European fitness landscape for children and adolescents: updated reference values, fitness maps and country rankings based on nearly 8 million test results from 34 countries gathered by the FitBack network.

OBJECTIVES: (1) To develop reference values for health-related fitness in European children and adolescents aged 6-18 years that are the foundation for the web-based, open-access and multilanguage fitness platform (FitBack); (2) to provide comparisons across European countries. METHODS: This study builds on a previous large fitness reference study in European youth by (1) widening the age demographic, (2) identifying the most recent and representative country-level data and (3) including national data from existing fitness surveillance and monitoring systems. We used the Assessing Levels of PHysical Activity and fitness at population level (ALPHA) test battery as it comprises tests with the highest test-retest reliability, criterion/construct validity and health-related predictive validity: the 20 m shuttle run (cardiorespiratory fitness); handgrip strength and standing long jump (muscular strength); and body height, body mass, body mass index and waist circumference (anthropometry). Percentile values were obtained using the generalised additive models for location, scale and shape method. RESULTS: A total of 7 966 693 test results from 34 countries (106 datasets) were used to develop sex-specific and age-specific percentile values. In addition, country-level rankings based on mean percentiles are provided for each fitness test, as well as an overall fitness ranking. Finally, an interactive fitness platform, including individual and group reporting and European fitness maps, is provided and freely available online (www.fitbackeurope.eu). CONCLUSION: This study discusses the major implications of fitness assessment in youth from health, educational and sport perspectives, and how the FitBack reference values and interactive web-based platform contribute to it. Fitness testing can be conducted in school and/or sport settings, and the interpreted results be integrated in the healthcare systems across Europe.

Physical literacy in Europe: The current state of implementation in research, practice, and policy.

Background/objective: The holistic concept of physical literacy (PL) embraces different person-centered qualities (physical, cognitive, affective/psychological) necessary to lead physically active lifestyles. PL has recently gained increasing attention globally and Europe is no exception. However, scientific endeavors summarizing the current state of PL in Europe are lacking. Therefore, the goal of this study was to comprehensively assess and compare the implementation of PL in research, policy, and practice across the continent. Methods: We assembled a panel of experts representing 25 European countries. Employing a complementary mixed-methods design, the experts first prepared reviews about the current state of PL in their countries (categories: research, practice/policy). The reviews underwent comparative document analysis, ensuring a transnational four-eyes principle. For re-validation purposes, the representatives completed a quantitative survey with questions reflecting the inductive themes from the document analysis. Results: The document analysis resulted in ten disjunct themes (related to "concept", "research", "practice/policy", "future/prospect") and yielded a heterogenous PL situation in Europe. The implementation state was strongly linked to conceptual discussions (e.g., existence of competing approaches), linguistic issues (e.g., translations), and country-specific traditions. Despite growing scholarly attention, PL hesitantly permeates practice and policy in most countries. Nevertheless, the experts largely anticipate increasing popularity of PL for the future. Conclusion: Despite the heterogeneous situation across Europe, the analysis has uncovered similarities among the countries, such as the presence of established yet not identical concepts. Research should intensify academic activities (conceptual-linguistic elaborations, empirical work) before PL may gain further access into practical and political spheres in the long term.

Physical Fitness and Anthropometric Values Among Lithuanian Primary School Children: Population-Based Cross-Sectional Study.

