ORIGINAL PAPER

The ‘Motorik-Modul’ (MoMo): physical fitness and physicalactivity in German children and adolescents

Alexander Woll & Bärbel-Maria Kurth & Elke Opper &

Annette Worth & Klaus Bös

Received: 20 July 2010 /Accepted: 23 December 2010 /Published online: 12 February 2011# Springer-Verlag 2011

AbstractObjectives The aim of the ‘Motorik-Modul’ (MoMoBasiserhebung, www.motorik-modul.de) was to establishprevalence measurements on physical fitness and physicalactivity in German children and adolescents and toidentify differences between age groups and genders. Atotal of 4,529 children and adolescents between the ages of4–17 years from 167 cities across all states of the GermanFederation participated in this study. Sociodemographicparameters were recorded. Physical fitness was measuredusing endurance, strength, coordination and flexibilitytests. Physical activity was assessed using a validatedquestionnaire, including aspects of physical activity partici-pation (school/club/non-club), intensity of physical activityand type of activity. Chi-square tests and ANOVASwere usedto compare groups and to detect age and gender effects, anddata were compared with criterion-related guidelines by theWHO. For parameters describing physical fitness, age was thedominant influencing parameter. Many parameters showedincreasing performance until the onset of puberty. Boysgenerally performed better than girls except in fine motorcoordination during precision tasks and in flexibility. Physical

activity was greater in older subjects with a greater intensityfor adolescents who were physically active. The generalactivity level was similar to the data reported in the HBSCstudy by the WHO but lower than the recommended activitylevels.

Conclusion With the results of this study, nationwiderepresentative prevalence data on physical fitness andphysical activity are available. These data contribute tothe scientific knowledge on the prevalence and conditionsof physical fitness and physical activity.

Keywords Physical fitness . Motor performance ability .

Sports . Physical activity . Age . Gender

Introduction

Physical fitness and physical activity are important determi-nants of health. Especially in children and adolescents,physical activity is a central component of health behaviour,and physical fitness is often used to evaluate a child’s generalhealth andmotor development.While a sedentary lifestyle andlack of physical activity have profound health implications forpersons of all ages, they may hinder normal development andgrowth in children and adolescents and result in life-longdebilitated health. Negative correlates of lack or limitedphysical activity include motor deficits, obesity, psychosocialdisorders, behavioural problems and cardiovascular disease[21, 34, 39, 43, 48, 57]. Hence, being involved in physicalactivities has been considered a central health resource [18].

Physical fitness can be defined as the ability of a personto be physically active and includes endurance, strength,agility, coordination and flexibility. Physical fitness inchildren and adolescents has received international attentionsince the 1950s [1, 12, 16, 45, 46]. Beunen et al. andTelama conducted large-scale studies on fitness in Europe-

A. Woll (*)Universität Konstanz,Sportwissenschaft | (Fach 30),78457 Konstanz, Germanye-mail: alexander.woll@uni-konstanz.de

B.-M. KurthRobert Koch-Institut,Berlin, Germany

E. Opper :K. BösKarlsruhe Institute of Technology,Karlsruhe, Germany

A. WorthPH Schwäbisch-Gmünd,Schwäbisch-Gmünd, Germany

Eur J Pediatr (2011) 170:1129–1142DOI 10.1007/s00431-010-1391-4

an children and adolescents [5, 47], yet only a few studieshave followed participants until today [36]. A largepercentage of children and adolescents present with poorphysical fitness including coordination, strength, enduranceand flexibility [55] and should thus receive special attentionand intervention. In addition, there is some evidence thatphysical fitness including coordination and endurance inchildren and adolescents has declined [8, 25]. However, todate, conclusions regarding actual physical fitness level inchildren and adolescence cannot be drawn because of thelack of comprehensive and representative data.

Many different tools have been used for the assessmentand comparison of physical fitness. However, even large-scale tools such as the Eurofit test battery do not assess allaspects of physical fitness [14]. Further, while physicalfitness in children and adolescents has been comparedbetween some countries [15, 31, 33, 44, 52], to date aninternationally accepted, reliable standard tool for theassessment of physical fitness in children and adolescentsis not available. Consequently, comparisons between exist-ing data sets are challenging. In addition, levels or criteriaof physical fitness in children and adolescents are needed toestablish specific recommendation guidelines for interven-tions aimed at improving physical fitness.

