, and 2) compare the physical
fitness of Norwegian teenagers with available European and International fitness data. Methods: 1059 adolescents (529 males,
530 females) from 12 public schools in Kristiansand were invited to testing at age 13, 14, and 15 years (Grades 8–10). Test
participation was 75%–80%. The participants performed objectively anthropometrical measures (height and weight) and six
field-based physical fitness tests. Results and Conclusions: As expected, sex differences in physical fitness expanded
from age 13 to 15. Strength and power increased more in males than females. Aerobic capacity increased slightly
in males while remaining stable or tending to decline in females. Balance and gross motor coordination improved
identically in males and females from age 13 to 15. Compared to European and International reference data,
the sample performed superior in endurance and balance, slightly above median in lower-body strength, but
inferior in flexibility.

Key Words: Balance, cardiovascular endurance, coordination, muscular strength, obesity, overweight

Introduction
The Scandinavian countries have not escaped the
trend towards decreased physical activity and
increased prevalence of overweight and obesity among
both children and adults [1,2]. Given the potential
benefits of good physical fitness and body composi-
tion on future risk of diseases [3], considerable atten-
tion has been given to increasing physical activity to
improve physical fitness and reduce or maintain a
healthy body composition, also within adolescents.
In recent years, a substantial body of research has
accumulated quantifying physical fitness levels
among adolescents worldwide according to age and
sex [4–6]. Tomkinson and colleagues [7] included
available studies reporting Eurofit data for children
and adolescents from different regions of Europe,
and the findings suggested fitness among adolescents
from Northern and Central European countries was
relatively high compared to the other reporting coun-
tries. Similarly, a paper from Olds and colleagues [8]
investigated worldwide variation in cardiovascular
endurance tested with the 20-m shuttle run test.
Regretfully, Norwegian data were not available for
either of these reviews.
Indeed, normative data quantifying different com-
ponents of fitness in Norwegian children and adoles-
cents is scarce, making longitudinal assessment in
the adolescent population of Norway difficult.
Moreover, normative data from Norway is warranted,
both for cross cultural comparison and for identifica-
tion of secular changes [9].
With increased focus on physical inactivity, cardi-
ovascular fitness, and overweight in youth, the term
physical fitness has tended to become more narrowly
defined in practice, with focus on endurance testing
and body composition, and less on other dimensions
of fitness that are part of motor development and
daily function, such as strength, motor coordination,
flexibility, and balance. Thus, in a larger context of

Correspondence: Tommy Haugen, Faculty of Health and Sport, University of Agder, Service box 422, 4604 Kristiansand, Norway. E-mail: tommy.
haugen@uia.no

(Accepted 19 August 2013)