Emeljanovas, A, Mieziene, B, Cesnaitiene, VJ, Fjortoft, I, and Kjønniksen, L. Physical fitness and anthropometric values among Lithuanian primary school children: population-based cross-sectional study. J Strength Cond Res 34(2): 414-421, 2020-The purpose of the current study was to derive representative reference scores on anthropometric measures and test scores for the musculoskeletal, motor, and cardiorespiratory fitness of Lithuanian primary school children according to age and sex. This cross-sectional design study included 3,456 Lithuanian first- to fourth-grade children from age 6 to 10 years. Physical fitness was measured using a nine-item test battery developed by Fjørtoft et al. The test battery included the following tests: standing broad jump (explosive strength), jumping a distance of 7 m on 2 feet, jumping a distance of 7 m on 1 foot (both tests indicate leg muscle strength), throwing a tennis ball with one hand, and pushing a medicine ball with 2 hands (both tests indicate arm muscle strength). These tests measured musculoskeletal fitness. In addition, there were measures of a 10 × 5-m shuttle run (agility), running 20 m as fast as possible (speed), and climbing wall bars (coordination)-general tests of motor fitness. Reduced 6-minute Cooper test (endurance) measured cardiorespiratory fitness. A Student's t test and analysis of variance were performed to indicate differences between sexes and across age, respectively. The significant differences in mean scores in anthropometric and fitness means indicated that boys had higher scores than girls, and older children scored higher than younger children (p < 0.05). Data on normative sex- and age-specific percentile values (3rd, 10th, 25th, 50th, 75th, 90th, and 97th) for physical fitness tests in Lithuanian primary school children are provided. These data are useful for educational settings, parents, clinicians, sports organizations, and sports clubs in identifying problems or outstanding performance and providing sports programs that develop children's athletic performance.

Levels of Physical Activity in Lithuanian Adolescents.

BACKGROUND AND OBJECTIVE: Population levels of physical activity are an international concern. The purpose of the present study was to describe and analyse physical activity levels in Lithuanian adolescents. MATERIALS AND METHODS: With this aim in mind, the Physician-based Assessment and Counselling for Exercise (PACE) questionnaire was administered to 5141 adolescents residing in Lithuania, 2502 boys (48.7%) and 2639 girls (51.3%), aged between 11 and 19 years. RESULTS: It was found that adolescents studied met the physical activity guideline, of 60 min of moderate-to-vigorous physical activity a day, on average 3.6 days/week (SD = 2.1). A total of 3426 adolescents (66.6%) were inactive as classified by the PACE questionnaire (at least 1 h of physical activity/day < 5 days/week). In the present sample there were more active (at least 1 h of physical activity/day ≥ 5 days/week) boys (n = 994, 39.7%) than girls (n = 721, 27.3%) (p < 0.001; OR 1.75, 95% CI 1.56 to 1.97), and, on average, boys were more likely to meet daily recommendations of physical activity than girls, 0.7 days more a week (p < 0.001; IRRs 1.21, 95% CI 1.17 to 1.25). According to age, younger adolescents (11⁻12 years) were significantly more active than older adolescents (13⁻19 years) and a curvilinear relationship between age and physical activity was observed with significant linear (unstandardized beta (B) = -0.807; standardized beta (ß) = -0.796; p < 0.001) and quadratic terms (unstandardized beta (B) = 0.024; standardized beta (ß) = 0.704; p < 0.001). CONCLUSIONS: It is necessary to increase the level of physical activity in Lithuanian adolescents and intervention programs should be carried out considering these results.

Psychometric Properties of the Attitudes toward Physical Activity Scale: A Rasch Analysis Based on Data From Five Locations.

This article describes the development and validation of the Attitudes toward Physical Activity Scale (APAS) to measure the attitudes, beliefs, and self-efficacy toward physical activity by children at the primary school level. The framework included: physical fitness, self-efficacy, personal best goal orientation in physical activity, interest in physical activity, importance of physical activity, benefits of physical activity, contributions of video exercise to learning in school subjects, contributions of video exercise to learning about health and environmental support. The sample comprised of 630 school students between grades 1 and 7 from five countries, namely Lithuania (29%), Poland (26%), Serbia (19%), Singapore (16%) and Zimbabwe (11%). Rasch analysis found empirical evidence in support of measurement validity of the APAS in terms of Rasch item reliabilities, unidimensionality, effectiveness of response categories, and absence of gender differential item functioning (DIF). The validation of the APAS according to the Rasch model meant that a dependable tool was established for gauging programme effectiveness of intervention programs on physical activity of primary school children in classroom settings at various geographical locations globally.