Physical activities are the main leisure activities in childrenand adolescents [20]. Physical activity behaviour depends onsocio-demographic parameters including age, gender, socialstatus, education, migration background and urban versusrural environment [6, 40, 54], and these aspects are importantin the context of physical activity and how it relates tohealth. Although more than 80% of German children andadolescents are members of a sports club at some pointduring their childhood and adolescence [20], the extent oftheir daily physical activities has decreased. A reduction ofphysical activity in children and adolescents appears to occurat a younger age. In addition, children not only becomeactive members in sports clubs at a younger age but also endtheir active sports involvement at a younger age [28]. Animportant fact for the problem of health-oriented physicalactivity is that an estimated 75% of European adolescentsbetween the ages of 11–15 years do not meet the guidelinesfor healthy activity behaviour recommended by the WHO[56]. However, previous studies on physical activity inGerman children and adolescents did not include all socialcontexts (school, club and non-organized) [9], did notdifferentiate between different types of physical activity[13] or are not representative of the entire population [24].

In general, representative prevalence data on physicalactivity in German children and adolescents are lacking,and representative longitudinal studies relating activitybehaviour in German children and adolescents to theiractivity behaviour during adulthood and to their later healthdevelopment are not available. Therefore, the purpose of

the ‘Motorik-Modul’ (MoMo) was to establish prevalencemeasurements on physical fitness and physical activity inGerman children and adolescents and to identify differencesbetween age groups and genders.

Materials and methods

The ‘Motorik-Modul’ is supported by the German Ministryfor Family, Seniors, Women and Youth and part of theGerman Child and Adolescent Health Survey (KiGGS) [27]conducted by the Robert-Koch-Institute in Berlin, Germany.Both studies were approved by the institutional review boardand have been performed according to the Declaration ofHelsinki. From 2003 to 2006, data on physical fitness andphysical activity of 4,529 children and adolescents betweenthe ages of 4–17 years from 167 cities across all states of theGerman Federation were collected. All participants or theirguardians gave written informed consent prior to studyparticipation. Participants were recruited from the KiGGSpopulation, allowing for future analyses not only of datacollected as part of the ‘Motorik-Modul’ but also theirrelationship to biomedical and psychosocial data collected aspart of KiGGS (Table 1). To obtain a study population that isrepresentative for children and adolescents with primaryresidence in Germany [27], the Robert-Koch-Institute (Berlin)and the Centre for Surveys, Methods and Analyses (ZUMA,Mannheim) used a stratified multi-stage probability samplewith three evaluation levels where level 3 applied to the‘Motorik-Modul’. To improve the representativeness of thestudy results, deviations from the sample from the population

Table 1 Biomedical and psychosocial data collected as part ofKiGGS

Parameters

Information on physical status

Acute and chronic conditions

Disabilities

Health risks and accidents

Psychological health and behavioural problems

Subjective health and quality of life

Social contacts

Social network and support system

Personal resources such as protection mechanisms for a healthypsychological development

Nutrition, eating disorders and adiposity

Thyroid health and iodine intake

Health behaviour and leisure activities

Medication consumption and immunization status

Utilization of medical services

1130 Eur J Pediatr (2011) 170:1129–1142

structure regarding age, gender, region and country ofcitizenship were corrected by weighing the data.

Teams of three testers from a total of 23 testers collecteddata at each location during two to three testing days, andeach subject was involved for approximately 1 h. Testerswere trained in data collection of motor tests, questionnaireadministration and logistics after completing a first-aid or adefibrillation course. Each team consisted of at least oneperson certified in first-aid, one person certified indefibrillation and one female tester. The bike endurancetest in girls between 6 and 10 years of age was alwaysconducted by a female tester. Testers received continuingtraining to resolve possible questions arising during fieldtesting. All testers received a tester identification code andwere responsible for data entry to facilitate correct datacollection and entry and to assess potential tester effects.

Sociodemographic parameters

The sociodemographic parameters included in this studywere gender, age, BMI, social status, migration back-ground, residential region (former German DemocraticRepublic (GDR) versus former Federal Republic ofGermany) and residential environment (urban versus rural).All sociodemographic parameters were assessed in theumbrella study KiGGS and are important for the differentialanalysis of the physical fitness, physical activity and healthstatus of children and adolescents. Differences betweengroups may reveal problem groups such as, for instance,children with activity deficits, fitness deficits or relevantenvironmental variables and hence provide prevalenceinformation for the design of intervention or preventionprogrammes.