© 2013 the Nordic Societies of Public Health

DOI: 10.1177/1403494813504502

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68    T. Haugen et al.
understanding how investigating physical activity
patterns relate to youth fitness, a broader fitness test-
ing scope is desirable, including upper-body strength,
lower body strength/power, flexibility, balance, coor-
dination and cardiovascular endurance.
The purpose of the present study was twofold: 1)
to provide normative data quantifying the current
physical fitness level and the body mass index of
13–15-year-old Norwegian children using a multi-
component fitness assessment, and 2) to compare the
physical fitness of Norwegian 13–15-year-old adoles-
cents relative to their age and sex matched peers from
23 other European countries (static balance, lower
body strength, flexibility and cardiovascular endur-
ance) from Tomkinson et al. [7], and to their age and
sex matched peers from 37 countries around the
world (cardiovascular endurance) from Olds et al.[8].
Materials and methods
Participants
All eight-grade students in the Kristiansand public
school system (529 male, 530 females, mean age at
initial testing was 13.4, SD = 0.3) were invited to
participate in this study. Kristiansand, Norway has a
population of about 80,000. Participants completed
a questionnaire, performed a series of field based
physical fitness tests, and completed objective height
and weight measurements. Testing was repeated on
the same sample of students in the Fall of 2004 (aged
13 years), 2005 (aged 14 years), and 2006 (aged 15
years). Participation rate was 75%–80%. This study
was approved by the regional research ethics review
board for southern Norway. Participation was volun-
tary and based on informed parental consent.
Procedure
All data was collected during October and November
of the observation years. The physical fitness tests
were carried out during a physical education session,
administered by trained research assistants or quali-
fied PE instructors who had been specifically trained
to administer the fitness test battery. Anthropometric
measurements were performed by either school
nurses or research assistants.
Measurements
Height and weight.  Standing height was measured
without shoes to the nearest 0.5 cm. Weight was mea-
sured without shoes in lightweight clothes to the
nearest 0.1 kg, using the portable balance scales
available at each school-nurse office. All scales were
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calibrated by the researchers prior to the testing.
Body mass index (BMI) was calculated as weight in
kilograms divided by the square of height in metres.
Cut off-points for overweight and obesity was
obtained in accordance with the suggestions from
Cole et al. [10], and for thinness (grade 3) in accor-
dance with Cole et al. [11].
Physical fitness.  The general physical-fitness test
battery included six physical subtests, quantifying
upper-body strength, lower body strength/power,
flexibility, balance, coordination and cardiovascular
endurance.
1. Upper body strength was estimated using a push-
up test (PU) to failure [12]. Subjects were
required to keep their body straight. All push-ups
had to be performed with a minimum angle of
90˚ at the elbow before returning to the arms fully
extended position. The number of push-ups to
failure was recorded. Males executed the push-
ups on the hands and toes while females executed
the push-ups on the hands and knees.
2. Lower body strength/power was assessed using
the standing broad jump (SBJ). Subjects com-
pleted three trials with the best result registered
to the nearest cm. Distance was measured from
the takeoff point to the landing point of the back
of the heel in accordance with the Eurofit testing
instructions [13].
3. Flexibility was measured with the sit and reach test
(SAR) using the procedures of the Eurofit direc-
tive. Subjects sat on the floor with knees extended
and feet placed at 90 degrees against a box. Testing
was performed without shoes. The edge of the box
was 15cm behind the zero point for measurement
such that if the fingertips were in line with the box
edge, a flexibility score of 15cm was assigned. The
participants were asked to reach forward slowly
and extend forward as far as possible, in a smooth
stretching movement. Scores were measured to the
nearest 0.5cm. The best of three trials was
recorded.
4. Balance was measured using the Flamingo bal-
ance test (FLB) from the Eurofit test battery.
Subjects balanced on one leg (without shoes) on a
3 cm wide plank, 4cm above the ground, for 60
seconds. Participants held the other foot with their
hand. When in balance a 60 second timer was
started. The time was stopped each time an error
(falling off the plank or letting go of the foot). The
result was registered as numbers of errors made
before achieving 60 seconds of balance time.
Subjects who fell repeatedly with minimal balance
time were assigned an error score of 30.

