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Try out PMC Labs and tell us what you think. Learn More. To perform a systematic literature review and meta-analysis to investigate the reliability of The International Fitness Scale questionnaire for assessing overall physical fitness and related components. Quality of the study was considered based on Assessment of Reliability Studies.

Data analysis used Kappa coefficient of agreement, Cochran and the Higgins I 2 test. Sensitivity analysis was conducted using the withdrawal model. A total of seven articles were included in the analysis. Test-retest reliability coefficients ranged from 0. In spite of appropriate test-retest scores attributed to most reliability indicators, heterogeneity among the studies remained high. Therefore, further studies with low risk of bias are needed to support the reliability of the self-reported The International Fitness Scale.

Physical fitness is a predictor of health problems. Satisfactory fitness levels contribute to health problem prevention and functional capacity maintenance and improvement, and limit the development of chronic degenerative dysfunctions, leading to better quality of life. Direct physical fitness measurement methods are considered gold standard. However, these methods have limitations, such as need for laboratories, high costs of equipment, need for a specialized team and difficult interpretation of findings. The IFIS has been employed in several international research studies. Still, instruments with accurate psychometric properties, capable of reproducing a given outcome consistently within time and space, or across different observers reliabilityare required for studies aimed to estimate physical fitness, identify associated risk factors, analyze relations with different outcomes, and assess effectiveness of training programs.

Given the ificance of physical fitness measurement using reliable, user-friendly instruments, and the growing interest in this field, this study set out to conduct a systematic review and meta-analysis of the available literature, in order to determine whether IFIS is a reliable tool for assessing overall physical fitness and related components. Terms were combined using the Boolean operator OR. The [TIAB] field code was used to limit exhibition to articles containing selected terms in the title and abstract Table 1.

An assessment form developed based on inclusion and exclusion criteria and calibrated prior to screening was used for study selection. Review articles were excluded. Duplicate studies were excluded. Two blinded, independent reviewers selected studies in two steps: title and abstract screening and full text reading. In the first step, titles and abstracts were examined according to predefined eligibility criteria for identification of relevant studies.

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Studies selected by at least one reviewer were included in the subsequent step. These were then read in full and examined by reviewers based on eligibility criteria, using an evaluation form. Articles selected for full text reading were submitted to cross-reference search for identification of relevant studies that might not have come up in electronic search. Data extraction was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Two independent raters extracted descriptive and outcome data from selected articles. Prior to data extraction, raters received training in calibration to ensure inter-rater consistency and data extraction spreheet refinement.

This instrument includes 11 items in the following domains: items 1 and 2 — sampling bias, participants and rater representativeness; items 3 to 7 — blinding of raters; item 8 — variations in order of examination; item 9 — appropriate time intervals between repeated measures; item 10 — correct test application and interpretation; item 11 — appropriate statistical analysis.

Inconsistencies in this study were discussed among authors and a final decision reached by consensus, according to Cochrane Handbook for Systematic Reviews recommendations. Reliability was tested using the Kappa coefficient of agreement; sample size was used for grouped Kappa calculation.

The random effects model was chosen over the fixed effects model due to varying levels of physical fitness among individuals, which may have reflected the impacts of physical activity during childhood and adolescence on adult life. Statistical analyses were performed using software R package meta; R 3. Subgroup analysis was conducted to explain study heterogeneity. Effects were divided by study population and sampling bias, then meta-regression calculation performed.

A total of 1, articles were found in the selected databases. Of these, duplicates were excluded. Seven of these articles satisfied eligibility criteria and were included in the quantitative narrative analysis of this meta-analysis Figure 1. Narrative and quantitative summary in this meta-analysis comprised seven studies. Sample size ranged from 89 to Overall, five studies 236816 included participants of both sexes; male sex prevailed in three studies, 3816 one study was based exclusively on women 7 and one study did not describe sex distribution of the sample.

This sample included five observational test-retest reliability studies, 2361617 one cluster randomized trial, 8 and one cross-sectional study 7 Table 2. Studies in this sample reported test-retest reliability estimates based on Kappa agreement coefficients. Time intervals between examinations ranged from 1 to 2 weeks, with 2-week intervals used in most studies 2681617 and 1-week intervals limited to two studies.

Inter-rater agreement regarding risk of bias was Overall, study participants 236781617 were representative of those to whom the authors intended the to be applied QAREL item Q2 and intervals between repeated measurements of the target variable QAREL item Q9 were reported. As regards primary sources of bias, blinding of raters to findings of other raters or to their own findings, to of the reference standard accepted for the target variable, to clinical information, to additional cues and to order of examination was not reported in any of the studies.