Table 2 Structure of physical fitness tests relating motor skills to motor abilities

Task structure

Motor abilities

Passive systems for transfer of

energy

Endurance Strength Agility Coordination Flexibility

aerobicstrength

endurance/ power

reaction time

coordination under time constraint/

coordination with precision

flexibility

Gross motor skills

Locomotion

walking backward balancing(BAL)

jumping standing long jump (SW)force plate

(KMP)

jumping side-to-side (SHH)

Gross motor limb movements

upper extremities

trunk

push-ups(LS)

forward bend(RB)

lower extremities

bike endurance test (RAD)

Posture whole body single leg stance (EINB)

Fine motor skills

Fine motor limb movements

hand

reaction test

(REAK)

MLS-tracinglines (LIN)

MLS-sorting pens (STI)

Eur J Pediatr (2011) 170:1129–1142 1131

Physical fitness tests

While different tools have been used to assess physical fitnessin children and adults [15, 31, 33, 44, 52], to date a generallyaccepted standard tool has not been established. The criterionfor the selection of physical fitness tests was the ability toassess as many aspects of physical fitness as possible. Thegeneral physical fitness test structure relating motor skills tomotor abilities is described in Table 2. Single leg stance wasused for assessing gross motor coordination during staticprecision tasks [42]. The subjects were asked to stand ontheir dominant leg for 1 min with their eyes open, and thenumber of floor contacts with the contralateral limb wasrecorded. The backward balancing was based on a bodycoordination test [41] and allowed the assessment of grossmotor coordination during dynamic precision tasks. Thesubjects were asked to balance backwards on 6-, 4.5- and 3-cm-wide beams, respectively, with two trials per beam. Thenumbers of steps on each beam were added. The test wasterminated if one foot touched the ground. Fine motorcoordination during precision tasks was assessed using thetracing lines and sorting pens tests. The subjects were askedto trace a groove on a board using a pen without touching therims of the groove. The average time of tracing withouttouching the rims was calculated. The subjects were thenasked to move 25 pens from a pen holder into wholes at theedge of a board as quickly as possible. Reaction time wasassessed using a computer-aided reaction test. The subjectswere asked to react as quickly as possible to 14 colourchanges of a traffic light, and the seven fastest times wereaveraged. Forward bends [26] were used for the assessmentof trunk flexibility and the flexibility of the sciatic cruralmuscle group. The lowest point reached by the fingertipswhile standing on a box with legs extended was recorded.Positive values indicated good flexibility while negativevalues indicated poor flexibility. Standing long jumps [23]and counter-movement jumps on a force plate that wasdeveloped by our group were used to assess leg power.Dynamic strength endurance of the upper extremities wasassessed using the push-up test [4]. The subjects were askedto do as many push-ups as possible within 40 s. The jumpingside to side test [41] was used to assess gross motorcoordination under time constraint. The subjects were askedto perform as many jumps from side to side as possibleduring two 15-s intervals, and the numbers for the twointervals were averaged. Aerobic endurance was tested usingthe bike endurance test with test parameter PWC170 [38].The initial load was adjusted to 0.5 W/kg body mass.Subsequently, the load was increased every 2 min by 0.5 W/kg increments. The test was abandoned when the predeter-mined threshold heart rate was reached for at least 15 s (190and 180 heartbeats/min for children aged 6–10 years andchildren and adolescents aged 11–17 years, respectively).

In a pilot study on 138 female and male subjects betweenthe ages of 4–17 years, the quality of the physical fitness testswas assessed using the test–retest method [32]. The correlationcoefficient for results for different testers was 0.98 or 0.99 forall tests. The percent difference between results for differenttesters was less than one percent point. The overall reliabilityfor the standardized overall values was r=0.971 (p<0.001).Overall, the selection of test tasks was sufficiently reliableand valid for the assessment of physical fitness in childrenand adolescents 4–17 years of age.

Physical activity assessment

A questionnaire consisting of 35 items was developed forthe assessment of physical activity. The main categories ofthe ‘Motorik-Modul’ questionnaire are given in Table 3.The first two items assessed overall physical activity for atleast 60 min per day during the preceding 7 days atmoderate to high intensity and facilitated comparisons withinternationally developed activity standards (e.g. 60 min perday). The remaining 33 items covered the following activitycategories: daily activities, physical activity classes atschool, club sports and physical activities outside of clubs.Information on duration and frequency was collected foreach activity category. In addition, information on per-ceived intensity (1—no, 2—mild, and 3—high perspirationand shortness of breath, respectively) was collected forphysical activities (at school, clubs or outside of clubs). Forall categories except physical activity at school, informationon the type of physical activity was collected. While theactivity type for daily activities was categorized intoplaying outdoors, garden and farming activities andwalking as mode of transportation, the subjects could listany type of activity for club and leisure activities. To obtaindetailed information, answers were given as duration(minutes per day) and frequency (days per week). Becausethe subjects do not participate in all activities during theentire year (e.g. skiing), separate items assessed the monthsof each activity (e.g. January–December) with the goal of aprecise assessment of activity behaviour in terms ofhabitual activity. Finally, a range of predicting parameterswere assessed, including accessibility of sports facilities,physical activity behaviour of next of kin, health-relatedexpectations, physical expectations, socio-emotionalexpectations and motive for being physically active [19].The reliability and validity of the final instrument wastested in a pilot study [32] using a test–retest. The reliabilityof the instrument was r=0.97, and no significant differ-ences in mean values between test and retest values weredetected. The validity of the instrument was tested bycomparing activity monitor and heart rate monitor data tovalues obtained using the instrument. The agreementbetween information obtained using these systems was