5. Cardiorespiratory endurance was estimated by
using the endurance shuttle run test (ESR) [14],
which requires participants to run back and forth
between two lines set 20 m apart. The running
pace is determined by an audio signal, and the
velocity increased by 0.5 km/h every minute. The
test was terminated when the participant failed to
reach the end lines in time with two consecutive
audio signals. The result was recorded as the
number of completed 20-m shuttles. Estimated
VO2-peak (mL/(kg·min); EVO2) and was esti-
mated from this score via regression equation.
6. One KTK-subtest (Körperkoordinationstest für
Kinder) [15], the Side-to-side jump (SS) was
included to estimate motor coordination. The
KTK-test battery is a standardized normative
instrument which measures gross motor coordi-
nation. According to the KTK protocol, the par-
ticipants were told to jump from side to side over
a little beam (60 cm × 4 cm × 2 cm) with both
feet together, as many times as possible within a
period of 15 seconds. The original KTK test was
applicable to an age range of 5–14 years. Because
the present study also consisted of 15-year-old
adolescents, a small modification was made to the
instructions. During two consecutive trials, the
participants were required to make 15 sideways
jumps as fast as possible, and the total time used
(in seconds) was recorded as the result.
The three tests taken from the Eurofit-battery
(Standing broad jump, Sit and reach, and Flamingo
balance test) have been validated previously [16].
The push-up test [12] and the ESR [14] are proven
to be highly reliable (in adolescents). Test–retest reli-
ability for the modified version of the KTK side-to-
side hop test was 0.84 in a group of 45 college
students (unpublished data).
Statistical analyses
Anthropometric measures and fitness test results for
the time points were summarized using mean +
standard deviation as well as percentiles. Where
appropriate, sex differences were compared using
independent samples t tests. When exploring changes
in physical fitness performance by age, repeated
measures ANOVA was conducted. Pearson’s correla-
tion coefficient was used to explore correlation
among the 6 fitness tests. A p value of < .05 was con-
sidered statistically significant. Mean and confidence
limits of the percentiles for the physical fitness tests
for 13–15-year-old adolescents from Norway were
compared with their age and sex matched peers from
23 other European countries [7] and their age and
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BMI and Physical Fitness in Adolescents   69
sex matched peers from 37 countries around the
world [8]. Higher percentile than 50 indicate supe-
rior performance relative to country averaged data
from these sources.
Results
Figure 1 provides the results of the height and weight
for both females and males. An independent t test
showed no significant differences in either height or
weight at age 13. At age 14 and 15, there were signifi-
cant differences (p < .02) between males and females
in both height and weight, with males scoring higher.
Moreover, as can be seen in Table I, mean BMI
increased significantly in both sexes with increasing
age (p < .01).
Bivariate correlations showed statistically signifi-
cant positive relationships between all the physical
fitness components. However, the correlations were
low to moderate (Pearson’s r = 0.2–0.5, p < .01). As
can be seen in Table II, in females, there were statisti-
cally significant increase in performance in all fitness
tests except EVO2. In EVO2, there was a statistical
significant reduction in performance from age 14 to
age 15.
As can be seen in Table III, male adolescents con-
sistently performed better on the physical fitness
tests with increasing age. More specifically, there
were significant differences in performance in PU,
SBJ, and SS at all three time-points. In EVO2, SAR,
and FLB however, only age 13 was significant differ-
ent from age 14 and 15.
In Table IV, FLB, SBJ, SAR and ESR results from
our Norwegian sample are compared with age-
matched peers from 23 other European countries
[7], and also the ESR test with age-matched peers
from 37 countries around the world [8]. Mean per-
centile for the Norwegian sample was for FLB 71;
euroESR 76; worldESR 72, indicating superior per-
formance than the reference sample. In SBJ, the
mean percentile was 57, slightly above median. The
percentile for the SAR-test however was 29, indicat-
ing inferior performance for the Norwegian sample
compared to the reference data.
Discussion
The purpose of this study was to present normative
values of body mass index and multiple components
of physical fitness among Norwegian adolescents
aged 13–15 years, and to compare the Norwegian
sample with age-matched peers from other countries.
The normative data quantifying the current physical
fitness level of 13–15-year-old Norwegian children
can be seen in Tables II and III. The different fitness
70    T. Haugen et al.
190 80

185 70

180
60

175

Weigth (kg)
Height (cm) 50
170
40
165

30
160 Female height
Male height
155 20
Female weight
Male weight
150 10
13 14 15
Age

Figure 1.  Mean and standard deviation for height and weight development among males and females through ages 13, 14 and 15 years.

Table I.  Mean body mass index, standard deviation, 95% confidence interval, and prevalence of overweight and obesity according to age
and gender.

