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President-elect John F. Kennedy highlighted the importance of a physically fit and healthy America to remain a strong nation in his Sports Illustrated article "The Soft American". Decades later, the physical and mental health of Americans are far too often neglected, putting our great nation’s future at risk. An unhealthy population is not only an unproductive population but one that lacks a positive morale and the general well-being that allows us to thrive in our daily lives — at home, at school and at work. We owe it to our children to dedicate the necessary resources and design and implement the appropriate initiatives to address the concerning health trends we are witnessing.

As an orthopaedic surgeon, I see the health benefits of routine exercise firsthand for general well-being and overall quality of life. But we are falling short. Today, greater than one in five U.S. children and teenagers are obese, while only about 25% are getting the recommended daily dose of physical activity. In addition, the prevalence of mental and behavioral health conditions among adolescents continues to increase at an alarming rate, up by 35% from 2016 to 2023. This is unacceptable, and we must do better.

Fortunately, efforts to tackle the growing pediatric and adolescent health crisis associated with a sedentary lifestyle and worsening mental health are underway. On July 31, 2025, President Donald Trump signedDonald Trump signed an executive order reinstating the Presidential Fitness Test. Since that time, numerous states, including Mississippi and Tennessee, have shown their strong support of the program as the exact design and implementation of a reinvigorated Presidential Fitness Test are ironed out.

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The reinstatement of the Presidential Fitness Test is not simply about nostalgia but is necessary for public health, national resilience, and American prosperity; here are design considerations and the lessons this intervention can teach our next generation.

First, we must ensure the updated Presidential Fitness Test is evidence-based using the latest gold standard science. Originating in 1956 by President D. Eisenhower and periodically updated until it fell out of favor, the Presidential Fitness Test can be reimagined today to focus on exercises and related physical benchmarks that better measure key components of health (for example, functional strength and aerobic capacity). Once the components of the test are identified and agreed upon by experts, physical education curriculums can then be adapted to better teach students the importance of staying physically active and how best to prepare and train for the yearly assessment. Resources for physical education teachers to support the educational mission associated with the test will be crucial.

Second, there should be a focus on both personal growth metrics and national competition. These ideas are not mutually exclusive. Critics of the Presidential Fitness Test have argued that the focus is too much on athletic ability over general health and because it is completed in a public environment, the test can damage self-esteem and mental health. However, if we stress both internal and external competition and support all children in finding tangible ways to discover joy in routine physical activity as part of more robust physical education curriculum support, this critique falls apart.

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Importantly, alongside a new focus on personal growth metrics, the national competition component must remain. Not only is there great pride in receiving a certificate and patch from the U.S. President if you win an award, but it helps teach grit, resiliency, and an important life lesson: some things are difficult, but perseverance, determination, and dedication can lead to improvement. Effort matters, and there are no shortcuts to circumvent hard work. Even still, participants may come up short of winning an award — learning that it is OK to be knocked down but more important to get back up is a skill in and of itself. Simply removing standards and the spirit of competition helps no one in the long term.

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Third, the rapid growth and adoption of fitness technology, such as wearables, presents an opportunity for an updated Presidential Fitness Test to access and utilize more accurate and relevant health data. For example, heart rate monitors can identify students who are able to keep their heart rate in a target "healthy zone" during exercise. Further, digital health tools can help gamify physical activity, enticing more individuals to stay physically active. The use of technology to support more consistent physical activity can teach children that digital tools can be a catalyst for movement, not just a sedentary lifestyle.

With the U.S. turning 250 years old in 2026 and welcoming many of the world’s greatest sports competitions over the next few years, including the 2026 FIFA World Cup and the 2028 Summer Olympics, there is no better moment to reinstate a modernized Presidential Fitness Test. By doing so, the government is making a clear commitment to the American people that they are with them hand-in-hand in working to improve the health and well-being of the next generation. It was time to bring the Presidential Fitness Test back to school gym classes across America in an updated fashion — all that was needed was bold, decisive leadership.

The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of any employer or affiliated institution.

David N. Bernstein, MD, PhD, MBA, MEI is a resident physician at the Harvard Combined Orthopaedic Residency Program at Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, and Boston Children’s Hospital and a Senior Researcher in health care transformation at Harvard Business School. Follow him on X (formerly Twitter): @DNBernsteinMD.

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