NYC FITNESSGRAM: Population-Level Physical Fitness Surveillance for New York City Youth.

The New York City Fitnessgram® (NYCFG), monitored by the NYC Department of Education and Department of Health and Mental Hygiene, functions as the NYC Department of Education's citywide youth fitness surveillance. Here, we present the methods, characteristics and data used in a surveillance system to monitor physical fitness in public school students (grades K-12; initiated 2006; n=6,748,265 observations; mean sample 519,097 per year to date). Youth physical fitness prevalence estimates, longitudinal trends and spatial analyses may be investigated using continuous fitness composite percentile scores and Cooper Institute defined sex- and age-specific Healthy Fitness Zones (HFZ). HFZ are based on individual-child fitness test performance, with standard errors clustered at the school- and student-levels and adjusted for socio-demographics. Results may be used to show trends in youth fitness attainment over time and highlight disparities in fitness prevalence of NYC students. In sum, continuous fitness composite percentile scores offer the opportunity for prospective tracking of shifts in youth physical fitness on a population scale, and across subpopulations. FITNESSGRAM® can accompany a growing body of surveillance tools demonstrating the potential for population-level surveillance tools to promote global public health.