13 years 14 years 15 years

  M F M F M F

N 457 429 448 380 461 403

BMI (Mean) 19.2a 19.8b* 20.3a 20.6b 20.9a 21.4b**
STD 2.92 3.13 2.90 2.98 3.02 2.97
95 % CI LCL 18.9 19.5 20.0 20.3 20.6 21.1
  UCL 19.5 20.1 20.6 20.9 21.2 21.7
Thinness % 5.0 7.5 3.2 7.1 3.5 6.7
Overweight % 13.6 11.4 15.2 13.7 15.0 13.6
Obesity % 2.6 2.6 1.8 1.3 2.2 2.2

Note. N = number of participants; M = males; F = females. Cut off-points for overweight and obesity from Cole et al. [10] and thinness
(grade 3) from Cole et al. [11]. a–b Equal letter indicates significant difference (Repeated Measures ANOVA; p < 0.02). * Female BMI sig-
nificant different from males (Independent Sample t test; p < 0.01). ** Female BMI significant different from males (Independent Sample
t test; p = 0.03)

components show only low to moderate inter-corre-
lation. This supports the need for a multi-component
measure of physical fitness [17].
The mean BMIs found in this study (Table I) are
generally consistent with other studies of adolescents
from similar age groups. For example, Bjørnelv and
colleagues [18] reported mean BMI for Norwegian
15-year-old females and males to be 21.0 and 21.3,
respectively. This is close to identical to the findings
in the present study (20.9 and 21.4 for males and
females, respectively). Lobstein and Frelut [19] sug-
gest a trend showing that the non-Eastern bloc coun-
tries surrounding the Mediterranean are reporting a
higher prevalence (20%–40 %) of overweight youth
(aged 11–17 years) than do the northern areas of
Europe (10%–20 %). However, similar to other
Western countries, the prevalence of overweight and
obesity among Norwegian adolescents are increas-
ing, and the current prevalence is comparable to
recent estimates from Western and Northern
European countries [20].
The mean VO2-peak estimates obtained in the
present study are similar to other findings from
Norwegian adolescents. For example, Kolle and col-
leagues [21] reported mean VO2-peak of 41.1 (6.0)
for 15-year-old females and 51.9 (6.7) for 15-year-
old males. Females increased their performances in
all fitness-tests, except ESR. In ESR, we identified a
decline from age 14 to 15 years. Males improved in
PU, SBJ and SS. There were also improvements in

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 BMI and Physical Fitness in Adolescents   71
Table II.  Means, standard deviations, and percentiles of physical fitness in 13–15-year-old females.

PU FLB SBJ SS SAR EVO2

13 years N 414 408 412 407 395 377

  Mean 22a 10b 160c 76d 19e 44f
  STD 11.8 6.1 23.8 12.0 7.7 5.1
  Percentiles 10 9.0 17.0 130.0 61.0 8.0 37.6
  25 14.0 13.0 144.0 68.0 14.0 40.3
  50 21.0 9.0 160.0 77.0 19.0 43.0
  75 30.0 5.0 177.0 84.0 24.5 48.2
  90 35.5 2.0 190.0 89.2 28.0 50.9
14 years N 413 411 419 421 418 381
  Mean 27a 8b 166c 85d 22e 45fg
  STD 14.1 5.9 23.9 13.5 7.9 5.7
  Percentiles 10 11.0 16.0 136.0 68.0 12.0 38.6
  25 18.0 12.0 150.0 78.0 17.0 40.0
  50 25.0 8.0 168.0 86.0 22.0 44.1
  75 33.0 4.0 184.0 94.0 27.0 49.5
  90 42.0 1.0 195.0 101.0 32.0 52.2
15 years N 373 381 388 389 383 352
  Mean 31a 8b 171,8c 90d 23e 44f
  STD 14.5 5.4 24.0 13.5 8.3 5.8
  Percentiles 10 15.0 15.0 141.0 74.0 13.0 36.9
  25 21.0 11.0 155.0 82.0 18.0 39.7
  50 30.0 7.0 172.5 91.0 23.0 42.5
  75 40.0 4.0 188.0 98.0 28.0 48.1
  90 50.0 2.0 203.0 106.0 34.0 50.9

Note. N = number of participants; PU = Push-ups (counts); FB = Flamingo balance test (n of errors); SJ = Standing broad jump (cm); SS
= Side-to-side jump (count); SR = Sit and reach; EVO2 = Estimated VO2-peak from Endurance shuttle sun test (mL/(kg•min). a–g: Equal
letters indicate significant difference according to age (Repeated measures ANOVA; p < 0.01).