Social Capital Promotes a Healthier Diet among Young Adults by Reducing Psychological Distress.

Studies have revealed the links between social capital and diet. However, the mediating role of psychological distress in this relationship has been understudied. This study aims to identify direct and indirect relationships between social capital and adherence to the Mediterranean diet among Lithuanian young adults and identify the mediating role of psychological distress in this relationship. Data were collected from 1336 young adults, aged 18-36 years; 40.5% were males. MEDAS was used to measure adherence to a healthy diet. Social capital was measured by eight separate items in terms of family support, social support, social cohesion, social trust, communication, collaboration, participation, and distant communication. Kessler's six-item scale was used to assess psychological distress. Higher family support (ß = 0.105), higher social participation (ß = 0.294), and lower psychological distress (ß = 0.073) directly predicted higher adherence to the Mediterranean diet. Social capital was indirectly related to adherence to the Mediterranean diet, with standardized effect sizes of 0.02-0.04, indicating small effect sizes. Thus, psychological distress mediates the relationship between social capital and a healthy diet. Given that social capital is related to psychological health and both directly and indirectly predicts healthy behavior in young adults, further longitudinal and experimental research is required to measure the effects of the intervention on incorporating, facilitating, encouraging, and implementing measures to strengthen the social connection between people and groups of people within the community, neighborhood, and organizations.

The Predictors of Psychological Well-Being in Lithuanian Adolescents after the Second Prolonged Lockdown Due to COVID-19 Pandemic.

Recent research highlights the impact of prolonged pandemics and lockdown on the mental health of youngsters. The second wave of COVID-19 brought an increase in mental health problems among young people. Therefore, this study aims to analyze the main factors arising from intra-individual, inter-individual, and environmental contexts that predict good psychological well-being in a group of adolescents after a second prolonged period of social restrictions and distance education. The study included 1483 school students from 11 to 19 years old. The survey assessed self-reported students' psychological well-being (WHO-5 index), physical activity, sedentary behavior, school social capital, communication with peers and relationships with parents, existing emotional and behavioral problems. The results indicated that 58% of adolescents were of good psychological well-being in spring 2021, after half a year in lockdown. Almost 19% of adolescents had depression risk. The study revealed that during a period of prolonged isolation, male gender, better relationships between young people and their parents, the absence of serious emotional and behavioral problems, less sedentary behavior, and higher school social capital were found to be significant factors predicting adolescents' psychological well-being. Lower physical activity is an important contributor to students' poor well-being. Finally, the lack of face-to-face communication with peers was revealed as a specific factor in predicting adolescents with depression risk.

Adherence to Mediterranean diet among Lithuanian and Croatian students during COVID-19 pandemic and its health behavior correlates.

Maintaining healthy behavior, especially in times of crisis like the COVID-19 pandemic, is particularly important for staying healthy. Nutrition is an everyday behavior and along with other health-related behaviors is associated with many health outcomes. The aim of this study was to assess and compare adherence to the Mediterranean diet (MedDiet) and particular food choices among the Mediterranean and non-Mediterranean populations of university students and identify its lifestyle correlates at the outburst of the COVID-19 pandemic. In total, self-reported data on health-related behavior and sociodemographic characteristics were collected from 1,388 study participants, 66.4% were Lithuanians, and 33.6% were Croatians. Results revealed that vegetables, olive oil, fruits, nuts, legumes, and fish were remarkably underconsumed among university students in the Mediterranean and non-Mediterranean countries during the COVID-19 pandemic, and the composite diet is similar between countries. The higher adherence to MedDiet is associated with physical activity (ß = 0.15) and non-smoking (ß = 0.08). In times of crisis, public health entities should provide knowledge, skills, and tools for healthy nutrition specifying them by age and subpopulation. Interventions at the university should be implemented to build infrastructure and provide an access to health behavior-friendly environments.