1132 Eur J Pediatr (2011) 170:1129–1142

Table 3 Main categories of the ‘Motorik-Modul’ questionnaire for the assessment of physical activity [37]

Content Question Source

General physical activity On how many days during the last week were you physically active forat least 60 min/day?

Prochaska, Sallis & Long [35]

On how many days of a normal week are you physically active for atleast 60 min per day?

Physical activity at school On how many days per week do you have physical education in school? Ulmer [52]

How many lessons (45-min lessons) per week does this usually amount to? Bös et al. [7]

How strenuous are these lessons usually for you? Bös et al. [7]

Are you a member of a school sports team? Ulmer [52]If yes, which sports team are these?

How many lessons of sports team practice (45-min lessons) per week doesthis usually amount to?

Daily physical activities How do you usually get to school? no reference

How often do you usually play outside during a typical week? Bös et al. [7]

Do you help out in the garden or with farm work (e.g. picking fruit, etc.)? Ulmer [52]How far do you usually walk on a daily basis?

Physical activity in a sports club Are you a member of a sports club? Ulmer [52]Which sport(s) do you actively do in a club?

How many times per week do you participate in each sport?

How long does a training session last?

During which months do you participate in each sport? Bös et al. [7]How strenuous are these practises typically?

Do you participate in competitions? Ulmer [52], Bös et al. [7]

Physical leisure activities outsideof sports clubs

Do you participate in any other sports outside of sports clubs? Kurz, Sack & Brinkhoff [28]Which sport(s) do you actively do outside of sports clubs?

How many times per week do you participate in each sport (outside of sports clubs)?

How many minutes per week do these activities usually amount to? Ulmer [52]

During which months do you participate in these sports? Fuchs [17]How strenuous are these activities typically?

Availability of sports facilities The closest sports facility is far from my home Fuchs [17]When I would like to do sports, I am lacking the facilities and equipment

Interest in physical activity at school How interested are you in physical activity at school? Bös et al. [7]

Physical activity behaviour of next of kin Is your dad regularly physically active? Fuchs [17]Is your mom regularly physically active?

Are your siblings regularly physically active?

How many of your friends are regularly physically active?

Health-related expectations When I am physically active regularly, … Fuchs [17]…I won’t get sick as easily

…I can easily get injured

Physical expectations …my endurance will improve

…my joints will stay flexible

…I will have a nice body and look nice

Socio-emotional expectations …I spend time with others

…I get rid of my energy

…I won’t be bored

…I will not think about my problems

Motivation for being physically active I do sports….. Ulmer [52]…to have fun

…to do something with other people

…to do something about my health

…to relax

…to stay in shape

…to get rid of stress

…to compete with others

…to stay fit

…to get better

…other

Eur J Pediatr (2011) 170:1129–1142 1133

small for low-intensity activities (r=0.26) to moderate forhigh-intensity activities (r=0.51) and comparable to resultsreported in the literature [7, 17, 35].

Statistical analyses

All statistical tests were conducted using SPSS Version 16.0(SPSS Inc., Chicago, IL, USA). Chi-square tests were used todetect differences in nominal and ordinal variables betweengroups. Univariate analyses of variance were used to detectdifferences in physical fitness and physical activity databetween subject groups (age, gender). Relevance of a meandifference was determined by a difference of at least 0.5 SD or5%. Data were compared with criterion-related guidelines.

Results

Sociodemographic parameters

The age and gender distribution details of the studypopulation are shown in Table 4. Of all subjects, 18.4%of subjects lived in rural areas, 27.9% in small towns,29.4% in small cities and 24% in major cities, respectively.Further, 14.3% of participants had a migration background,and 13.6% lived in states that formerly belonged to theGDR. Finally, 24.6% of subjects belong to the lower class,46.8% to the middle class and 27.2% to the upper class.Overall, the study sample was representative of childrenand adolescents residing in Germany with regards to age,gender, region and country of citizenship according to data

provided by the Centre for Surveys, Methods and Analyses(ZUMA, Mannheim).