Table III.  Means, standard deviations and percentiles of physical fitness in 13-15 years old males.

PU FLB SBJ SS SAR EVO2

13 years N 410 406 422 405 403 393

  Mean 18a 10bc 176d 75e 14fg 49hi
  STD 10.2 6.2 22.8 12.3 7.5 6.0
  Percentiles 10 5.0 18.0 144.0 59.0 3.0 40.3
  25 10.0 14.0 162.0 68.0 8.0 45.6
  50 17.0 9.0 178.0 76.0 14.0 48.3
  75 24.0 6.0 190.0 84.0 19.0 53.6
  90 30.0 3.0 203.0 91.0 23.0 56.2
14 years N 423 430 434 427 429 406
  Mean 24a 9b 194d 86e 16f 51h
  STD 12.3 5.6 23.2 12.3 7.9 6.3
  Percentiles 10 10.0 17.0 160.0 70.0 4.0 44.1
  25 16.0 12.0 180.0 78.0 10.3 46.8
  50 22.0 8.0 195.5 87.0 16.0 52.2
  75 31.0 5.0 210.0 93.0 22.0 55.0
  90 40.0 3.0 223.0 100.0 26.0 58.5
15 years N 409 406 415 404 427 396
  Mean 30a 8c 204d 92e 17g 52i
  STD 13.4 5.2 24.4 14.6 8.6 6.3
  Percentiles 10 13.0 15.0 174.0 76.0 4.0 42.5
  25 21.0 12.0 190.0 85.0 11.0 48.1
  50 30.0 8.0 205.0 94.0 16.0 52.3
  75 40.0 4.0 220.0 101.0 23.0 56.5
  90 48.0 2.0 233.4 107.0 28.0 59.3

Note. N = number of participants; PU = Push-ups (n counts); FB = Flamingo balance test (n errors); SJ = Standing broad jump (cm); SS
= Side-to-side jump (n counts); SR = Sit and reach (cm); EVO2 = Estimated VO2-peak from Endurance shuttle run test (mL/(kg•min). a–i:
Equal letters indicate significant difference according to age (Repeated measures ANOVA; p < 0.01).

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72    T. Haugen et al.
Table IV.  Mean and confidence limits of the percentiles for the physical fitness tests for 13–15-year-old adolescents from Norway, relative
to their age- and sex-matched peers from 23 other European countries [7].

FLB SBJ SAR euroESR worldESR

  x LCL UCL x LCL UCL x LCL UCL x LCL UCL x LCL UCL

13F 68 66 71 53 50 57 23 20 26 70 66 73 67 64 70
14F 74 71 77 59 55 62 32 28 35 84 81 86 77 74 80
15F 72 69 75 64 60 67 34 30 38 80 77 83 78 75 81
13M 70 67 74 52 49 56 27 24 31 66 62 69 62 59 65
14M 71 68 74 60 57 63 31 28 34 81 78 83 73 70 76
15M 71 68 74 55 52 59 26 23 29 77 74 79 73 70 76

Note. Mean percentiles (x) and lower (LCL) and upper (UCL) 95% confidence limits for the Norwegian sample relative to the matched
peers from other European countries. The physical fitness tests were flamingo balance (FLB), standing broad jump (SBJ), sit-and-reach
(SAR), and endurance shuttle run (euroESR). Note, for the endurance shuttle run, the Norwegian sample was also compared to age and
sex matched peers from 37 countries around the world (worldESR) [8]. Higher percentile than 50 indicate superior performance.