The Direct and Indirect Relationships Within the Extended Trans-contextual Model for Moderate-to-vigorous Physical Activity.

Given the low levels of physical activity (PA) in adolescence, there are challenges to increasing students' PA outside of the school setting. Thus, researchers emphasize the supportive role that physical education (PE) teachers can play in PA motivation both in and out of school. The aim of the present study was to examine an expanded trans-contextual model (TCM) model for the transit of teachers' perceived support of students' autonomy in terms of contextual and situational motivation in PE to objectively measured moderate-to-vigorous physical activity (MVPA) in PE across different PE contents as well as to the motivational sequence for, and participation in, subjective MVPA during leisure time. This cross-sectional study involved 283 high school students, of whom 43.9% were boys. The autonomous support students received and other motivational factors and objective measures of MVPA in PE and subjective MVPA in leisure time were measured. The results indicate that support for autonomy was significantly and directly related to needs satisfaction (ß = 0.61, p < 0.001) and indirectly to autonomous motivation in PE (ß = 0.19, p < 0.001) and leisure time (ß = 0.16, p < 0.001), intention in PE (ß = 0.03, p < 0.05) and leisure time (ß = 0.07, p < 0.001), and leisure time MVPA (ß = 0.04, p < 0.001), although not MVPA in PE. Gender was a significant covariate for both MVPA in PE (ß = -0.62, p < 0.001) and MVPA in leisure time (ß = -0.37, p < 0.001), with higher MVPA in boys than girls. This study filled a gap in the scientific literature by demonstrating the full motivational sequence resulting in actual MVPA in PE classes. It also demonstrated that the main goal of PE of enhancing PA not only in school but also outside of school is working. The main motivator is needs satisfaction based on PE teachers' support.

The Direct and Indirect Relationships of Environmental, Interpersonal and Personal Factors with High School Students Physical Activity: An Ecological Approach.

BACKGROUND: Across countries, young people are not sufficiently physically active. The evidence confirms that beyond demographic and individual agents, individuals participate within their social and physical environment. The ecological model enables a search for the modifiable factors in specific populations, as it allows consideration of factors affecting individuals' lives on different levels, as well as considering the interplay of those factors. The aim of this study was to examine the complex interconnections among environmental, social capital and motivational factors at different levels, within an ecological model for high school students' moderate-to-vigorous physical activity during their leisure time. METHODS: This cross-sectional population-based study included 1285 students from 14 to 18 years old, with a mean age of 16.14 ± 1.22. Physical activity, neighborhood physical activity recourses, neighborhood safety, social capital, physical activity motivation and sociodemographic factors were evaluated. Logistic regression, mediation and moderation analyses were performed predicting moderate-to-vigorous physical activity during leisure time. RESULTS: In the final multivariate logistic regression model, greater social participation (OR 1.03 [1.01-1.05]), higher relative autonomy index (OR 1.11 [1.06-1.15]) and male gender (OR 1.71 [1.13-2.57]) directly predicted meeting MVPA recommendations. Any significant moderation effects (p > 0.05) of environmental characteristics were not found for the relationship between social capital, motivational factors and moderate-to-vigorous physical activity. The evidence of positive indirect mediation effects was found in all five models for social capital components as all CIs for its ßs do not contain 0, though standardized effect sizes were between 0.02 and 0.07, indicating small effect sizes. CONCLUSION: These findings provide support for the presence of some direct and indirect pathways from social capital to moderate-to-vigorous physical activity. Future intervention strategies should focus on strengthening physical activity motivation by encouraging the development of social network and social participation as well as family, neighborhood and school social capital within the framework of the ecological model.

Dietary Pattern and Its Correlates among Lithuanian Young Adults: Mediterranean Diet Approach.

