Physical activity and health in Chinese children and adolescents: expert consensus statement (2020)

Preschool-aged children 24-hour movement behaviours before and during COVID-19

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affected health, economies, and lifestyles, but little is known about its impact on children. We aimed to investigate changes in 24-hour (h) movement behaviours of pre-school children before and during COVID-19, and factors that influenced these. Children aged 3-6 years were recruited in Beijing in 2019, and their movement behaviours over 24 ​h assessed by questionnaire, as part of the International Study of Movement Behaviors in the Early Years (SUNRISE) study. We conducted the survey again during COVID-19, and compared the children's movement behaviours before and during COVID-19 and associated factors. Overall, 196 parents completed the survey at both time points. The percentage of children meeting movement guidelines decreased during the pandemic (p ​< ​0.01). Total physical activity decreased less among children getting good quality sleep or with more adults in the household (p ​< ​0.01). Children who were not cared for primarily by their mother had a greater decrease in moderate to vigorous intensity physical activity (p ​= ​0.02), but the decrease was smaller among children whose parents used the internet to support their physical activity and/or screen time (p ​< ​0.05). Children who used electronic screen devices in the 2 ​h before bedtime or whose parents reported body temperature in webchats had a greater increase in sedentary screen time (p ​< ​0.05). Children spending more time outdoors showed a smaller decrease in sleep (p ​< ​0.01). Overall, children's movement behaviours changed significantly during the pandemic.

Enhancing Ethnic Traditional Sports Education Through Sports Psychology: Significance, Challenges, and Strategies

As a vital carrier of Chinese national culture, ethnic traditional sports encapsulate the life wisdom and spiritual essence of diverse ethnic groups, serving as both intangible heritage and dynamic educational tools. While previous studies have addressed cultural preservation, this study innovatively integrates sports psychology theory with ethnic sports pedagogy, systematically examining how psychological principles-such as intrinsic motivation (Self-Determination Theory) and group dynamics-enhance students' cultural identity, prosocial behaviors, and resilience. Through a mixed-methods approach combining literature analysis and cross-cultural case studies (eg, Japan's kendo and Mexico's ulama), we identify key barriers to implementation, including resource gaps and teacher training deficits, and propose actionable strategies: gamified curriculum design, AR/VR-enhanced cultural immersion, and community-driven psychosocial support systems. Our findings contribute to three domains: (1) a novel theoretical framework linking sports psychology to ethnic cultural education; (2) empirical evidence of stress inoculation techniques improving student persistence by 45%; and (3) policy recommendations for scalable, culturally adaptive teaching models. This work bridges the gap between tradition and modernity, offering a replicable blueprint for global educators seeking to harmonize cultural heritage with psychological pedagogy.

The effects of physical activity on the mental health of typically developing children and adolescents: a systematic review and meta-analysis

BACKGROUND

Physical activity has gained attention in recent years as a promising intervention for improving the mental health of children and adolescents. However, evidence supporting the effectiveness of physical activity interventions for the mental health of typically developing children and adolescents remains limited.

METHODS

This study conducted a comprehensive search across five electronic databases up to July 2024. Studies were eligible for inclusion if they involved an intervention with a control group that examined the effects of physical activity on the mental health of typically developing children and adolescents. Articles focusing on participants with developmental, behavioral, or psychiatric disorders were excluded. A random-effects meta-analysis was conducted using Stata 18.0. The quality of evidence and risk of bias were assessed using the GRADE framework and the PEDro scale.

RESULTS

The initial search yielded 27,527 articles, of which 30 met the inclusion criteria. Meta-regression analysis indicated that country and intervention frequency were significant sources of heterogeneity. Physical activity interventions were significantly more effective than the control group in improving mental health (SMD = 0.37, 95% CI: 0.20 to 0.53). These interventions showed particularly strong effects on stress reduction (SMD = 0.86, 95% CI: 0.15 to 1.56) and social competence enhancement (SMD = 0.56, 95% CI: 0.07 to 1.06). Moreover, physical activity interventions were notably more effective for male adolescents (SMD = 1.11, 95% CI: 0.34 to 1.88) and those at the secondary school level (SMD = 0.45, 95% CI: 0.23 to 1.69).

CONCLUSIONS

Physical activity is beneficial in improving various aspects of mental health, including anxiety, depression, stress, self-esteem, and social competence in typically developing children and adolescents. However, the quality of evidence in this study is low due to methodological limitations of the studies included in this review. More high-quality randomized controlled trials are needed to validate these findings. Teachers and community workers can leverage physical activity as a preventive strategy to promote the mental health of children and adolescents. Future research should also investigate how factors like socioeconomic status and the sporting environment impact the effectiveness of these interventions.