ESR, SAR and FLB, but only from age 13 to 14
years. During early adolescence, strength and power
increased in both sexes, most likely due to increased
muscle mass [22]. Cardiovascular fitness may in gen-
eral be reduced by lower performance, or increased
fatness, or both [23]. The increase in peak VO2 for
males is usually explained by greater muscle mass
(combined with matching relative increase in heart
size) and higher haemoglobin concentration [22].
Beunen and Malina [24] claim the highest peak VO2
in females to be near the time of peak height velocity.
Onwards, it has been reported that puberty has an
independent positive effect on aerobic power in males
but not in females [25].
When comparing the results from this study with
the European and worldwide reference data (Table IV),
superior performances were identified in both bal-
ance and cardiovascular endurance. These differ-
ences may be due to several factors. Flammer and
Schaffner [26] reported that Norwegian children and
adolescents spent more of their leisure-time doing
sports-related activities, than did other European
countries. In the Norwegian society, the use of nature
and outdoor recreation is an important cultural
aspect [27,28] and the use of nature as a playground
for activity is also common [29]. Indeed, Tomkinson
and colleagues [7] argue that both the popularity of
vigorous outdoor winter sports and the societal
importance placed upon sport may be plausible
explanations for the superior performance of north-
ern European countries. Taken together, this may be
a plausible explanation for the endurance, and also
possibly the balance results. However, Wold [9]
argues that the higher physical activity level found in
Norwegian teenagers compared to other European
countries is rapidly declining toward the European
level. Further studies accurately assessing both physi-
cal fitness and physical activity will be required in
order to establish more objective evidence regarding
potential cultural differences and potential changes
over time.
In contrast to generally better fitness performance,
the flexibility score was lower in the Norwegian sam-
ple than in the reference data. One may speculate
whether flexibility is in some ways inhibited by early
onset of puberty. Peak height velocity in legs occurs
in general 6 to 9 months earlier than do trunk length
[30]. This asymmetric acceleration in growth could
affect the flexibility (especially when measured by the
sit-and-reach test) during pubertal growth. To which
extent the onset of puberty in the Norwegian sample
compared to the European reference sample may
account for the difference in flexibility is unknown.
To our knowledge, no study has investigated the flex-
ibility of adolescents when taking into account the
possible difference in growth velocity of legs and
trunk during maturation.
Taken together, this study provides normative
data on multiple fitness dimensions and BMI for
Norwegian adolescents during a period of rapid
growth. Such data on Norwegian adolescents are
scarce. A solid sample size throughout the three test
points is one of the major strength of this study.
However, the region of Kristiansand may not fully
represent Norwegian adolescents aged 13 to 15 years.
Future population studies stratified on geographical
areas in Norway are warranted. Furthermore,
although providing a relative comprehensive battery
of physical fitness tests suitable for adolescents, other
tests not included may be preferable or at least
equally relevant.
Perspectives
Quantifying different components of fitness in
Norwegian adolescents are important in order to
investigate cross cultural comparisons and for the
identification of secular changes in physical fitness.

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The prevalence of such data from Norway is scarce.
This study provides normative data on multiple
physical fitness dimensions in Norwegian adoles-
cents aged 13 to 15 years. Although the current sam-
ple of early adolescents are have good physical fitness
compared to other European and worldwide adoles-
cents of same age and sex, the Norwegian society
cannot claim to have escaped from the trends towards
decreased physical activity and physical fitness, and
increased prevalence of overweight and obesity. Thus,
monitoring the physical fitness level of Norwegian
adolescents is an important public health task.
Acknowledgements
The authors would like to thank Dr. Grant
Tomkinson, University of South Australia for provid-
ing the comparable data for Table IV.
Conflict of interest
None declared.
Funding
This research received no specific grant from any
funding agency in the public, commercial, or not-for-
profit sectors.
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