A poor diet leads to serious health risks and accounts for a significant proportion of deaths. Young adults are the population whose health behaviors particularly need to be studied in terms of nutrition because they are in a period of life when the effects of nutrition accumulate to health outcomes that usually appear later in life in forms of disease or infirmity. The aim of this study is to examine the dietary pattern and its relationships with physical activity and covariates, such as body mass index, gender, age and education among Lithuanian young adults of 18-36 years old. A cross-sectional study was performed among Lithuanian young people aged 18-36 years. Snowball sampling-a non-probability, convenient sampling strategy-was used. In total, data were collected from 3031 study participants: 1723 (56.8%) were male and 1308 (43.2%) were female. The mean age was 23.72 ± 4.80 years. Adherence to a dietary pattern was evaluated using the Mediterranean Diet Adherence Screener (MEDAS). Physical activity, height, weight and education data were also gathered. About 7% of young people fully complied with the health-related Mediterranean diet, and one-third had poor compliance. Non-compliance is mostly related to the underconsumption of olive oil, nuts, fish, seafood, legumes and wine, as well as the overconsumption of red meat. The female gender (ß = 0.26; p < 0.01), higher education (ß = 0.30; p < 0.01) and a sufficient level of physical activity (ß = 0.15; p < 0.01) predict a healthier diet. These study results should be considered by nutrition policymakers and public health authorities to improve policies and develop intervention plans for improving the nutrition habits of young adults in order to prevent health-damaging outcomes later in their life.

Health Behaviors and Psychological Distress Among Conscripts of the Lithuanian Military Service: A Nationally Representative Cross-Sectional Study.

The decline in healthy behavior in young people is a concern for public health in general and for country's defense. The aim of this study is to identify and compare health behaviors and psychological distress between male conscripts enlisted and rejected for military service. This cross-sectional study included 1243 men aged 19-26 years (mean age 22.50 ± 2.43 years). We assessed health behaviors (physical activity, adherence to healthy eating patterns, cigarette smoking, and alcohol consumption) and psychological distress. Among all conscripts, 44.7% were physically inactive, 50.2% had low adherence to healthy nutrition, 9.6% were heavy drinkers, 62.3% were current smokers, and 9.1% had high psychological distress level. Compared with physically inactive conscripts, physically active conscripts were more likely to be enlisted (adjusted odds ratio (OR) = 1.42; 95% confidence interval (CI) 1.11-2.03). Compared with current nonsmokers, current smokers were less likely to be enlisted (OR = 0.58; CI 0.39-0.86). Compared with conscripts with a high distress level, those with a low distress level were almost four times more likely to be enlisted (OR = 0.26; 95% CI 0.12-0.55). Adherence to guidelines for healthy eating and alcohol consumption was not significantly related to enlistment. These findings suggest that health behaviors in male conscripts are unsatisfactory. That is, about half are physically inactive, have a poor diet, and smoke, and nearly one in 10 is a heavy drinker and has a high psychological distress level. The enlisted conscripts were more likely to be sufficiently physically active and less likely to be a current smoker or have a high distress level. Early intervention programs to provide a heathier population of young men for conscription should focus on mental well-being and target health-related behaviors such as physical activity and not smoking. Preferably, these should be implemented as health education programs in schools to help prevent the development of adverse health behaviors among young men. Governmental policies and strategies are required to enable intersectional collaboration and shared responsibility among the education, military and health sectors.

The Relationship between Social Capital within Its Different Contexts and Adherence to a Mediterranean Diet Among Lithuanian Adolescents.