Physical fitness

Eighty-seven percent of the 3,528 children and adults testedreached the threshold heart rate. Thirteen percent terminat-ed the test prematurely because of subjective exhaustion orlack of motivation. For 208 (5.7%) of subjects, PWC170could not be determined. The mean values of absolute andrelative endurance performance were greater in oldersubjects of both genders (P<0.001; Fig. 1). In all agegroups, male subjects performed better than female subjects(P<0.001). A significant interaction between the factorsage and gender was identified (P<0.001) where the differ-ences were greater in boys over the age of 10 years whilethe differences were linear in girls of all ages. On average,

Table 4 Study population by age and gender (4–17 years)

Age [years] Boys Girls Total

4 153 146 299

5 155 146 301

6 158 149 307

7 161 153 313

8 158 151 309

9 152 147 299

10 156 142 298

11 157 154 311

12 158 154 312

13 174 160 334

14 180 179 359

15 186 176 362

16 194 178 372

17 172 178 350

Total (4–17 years) 2,314 2,215 4,529

Percent (total) 51.1% 48.9% 100%

Fig. 1 Endurance tests. Mean (1 SD) power at 170 b/min during the bikeendurance test by age and gender (N=3.410). Top graph—absolutepower. Bottom graph—relative power (normalized to body mass)

1134 Eur J Pediatr (2011) 170:1129–1142

the difference in performance is 11 W/year for boys and6 W/year for girls.

All strength tests showed that strength is higher the olderthe subjects are (P<0.001; Fig. 2). While the difference instrength between age groups was constant for boys, thedifference in strength between age groups for girls abovethe age of 12 years was negligible, causing a greater meanstrength in boys aged 14-17 years than in girls in the sameage groups (P<0.001; Fig. 2). Only in the standing longjump test did boys aged 4–13 years perform better thangirls in the same age groups (P<0.001; Fig. 2).

The number of jumps in the jumping side to side testwas higher in older subjects (P<0.001; Fig. 3). Whilebelow the age of 10 years the difference in the number ofjumps between age groups was three jumps per year, thisdifference was only one jump/year in subjects aged 11–17 years. Results for boys and girls were similar in all agegroups.

The number of ground contacts for the single leg stancetest was lower and the number of points for the backwardbalancing was higher in older subjects (P<0.001 for both;Fig. 4). Both tests revealed better test performance for girlsthan for boys in all age groups (P<0.001 for both). Thedifference in test results between age groups was similar forboth genders. While the difference in test performancebetween age groups was close to constant for children11 years and younger, these differences were negligible forage groups 12 years and older. Both tests differentiate wellonly in younger children.

Test performance in all tests for fine motor coordinationwas higher in older subjects (P<0.001; Fig. 5). While boysand girls showed similar test performance for the reactiontest, girls performed better than boys in the tracing lines and

Fig. 2 Strength tests: top graph—mean (1 SD) number of push-upsperformed during 40 s by age and gender (N=3,887). Centre graph—mean (1 SD) distance achieved during the standing long jump test byage and gender (N=4,504). Bottom graph—mean (1 SD) distanceachieved during the force plate test with bilateral push-off, armsakimbo and no arm swing

Fig. 3 Test for coordination under time constraint. Mean (1 SD)number of side-to-side jumps performed during two 15-s intervals byage and gender (N=4,471)

Eur J Pediatr (2011) 170:1129–1142 1135

sorting pens tests (P<0.001 for both). The difference in testperformance between age groups was similar for bothgenders for the reaction test and the sorting pens test andwas negative in older subjects. Differences in test perfor-mance for the tracing lines test between age groups werealmost constant for both genders, but the difference betweenage groups was greater in girls than in boys (P=0.006).

Values for the forward bend test were consistent betweenall age groups (Fig. 6). In all age groups, girls performedbetter than boys (P<0.001).

Physical activity

On average, children and adolescents participated in 2.2±0.9 h per week on 1.6±0.9 days per week of physical activity

Fig. 4 Tests for coordination during precision tasks. Top graph—mean(1 SD) number of ground contacts during a 60-s single leg stance trialon a T-shaped beam by age and gender (N=4,459). Bottom graph—mean (1 SD) number of points achieved during six backward balancingtrials on three different width beams by age and gender (N=4,502)

Fig. 5 Tests for fine motor coordination. Top graph—mean (1 SD)reaction time to colour changes of a traffic light by age and gender (N=4,467). Centre graph—mean (1 SD) time between mistakes whiletracing a groove using a pen by age and gender (N=4,406). Bottomgraph—mean (1 SD) time needed to move 25 pens by age and gender(N=4,401)

