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Background <p>This study aimed to analyze the secular trends and urban–rural inequalities in comprehensive physical fitness among Chinese children and adolescents over a span of two decades, while further assessing the non-linear association between urbanization and physical fitness.</p> Methods <p>Using data from six cycles (1995–2019) of the Chinese National Survey on Students’ Constitution and Health, we included 1,278,504 children and adolescents aged 7–18&#xa0;years. Physical fitness was assessed via six core components and aggregated into a summary physical fitness indicator (PFI). Nutritional status was assessed using body mass index in accordance with the World Health Organization criteria. Provincial urbanization rates were obtained from the National Bureau of Statistics. Mixed-effects linear models assessed differences in trends of PFI between the 1995–2005 and 2010–2019 periods. Quantile regression models evaluated urban–rural inequalities, and generalized additive models examined non-linear relationships between urbanization rates and PFI.</p> Results <p>Boys’ PFI declined markedly from 1995 to 2005, then remained relatively stable from 2010 to 2019, with a significant difference in trend slopes between the two periods (<i>β</i> = 0.16, 95% CI = 0.13–0.19). Girls’ PFI decreased substantially from 1995 to 2005, followed by a notable increase from 2010 to 2019, also showing a significant difference in trend slopes (<i>β</i> = 0.32, 95% CI = 0.29–0.35). Across all age groups, adolescents aged 13–15&#xa0;years exhibited the most pronounced improvement in PFI during 2010–2019. Urban–rural inequalities in boys’ PFI disappeared by 2019, while the PFI of urban girls in 2019 exhibited higher values than those of rural girls at all quantiles. A U-shaped association between urbanization rates and PFI was observed from 1995 to 2019, with an inflection point at about 50.0% urbanization rate, beyond which individuals with overweight and obesity and those aged 16–18 showed the slowest improvement in PFI.</p> Conclusions <p>This study revealed substantial shifts in physical fitness among Chinese children and adolescents, characterized by early declines followed by stabilization and partial improvements. Meanwhile, the urban–rural inequalities have narrowed, indicating progress toward equity. However, as urbanization progressed, older adolescents and those with overweight and obesity exhibited slower gains in physical fitness, necessitating targeted interventions.</p>

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Changing landscape of physical fitness and urban–rural inequalities: evidence from 1.2 million children and adolescents over 20 years of urbanization

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月19日

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  • Shan Cai,
  • Jiaxin Li,
  • Tianyu Huang,
  • Yunfei Liu,
  • Jiajia Dang,
  • Ziyue Chen,
  • Yihang Zhang,
  • Ruolan Yang,
  • Yang Yang,
  • Ziyue Sun,
  • Peijin Hu,
  • Yanhui Dong,
  • Jun Ma,
  • Yi Song

摘要

Background

This study aimed to analyze the secular trends and urban–rural inequalities in comprehensive physical fitness among Chinese children and adolescents over a span of two decades, while further assessing the non-linear association between urbanization and physical fitness.

Methods

Using data from six cycles (1995–2019) of the Chinese National Survey on Students’ Constitution and Health, we included 1,278,504 children and adolescents aged 7–18 years. Physical fitness was assessed via six core components and aggregated into a summary physical fitness indicator (PFI). Nutritional status was assessed using body mass index in accordance with the World Health Organization criteria. Provincial urbanization rates were obtained from the National Bureau of Statistics. Mixed-effects linear models assessed differences in trends of PFI between the 1995–2005 and 2010–2019 periods. Quantile regression models evaluated urban–rural inequalities, and generalized additive models examined non-linear relationships between urbanization rates and PFI.

Results

Boys’ PFI declined markedly from 1995 to 2005, then remained relatively stable from 2010 to 2019, with a significant difference in trend slopes between the two periods (β = 0.16, 95% CI = 0.13–0.19). Girls’ PFI decreased substantially from 1995 to 2005, followed by a notable increase from 2010 to 2019, also showing a significant difference in trend slopes (β = 0.32, 95% CI = 0.29–0.35). Across all age groups, adolescents aged 13–15 years exhibited the most pronounced improvement in PFI during 2010–2019. Urban–rural inequalities in boys’ PFI disappeared by 2019, while the PFI of urban girls in 2019 exhibited higher values than those of rural girls at all quantiles. A U-shaped association between urbanization rates and PFI was observed from 1995 to 2019, with an inflection point at about 50.0% urbanization rate, beyond which individuals with overweight and obesity and those aged 16–18 showed the slowest improvement in PFI.

Conclusions

This study revealed substantial shifts in physical fitness among Chinese children and adolescents, characterized by early declines followed by stabilization and partial improvements. Meanwhile, the urban–rural inequalities have narrowed, indicating progress toward equity. However, as urbanization progressed, older adolescents and those with overweight and obesity exhibited slower gains in physical fitness, necessitating targeted interventions.