The eating habits of adolescents are a serious current public health problem. Scientists call attention to the availability of social resources for enhancing healthy eating behavior. Social capital defines those resources as trust, reciprocity, social participation, integrity, and coherence, and they are supposed to help people achieve their life goals, in general, and health goals, in particular. Our aim is to investigate the relationship between social capital within its different contexts and adherence to a Mediterranean diet (MD) among Lithuanian adolescents. The nationally representative cross-sectional study included 1863 students (906 boys and 957 girls). The KIDMED index questionnaire (Mediterranean Diet Quality Index in children and adolescents) was used to evaluate the adherence to an MD. Family, neighborhood, and school contexts of social capital were assessed using six items indicating family support, neighborhood trust, social control, vertical trust, horizontal trust, and reciprocity at school. Covariates such as gender, physical activity, parental education, and body mass index were also included in the analysis. Descriptive results showed that only 14% of Lithuanian adolescents followed an MD. Linear regression analysis indicated that family support (ß = 0.096) and trust in school teachers (ß = 0.074) were related to better rates of adherence, especially regarding the consumption of fruits, vegetables, cereals, fish, and the use of olive oil as a main source of fat. More adolescents who perceived family support and trust in their teachers used these products regularly and were less likely to skip breakfast. These findings could be used as a base for further developing nutrition education programs aimed at enhancing support and trust among families and schoolteachers.

Reasons and Barriers for University Students' Leisure-Time Physical Activity: Moderating Effect of Health Education.

This study aimed to investigate the relationship between health education and motives and barriers for university students' engagement in leisure-time physical activity (PA). The research sample included 709 students (312 females and 397 males) in different years of study, ranging in age between 18-25 years. A questionnaire survey method revealed a significant positive relationship between fitness and health motives and students' leisure-time PA. External barriers were negative predictors of students' leisure-time PA, while more health education-related courses per week were positively associated with students' leisure-time PA. Finally, we found that the number of health education-related courses per week moderated the relationship between fitness and health motives and students' leisure-time PA. These findings suggest that university students' fitness and health motives and external barriers to be physically active outweigh other motives and barriers in determining their leisure-time PA. In addition, health education in university studies can effectively increase students' health-related motivation for PA.

Results from Lithuania's 2018 Report Card on Physical Activity for Children and Youth.

The Global Matrix 3.0 "Report Card" assessment of physical activity was developed to achieve a better understanding of the global variability in child and youth physical activity. Lithuania joined the Global Matrix 3.0. The aim of this article is to summarize the results of the first Lithuanian Report Card, which included 10 indicators, as representative of individual behaviors, sources, and settings of influence indicators, and a health-related characteristic. The grades for each indicator were based on the best available Lithuanian data. The findings showed poor Overall Physical Activity, Active Transportation (C-), and Family and Peers (D). Sedentary behavior was graded C-, and Organized Sport Participation, Community and Environment, and Government were graded C. Physical Fitness and School indicators received the highest grade (C+). The first Lithuanian Report Card on Physical Activity of Children and Youth shows that Lithuanian children and youth have less than satisfactory levels of organized physical activity, active transportation to and from school, community and built environments, and government strategies and investments. The low levels of support from family and peers require more attention from health promoters. There is a gap in the evidence about active play that should be addressed by researchers and policy makers.

Aerobic Capacity Is Related to Multiple Other Aspects of Physical Fitness: A Study in a Large Sample of Lithuanian Schoolchildren.

This study evaluated how aerobic capacity is related to performance in other aspects of health-related physical fitness among schoolchildren. The study involved >15,200 schoolchildren of both genders aged 11-18 years, who were tested with a reliable tests from Eurofit battery for most important aspects of exercise capacity and anthropometrics from 1992 to 2012. The analysis showed that aerobic capacity was weakly but significantly positively related to all other aspects of exercise abilities tested in all age groups for both genders. Variance of performance in agility shuttle run and standing broad jump were each explained by aerobic capacity the strongest (>10%), followed by weaker but still significant positive relation of aerobic capacity with the abilities in bent arm hang and abdominal curl tests (aerobic capacity explaining ∼6.5% of the variance of the performance in these tests), as well as in balance and flexibility tasks (aerobic capacity significantly explaining ∼3% of the variance). Thus, while aerobic capacity in schoolchildren of all ages and both genders can explain the performance in other aspects of physical fitness and especially leg muscle power, the percent of explained variance in the results of any these tests was not high and therefore aerobic capacity should be tested as a separate important fitness parameter which cannot be substituted by other tests from the Eurofit battery.