1136 Eur J Pediatr (2011) 170:1129–1142

at kindergarten and school with a significant age effect (P<0.001 for both; Table 5). In addition, 10.8% of boys and 9.0%of girls participated in elective physical activities at school(Table 5). Younger children participated in outdoor physicalactivities on more days per week than older children andadolescents (P<0.001) did, and boys were more frequentlyactive outside than girls of the same age (P<0.001; Table 5).On average, approximately 60% of boys and girls partici-pated in non-club physical activities with an average ofalmost 2.5 h per week (Table 5). While 63% of boys and52% of girls are members in a sports club, 16.5% of boysand 21.0% of girls have opted out of their previous clubmembership, a phenomenon that increases with increasingage (P<0.001; Table 5). The time spent on club sports and thepercentage of children participating in competitions wasgreater in older subjects and greater for boys than for girls(P<0.001 for both; Table 5). Nevertheless, only 17.4% ofgirls and 13.1% of boys fulfil the requirement put forward bythe WHO in 2002 (Tables 5 and 6).

Girls perceived physical activity at kindergarten orschool, non-club and club physical activities as moreintense than boys (P<0.001 for all; Figs. 7, 8 and 9). Theintensity of physical activity at kindergarten and school,non-club and club physical activity was smaller in oldersubjects for both genders (P<0.001 for all; Figs. 7, 8 and9). While the percentage of moderate-intensity activitiesremained relatively constant across all age groups forphysical education at kindergarten and school and fornon-club physical activities (Figs. 7 and 8), this percentagewas smaller in older subjects for club sports with anassociated greater amount of low-intensity activities for thistype of physical activity (Fig. 9).

Fig. 6 Flexibility test: mean (1 SD) of height reached during theforward bending test by age and gender (N=4,464)

Tab

le5

Phy

sicalactiv

ityin

child

renandadolescentsby

agegrou

p.Mean(1

SD)values

arepresented.

P-valuesforageeffect

aregiven

Category

Param

eter

Cou

nt,N

4–5yearsold

6–10

years

old

11–1

3years

old

14–1

7years

old

Overall

P-value

Activities

atscho

olor

kind

ergarten

Num

berof

hours/weekspenton

physical

activ

ity4,42

61.5(1.2)

2.4(0.8)

2.5(0.8)

2.1(0.9)

2.2(0.9)

<0.00

1

Num

berof

days/weekof

physical

activ

ity4,07

11.3(1.0)

2.0(0.8)

1.7(0.8)

1.3(0.8)

1.6(0.9)

<0.00

1

Participationin

electiv

esportsclasses

(boy

s/girls)

[%]

3,87

9N/A

11.0/7.1

13.0/10.3

10.0/9.6

10.8/9.0

n.s.

Daily

activ

ities

Num

berof

days/weekwith

outdoo

ractiv

ities

(boy

/girls)

4,41

76.2/5.8

5.5/5.3

4.5/4.2

3.3/2.7

4.6/4.2

<0.00

1(for

age,

gend

er)

Activities

outside

sportsclub

sParticipationin

non-club

sports(boy

s/girls)

[%]

4,39

450

/49

60/58

64/66

67/61

61.7/59.5

<0.00

1

Num

berof

minutes

perweekforno

n-club

sports(boy

s/girls)

4,21

978

/59

117/96

178/10

920

8/12

715

6/10

6<0.00

1(for

age,

gend

er)

Activities

insports

club

sMem

bershipin

sportsclub

s(boy

s/girls)

[%]

4,50

250

.0/54.5

71.4/57.3

68.8/52.8

55.8/21.7

63/52

<0.00

1(for

age,

gend

er)

Opt

outof

sportsclub

s(boy

s/girls)

[%]

842

5.7/5.9

8.3/12

.416

.6/25.2

29.7/33.4

16.5/21.0

<0.00

1(for

age,

gend

er)

Num

berof

minutes

perweekforclub

sports

(boy

s/girls)

2,45

190

/82

150/12

321

9/18

325

6/21

919

0/15

7<0.00

1(for

age,

gend

er)

Participationin

competitions

(boy

s/girls)

[%]

2,24

722

.7/9.9

65.5/36.3

74.2/67.6

79.6/68.5

67.0/48.0

<0.00

1(for

age,

gend

er)

Fulfilm

entof

WHO

activ

itygu

idelines

Boy

s/girls[%

]3,94

335

.4/28.4

24.2/17.9

9.4/8.3

8.1/5.0

17.4/13.1

<0.00

1(for

age,

gend

er)

Eur J Pediatr (2011) 170:1129–1142 1137

Soccer and swimming were the only sports that werelisted as the favourite club and non-club physical activitiesby boys of all ages, and swimming was the only sportslisted as their favourite sports by girls of all ages (Tables 7and 8). While 4- to 5-year-olds by far favoured biking asnon-club physical activity and gymnastics as club sports,the distribution among different sports became more evenbetween the top five sports with increasing age, especiallyfor girls (Tables 7 and 8).

