Reimagining School Fitness Testing to Advance Pediatric Health

Love it or hate it, we need to talk about fitness testing in schools.

The topic made headlines on May 5, 2026, with the restoration of the Presidential Physical Fitness Award for top youth performers in speed, strength and endurance. While the thought of running a timed mile during P.E. likely garners a collective groan from kids across the nation, Dan M. Cooper, MD, welcomes the renewed national interest in school-based physical fitness testing.

“I’m a pediatrician, and as someone who studies lung disease in children, I’ve always been interested in physical activity and exercise and how it affects growth and development,” says Cooper, a Distinguished Professor of Pediatrics in the UC Irvine School of Medicine.

In fact, the May 5 announcement coincided with the Pediatric Research publication of “School Based Physical Fitness Testing: Challenges and Opportunities,” a paper co-authored by Cooper and other researchers at UC Irvine in collaboration with colleagues from Boston Children’s Hospital, the Orange County Department of Education, the University of California Agriculture and Natural Resources and Iowa State University. The work offers recommendations for reimagining school testing as a useful and predictive biomarker of pediatric health.

“If we’re going to do the testing,” says Cooper, “let’s do it right.”

A Hotly Debated Topic

As Cooper and his co-authors acknowledge in the paper, school-based physical fitness testing has been a “hotly debated” topic for decades. They touch on the revival of the Presidential Fitness Test in 2025, which reignited the debate after a shift in 2012 away from performance-based outcomes toward more health-based outcomes. They also acknowledge concerns around time and space constraints when testing at school, as well as the potential for stigmatization and embarrassment.

“We are worried,” Cooper noted, “because many schools in California are no longer reporting the physical fitness data, and some policy leaders are even considering eliminating this important testing.”

Yet they stress the role school-based physical fitness testing can play in optimizing pediatric health during a time of unprecedented inactivity and chronic disease. “We can use it as a biomarker of what’s happening not only for an individual child,” says Cooper, “but for the population as a whole.”

Leveraging Real-World Data

Cooper, who has been following school-based fitness testing for decades, laments that the data is underutilized. “You’re testing a health-related physiological biomarker, but the data hardly ever goes anywhere — certainly not to the doctor’s office,” he says. As a pediatric pulmonologist for both UCI Health and Children’s Hospital of Orange County (now part of Rady Children’s Health), he sees great value in gaining access to data from fitness testing. “My colleagues at CHOC and I are very interested in getting school-based health data into electronic health records,” he says.

This would require compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA), but an even bigger obstacle for Cooper is ensuring data consistency and reliability. “We need to improve the nuts and bolts of testing so the quality of the data is as good as it can possibly be,” says Cooper.

For example, how do schools measure the distance for the mile run? Are students running on a track or a course with inclines? Is it the teacher or a student recording the time? “The world is looking more at real-world data as a way of augmenting healthcare, and school fitness is a prime example,” says Cooper, “but it has to be collected in a way that meets the highest standards of quality and reproducibility.”

Getting data into the EHR system also requires standardization, which Cooper has already started to address through collaboration with the nonprofit Health Level Seven International. “We’re working with HL7, which standardizes everything that appears in EHRs.”

Another challenge is ensuring school tests actually represent the child’s health. “What we want to do is improve the correlation between a well-done school test and the data collected when a kid comes to our lab,” says Cooper. The “lab” he’s referring to is the Research Center for Exercise Medicine and Sleep (RCEMS), launched in 2012 as the Pediatric Exercise and Genomics Research Center. Led by Shlomit Radom-Aizik, PhD, the center conducts pediatric exercise research using cutting-edge platforms.

“The health-related data that lets you compare fitness to cardiovascular disease risk comes from laboratory studies,” says Cooper. One example is the lab test to measure a person’s maximum volume of oxygen (VO2 max) during exercise. “You can’t do VO2 max tests on 50 kids at school, but our decades of experience conducting cardiopulmonary exercise tests can help identify field tests that correlate with this data.”

Advancing Pediatric Health

Cooper is excited by the possibilities when it comes to reimagining school fitness testing. “Things are changing dynamically with the use of wearables and the amount and type of data we can collect,” he says. “You don’t want to say that the only way to test physical fitness is counting how many pull-ups you can do. Testing should be informed by advances in science and technology.”

He also emphasizes the behavioral component. “It’s not just a contest; it’s really about the context of physical literacy,” he says. “It’s about teaching kids at a critical period of growth and development the importance of physical fitness and the concept of energy balance.” This ties in with teaching students about the connection between diet, exercise and overall health, and with training clinicians to interpret school-based data and to make it actionable for patients.

Ultimately, Cooper hopes to collaborate with both educators and physicians to build transformative solutions when it comes to school-based physical fitness testing. “UC Irvine is uniquely positioned to help with this effort because of our years of work with both healthy kids and kids with chronic diseases, the amount of data that we have, and our experience partnering with schools,” he says. “We have this great opportunity to really advance the field of pediatric health.”

Learn more about this topic and Cooper’s recommendations in "School Based Physical Fitness Testing: Challenges and Opportunities."

— Shani Murray