How different contexts of social capital are associated with self-rated health among Lithuanian high-school students.

BACKGROUND: Adolescents' self-rated health is related to a number of sociodemographic and socio-economic factors, health-related behaviors, and their social environment. The impact of the latter is still not well explored. An adolescent's social environment is represented by the social capital, i.e. social resources that they can access. The relationships between various contexts of social capital (family, neighborhood, peers, and school) and self-rated health among adolescents are still unclear. OBJECTIVE: This study aims to examine the relationships between various social capital contexts and self-rated health in Lithuanian adolescents. METHODS: The current cross-sectional study includes a nationally representative sample of 1863 adolescents (51.4% were girls) aged 14-18 years. The indicators of self-rated health as well as indicators of social capital in family, neighborhood, and school contexts were assessed. The results of the relationships between self-rated health and contexts of social capital were calculated controlling for the following covariates: physical activity, psychological distress, gender, body mass index, and family socioeconomic status. RESULTS: Results indicate that there are significant relationships between good self-rated health and a higher level of family support, neighborhood trust, and vertical school trust. In the final logistic regression model, while controlling for all covariates, a higher level of family support and neighborhood trust remain significant predictors of good self-rated health. CONCLUSIONS: Family support and neighborhood trust are important correlates of self-rated health in adolescents.

Secular trends in physical fitness and body size in Lithuanian children and adolescents between 1992 and 2012.

BACKGROUND AND METHODS: There is a paucity of data on contemporary secular trends on the different aspects of physical fitness in school-aged children and adolescents. This study presents the largest ever data set on changes in fitness between 1992, 2002 and 2012 for both genders of schoolchildren aged 11-18 years (n=16 199). Eurofit test battery was used to assess the balance, flexibility, muscular strength and power, agility and cardiorespiratory fitness. Anthropometrics were also measured and body mass index (BMI) was calculated. RESULTS: The study has shown loss of flexibility, leg muscle power, upper body strength and cardiorespiratory fitness between 1992 and 2012, although there was an improvement in abdominal muscle strength in girls, agility in boys and balance in both genders during the same period. At large, negative trends in aspects of fitness seen between 1992 and 2002 have not slowed down between 2002 and 2012. Positive trends in agility and abdominal muscle strength seen before 2002 have regressed or were reversed between 2002 and 2012, while balance continued to improve at increased pace. While the BMI continued to increase in all groups, analysis of covariance has shown that it was not the main cause of changes in fitness. CONCLUSIONS: The general decline in physical fitness in Lithuanian schoolchildren observed between 1992 and 2002 continued between 2002 and 2012, although some aspects of fitness showed a positive trend. If this general negative trend continues, it will compromise the well-being of future adults and create a serious economic burden on the society.

Mediterranean Diet and Its Correlates among Adolescents in Non-Mediterranean European Countries: A Population-Based Study.

Little is known about the factors which might influence the adherence to a Mediterranean diet in non-Mediterranean European countries. Thus, the main purpose of this study was to determine the associations between socioeconomic, psychological, and physical factors on a Mediterranean diet. In this cross-sectional study, participants were 14-18-year-old adolescents (N = 3071) from two non-Mediterranean countries: Lithuania (N = 1863) and Serbia (N = 1208). The dependent variable was Mediterranean diet, and was assessed with the Mediterranean Diet Quality Index for children and adolescents questionnaire. Independent variables were gender, body-mass index, self-rated health, socioeconomic status, psychological distress, physical activity, and sedentary behavior. The associations between dependent and independent variables were analyzed by using logistic regression. Results showed that higher adherence to a Mediterranean diet was associated with higher self-rated health, socioeconomic status, and physical activity, yet low adherence to a Mediterranean diet was associated with being female, having higher body-mass index, psychological distress, and sedentary behavior. Our findings suggest that future studies need to explore associations between lifestyle habits-especially in target populations, such as primary and secondary school students.