More than 85% of children and adolescents walked 1 kmor more per day (Fig. 10). Only 9.8% of children andadolescents walked more than 6 km per day. Walkingdistance per day was greater in older subjects (P<0.001)but did not differ between boys and girls.

Discussion

The purpose of this study was to establish prevalencemeasurements on physical fitness and physical activity inGerman children and adolescents and to identify differencesbetween age groups and genders. A large data set onphysical fitness test results and physical activity informa-tion was presented. Common age and gender-dependentpatterns were observed for many parameters and testsdescribing physical fitness and for physical activities indifferent settings.

For parameters describing physical fitness, age was thedominant influencing variable. Only for forward bends wasthe effect of gender stronger than the effect of age [3]. Ingeneral, endurance and strength increased from childhoodto puberty as reported in the literature [22, 30]. Whileendurance and strength continues to increase in boys older

Fig. 8 Intensity of non-club physical activities by age and gender (M,boys: N=1,372; F, girls: N=1,279)

Fig. 7 Intensity of physical activity at kindergarten and school by ageand gender (M, boys: N=2,206; F, girls: N=2,111)

Table 6 Comparison between results of the ‘Motorik-Modul’ and WHO with regards to activity guidelines

Guidelines Gender Age group

11 years 13 years 15 years

MoMo2006

WHO2002

WHO2008

MoMo2006

WHO2002

WHO2008

MoMo2006

WHO2002

WHO2008

Number of days beingactive for at least 1 h

M 3.9 4 3.9 3.8 3.4 3.8

F 3.4 3.5 2.9 3.3 3.0 3.2

Being active for 1 h on5 days per week [%]

M 34.6 35.3 31.3 30.8 25.1 29.4

F 26.0 23.5 16.8 18.7 18.2 17.9

Being active for 1 h on7 days per week [%]

M 16.7 25.0 20.4 19.0 12.6 16.0

F 15.3 20.0 9.6 13.0 12.7 10.0

1138 Eur J Pediatr (2011) 170:1129–1142

than 12–13 years, levels remain constant for girls in this agerange [30]. Only aerobic endurance continued to improvethroughout puberty in girls; however, these improvementsoccurred at a slower rate for girls than for boys, resulting ina gender-specific pattern.

While girls excelled in gross motor coordination com-pared to boys at all ages, no gender difference was foundfor gross motor coordination under time constraints. Ingeneral, gross motor skills improved from childhood topuberty and reached a plateau during adolescence. Incontrast to strength and endurance, values started to beconstant at age 11–12 years. Similarly, reaction time andfine motor coordination under time constraint was onlyslightly better in older subjects. However, fine motorcoordination during precision tasks continued to increasethroughout adolescence [53], describing age difference dueto neuromotor development [29].

Activity behaviour in children and adolescence is ofspecial interest with the increasing influence of technologyin our daily lives and the importance of being physicallyactive for our long-term health [2]. While the educationminister of the German federation recommends at least 3 hof physical education at schools, these recommendationsare not always met. In fact, similar to the results of theSPRINT study [9], the results of this study revealed thatonly 2.2 h per week of physical education are taught atGerman schools. Similar to previous reports [28, 52], lessthan 10% of children and adolescents participated inelective physical activity classes and because of theirparticipation in elective physical activity classes thesechildren typically exceed the recommended hours ofphysical education at school. Younger children and boys

had a greater desire of being physically active as previouslyreported [49, 50], and all children and adolescentsperformed these activities predominantly outdoors and asleisure activities.

In Germany, there are 90,000 registered sports clubs, and56,500 of these clubs offer physical activity programmes forchildren under the age of 7 years and 84,000 offer physicalactivity programmes for children and adolescents aged 7–17 years [10]. Membership fees are affordable, sports clubsexist even in rural areas and programmes in a variety ofsports are offered. The attractiveness of these programmes isreflected in the large percentage of children and adolescentswho are members in sports clubs. On average, children andadolescents spend almost 3 h per week participating in clubssports. However, many clubs appear to have difficulty inbeing attractive for adolescence, and 30% of adolescents optout of their club membership. These results emphasize the

Fig. 9 Intensity of club sports by age and gender (M, boys: N=1,446;F, girls: N=1,113)

Table 7 Order of favourite sports outside of sports clubs by age andgender in percent

Sports Boys [%] Girls [%]

4–5 years (M, N=145; F, N=138)

Biking 57.7 52.3

Soccer 30.9

Swimming 22.6 33.1

Inline skating 7.7 11.6

Dancing 10.7

Skiing 6.5 7.8

6–10 years (M, N=455; F, N=420)

