The overall aim of this study was to explore how upper secondary school students (age 16-19) in Sweden perceive physical education and health (PEH) through the assessment practices they experience in this subject. In particular, the study aimed to examine the students' experiences of what can be considered as valid knowledge and what the students perceive to form the basis for assessment in PEH. Data were collected by conducting focus group interviews with a total of 38 students from four different upper secondary schools in southern Sweden. The focus groups cohered around discussing three different vignettes that were constructed based on various 'pedagogical dilemmas' identified through earlier research on valid knowledge and assessment in PEH. Data were analysed by drawing on Scott's (2008) institutional theory in order to demonstrate how regulative, normative and cultural-cognitive conditions shape practices and assessment in PEH. The results highlight that there is a misalignment between curriculum objectives and assessment in Swedish PEH practice, where the cultural-cognitive conditions as strongly associated with club sports are more influential in the construction of valid knowledge and assessment practice than the regulative and normative conditions as stipulated in the PEH curriculum. The results also demonstrate that there is an ongoing prioritisation of practical over theoretical knowledge in PEH practice, involving an emphasis on doing and being active without any clear learning objectives. It is argued that clearly communicated learning objectives and assessment criteria can help achieve a better alignment between curriculum intentions, pedagogy and assessment in PEH.