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Background: The nationwide epidemic of obesity may be due, in part, to declining levels of physical activity, raising the possibility that other components of health-related physical fitness may also be in decline. Few data are available to describe and monitor the physical fitness of children and youth. The Georgia Youth Fitness Assessment was conducted to assess health-related fitness in Georgia''s fifth- and seventh-grade students, provide a baseline against which future progress could be measured, and guide public and private leaders and decision makers. Methods: A statewide probability sample of fifth- and seventh-grade students designed to enable grade-specific comparisons by gender, race/ethnicity, and urban/rural status was drawn. Measurements included aerobic capacity; body composition; and muscular strength, endurance, and flexibility. Physical activity during the most recent 3 days was assessed. The survey was conducted in 2006; the data were analyzed in 2007–2008. Results: Ninety-three schools (86% response rate) and 5248 students (77% response rate) participated. Fifty-two percent of students did not meet the standard for healthy aerobic fitness; 23% did not meet the standard for muscular strength, endurance, and flexibility; 30% were outside the recommended range for BMI. Twenty-two percent did not achieve the recommended 60 minutes of daily moderate-to-vigorous physical activity. All subgroups (e.g., boys/girls, urban/rural) scored poorly. Conclusions: Substantial numbers of Georgia''s fifth- and seventh-grade students exhibit unhealthy levels of physical fitness. These data are consistent with the suggestion that physical inactivity has led to deficient levels of health-related fitness in more areas than just body composition. Monitoring all components of health-related fitness would provide helpful information about the health of children and youth. [Copyright &y& Elsevier]