Biking 63.6 61.4

Soccer 31.7

Swimming 30.6 32.1

Inline skating 23.4 36.5

Horseback riding 6.9

Skiing 10.2 7.9

11–13 years (M, N=303; F, N=300)

Soccer 43.4 13.4

Biking 38.6 42.7

Swimming 18.5 17.6

Inline skating 13.0 29.7

Jogging, running 13.6

Basketball 12.5

14–17 years (M, N=477; F, N=427)

Soccer 34.1

Biking 28.8 31.4

Basketball 19.2

Jogging, running 13.1 26.2

Inline skating 20.3

Dancing 9.5

Swimming 10.4 19.2

Eur J Pediatr (2011) 170:1129–1142 1139

importance of physical education at schools especially forchildren and adolescents aged 11–17 years. In contrast, thosewho maintained their membership spent up to more than 4 hper week on training. This development is likely related tothe increasing time required for preparation for competitionsas three out of four adolescents who were members in asports club also participated in competitions.

Physical activity performed at a club usually occurredwith a higher intensity than physical activity at kindergartenand school and during leisure time, and intensity increasedwith increasing age. However, in this study, subjectivemeasures of intensity were used. Hence, it is unclear if therequired intensity differed between settings or if children

and adolescents perceived the intensity differently indifferent settings. Nevertheless, it appears that thosechildren and adolescents who actively participated in clubsports did their sports with moderate to high intensity. Thisresult is in agreement with previous reports of greaterintensity of after-school physical activity than that duringphysical activity classes in school in American children[51]. The fact that the type of club sports favoured bychildren and adolescents remains relatively consistentthroughout childhood and adolescence suggest an associa-tion of age-related increasing intensity with competitioninvolvement rather than with type of sports.

Only 15.3% percent of children and adolescents fulfilledthe recommended activity level of 60 min of physicalactivity with moderate intensity on 7 days per week, andthe younger the age group the more children fulfilled theserequirements. These results suggest that, with increasinginstitutionalization of the child’s daily routines, longerschool days and increasing time requirements for home-work, less and less time is available for daily physicalactivities. Simultaneously, physical activity shifts from thedaily activity setting to organized sports at sports clubs on afew days per week with a change in frequency and qualityof physical activity. These developmental processes explainthe apparent paradox that children are more physicallyactive while less frequently fulfilling activity requirementswith increasing age. Hence, the question arises if theactivity guidelines are appropriate measures for amount ofactivity and if a 1-h daily activity at moderate intensity isbetter with regards to health than an activity that isperformed less frequently but at a higher intensity.Nevertheless, the results for German children and adoles-

Fig. 10 Average walking distance per day for both genders by age(N=3,878)

Table 8 Order of favourite club sports by age and gender in percent

Sports Boys [%] Girls [%]

4–5 years (M, N=150; F, N=157)

Gymnastics 46.6 55.6

Soccer 38.3

Dancing 29.7

Swimming 11.4 15.5

Handball 5.3 2.0

Tennis 3.7 2.0

Track and field 2.9

6–10 years (M, N=558; F, N=422)

Soccer 52.0

Swimming 17.9 19.9

Dancing 26.0

Gymnastics 10.1 31.5

Track and field 9.6 8.0

Tennis

Handball 7.7

11–13 years (M, N=333; F, N=247)

Soccer 47.1

Gymnastics 15.2

Table tennis 11.7

Horseback riding 13.5

Swimming 11.2 18.5

Handball 6.1

Dancing 12.8

Volleyball 4.0 9.3

14–17 years (M, N=407; F, N=317)

Soccer 42.9 8.9

Dancing 29.9

Tennis 12.7

Horseback riding 13.7

Table tennis 7.0

Swimming 6.7 8.2

Volleyball 10.2

Handball 6.1

1140 Eur J Pediatr (2011) 170:1129–1142

cents are in general agreement with those reported by theWHO and by other studies [11, 56].

In summary, this large-scale cross-sectional study pro-vides prevalence data on physical fitness and physicalactivity in children and adolescents. Age and genderdifferences were identified for many parameters describingphysical fitness and physical activity. The relevance ofthese differences will become apparent when the currentdata set is put into relationship with other aspects such associoeconomic factors and health information. In addition,longitudinal data building upon the current data set willprovide critical information on the predictive value ofphysical fitness and physical activity behaviour for anindividual’s long-term health.

Acknowledgements The authors thank PD Dr. habil. AnnegretMündermann (Ph.D.) for her writing assistance. This study wasfunded by the German Bundesministerium für Bildung und Forschung(Federal Ministry of Education and Research).

Conflict of interest The authors do not have a financial relationshipwith the organization that sponsored the research.

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