In two studies, 26 tests were conducted by raters who were representative of those to whom the authors intended the to be applied. Finally, correct test application and appropriate interpretation, as well as appropriate statistical analysis, were performed in studies in this sample Table 3.

Q1: Was the test evaluated in a sample of subjects who were representative of those to whom the authors intended the to be applied?

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According to Kappa coefficients, overall test-retest reliability ranged from 0. When all items assessed in selected studies were ed for, reliability ranged from 0. Lower Kappa coefficients attributed to the adult population compared to other subgroups in all domains suggest moderate agreement in that population Table 4.

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More strict studies regarding risk of bias assessment as per Q2 had lower Kappa coefficients compared to other subgroups. A difference was observed in population profile in the studies. Global organizations, such as the World Health Organization WHO and the American College of Sports Medicine ACSM currently recommend regular practice of moderate to vigorous physical activity for minutes per week for overall physical fitness improvement.

A retrospective cohort study following up onpatients revealed that cardiorespiratory fitness is inversely associated with long term mortality. Physical fitness is a health problem predictor and a modifiable indicator. However, application of aforementioned tests in scarce financial resource settings, or when specialized personnel is lacking, is not feasible and may preclude large scale studies.

This is the first systematic review and meta-analysis investigating IFIS reliability — or consistency over time — based on test-retest, which is a ificant aspect of any assessment tool. Low test-retest reliability tools are not able to detect true score changes over time. In this study, steps were controlled via a systematic approach and strict protocol. Comprehensive search with no restrictions regarding study type, population, language, age, sex and date of publication was also conducted. Besides other advantages of questionnaires, IFIS has ificant clinical applicability, once findings are associated with directly measured cardiorespiratory fitness and risk factors for cardiovascular disease, such as adiposity and metabolic syndrome, in different populations.

In spite of acceptable Kappa coefficient values, of this meta-analysis involve potential risk of bias and overestimation. This heterogeneity was in part attributed to test-retest reliability dispersion across different populations.

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Some authors reported high test-retest reliability among measures in children, whereas others reported medium and low values in adolescents and adults, respectively. Low methodological quality QAREL items Q4-Q7 may also have compromised reliability, as selected studies in this sample failed to satisfy these criteria. High heterogeneity among items detected in sensitivity analysis indicates that health status, age group, blinding of raters, test-retest time intervals, questionnaire application instructions and understanding by volunteers 73 may impact study findings.

Therefore, interpretation and generalization of findings reported here must be done with caution, since this meta-analysis excluded grey literature and the few studies investigating IFIS reliability were of low methodological quality and involved high statistical heterogeneity according to grouped Kappa coefficients. Finally, the fact that IFIS is available in nine languages must be emphasized. Should it be applied without adaptation and testing in samples with different characteristics from those ed for in instrument construction and testing, cultural bias may occur.

Hence, further studies with low risk of bias and investigating instrument reliability and health status in different populations are needed to support the reliability of the self-reported International Fitness Scale questionnaire as an alternative tool for large scale physical fitness assessment or follow-up and an alternative ancillary test. A qualidade dos estudos foi avaliada pelo Assessment of Reliability Studies.

Foram encontrados 1. Quanto ao tipo do estudo, cinco eram observacionais do tipo confiabilidade teste-reteste, 2361617 um ensaio randomizado em cluster, 8 e um estudo transversal 7 Tabela 2.

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Dois estudos 26 realizaram o teste com avaliadores representativos daqueles a quem os autores pretendiam que os resultados fossem aplicados. Q1: O teste foi avaliado em uma amostra de sujeitos que foram representativos daqueles a quem os autores pretendiam que os resultados fossem aplicados? Um estudo de coorte retrospectivo que acompanhou National Center for Biotechnology InformationU.

Journal List Einstein Sao Paulo v. Einstein Sao Paulo. Published online Jul Author information Article notes Copyright and information Disclaimer. Received Jun 18; Accepted Nov Copyright notice. This is an Open Access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conclusion In spite of appropriate test-retest scores attributed to most reliability indicators, heterogeneity among the studies remained high.

Table 1 Search strategy.

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Open in a separate window. Study selection An assessment form developed based on inclusion and exclusion criteria and calibrated prior to screening was used for study selection. Data extraction Data extraction was performed according to the Cochrane Handbook for Systematic Reviews of Interventions.

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Data analysis Reliability was tested using the Kappa coefficient of agreement; sample size was used for grouped Kappa calculation.

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