TRIAL REGISTRATION

PROSPERO, CRD42024567153.

Physical Activity, Academic Self-Efficacy, and Depression Among Ninth-Grade Students in Shanghai

Our main objective of this study was to identify the relationship between different intensity levels of physical activity (PA), academic self-efficacy (ASE), and depression among 9th-grade students in Shanghai junior high schools. We used quantitative questionnaires to collect and analyze data from 407 junior high school students, and we used Structural Equation Modelling Partial Least Square (SEM- PLS) version 4.0 to analyze the data and examine the relationships between light PA (LPA), moderate PA (MPA), vigorous PA (VPA), ASE, and depression. The results revealed that only VPA had a positive relationship with ASE and a negative relationship with depression, while ASE was negatively related to depression and mediated the relationship between VPA and depression. These findings helped to develop an assumptive framework for understanding the interaction between Shanghai junior high school students' PA, ASE, and depression; thereby, contributing valuable knowledge to the field of educational psychology and public health. These data also provide targeted insights for educators, policymakers, and parents in Shanghai and may be beneficial to planning interventions and policies aimed at enhancing student well-being and academic performance.

Optimising Psychological Well-Being in Chinese-Australian Adolescents: A 24-Hour Movement Guidelines Approach

BACKGROUND

Chinese-Australian adolescents face unique academic and cultural challenges that may impact their lifestyle and psychological well-being. Physical activity, screen time, and sleep are known to influence well-being. However, research on the adherence to the 24-Hour Movement Guidelines among Chinese-Australian adolescents remains limited and awaits further investigation.

OBJECTIVE

This study hypothesized a significant positive association between adherence to the 24-Hour Movement Guidelines for physical activity, screen time, and sleep, and the psychological well-being of Chinese-Australian adolescents.

METHODS

A self-reported questionnaire was distributed to two language schools in Brisbane, Australia, targeting high school students from grades 7 to 12 with Chinese-Australian backgrounds. This study used multiple linear regression modelling to examine the associations between meeting or not meeting recommendations. Meeting the 24-Hour Movement Guidelines was defined as ≥60 min/day of moderate to vigorous physical activity (MVPA), ≤2 h/day of recreational screen time, and 9-11 h/night of sleep.

RESULTS

Out of 251 participants (average age: 13.31 years; 58% female), only 20.3% met two or three recommendations, while 43.3% met one, and 36.2% met none. The most common compliance was meeting only the screen time guideline alone (48%), while 9.6% met either MVPA + screen time or screen time + sleep. The regression analysis showed that meeting at least MVPA (β = 1.41, 95% CI: 0.07 to 2.74) or at least sleep (β = 1.40, 95% CI: 0.19 to 2.60) was associated with better psychological well-being. Notably, meeting MVPA and sleep guidelines was significantly associated with higher well-being (β = 3.83, 95% CI: 1.06-6.60). From the results, adherence to additional 24-Hour Movement Guidelines was associated with improved psychosocial well-being. However, a small proportion of adolescents met all the guidelines.

CONCLUSIONS

Greater adherence to physical activity and sleep guidelines is linked to better psychological well-being among Chinese-Australian adolescents. These results highlight the importance of promoting healthy behaviours and implementing public health strategies to enhance education on exercise and sleep, particularly at the school and family levels, to support adolescents' psychological well-being.

The impact of family socioeconomic status on adolescent mental and physical health: the mediating role of parental involvement in youth sports

Introduction

The physical and mental health of adolescents is a crucial cornerstone for social development. Therefore, this study aimed to examine whether family socioeconomic status made a difference in Chinese teenage mental and physical health and to disentangle the mediating role of parental involvement in youth sports in the process in which family socioeconomic status influenced adolescent health.

Methods

A quantitative analysis used a sample of approximately 11,000 adolescents from Chinese middle schools. The research employed structural equation modelling (SEM) to explore the relationships among family socioeconomic status, parental involvement in youth sports, and adolescent mental and physical health.

Results

The findings indicated that both family socioeconomic status and parental involvement in youth sports significantly positively predict levels of adolescents' physical health and mental health. Further analysis revealed that parental involvement in youth sports mediated the relationship between family socioeconomic status and adolescent health.

Discussion

It is evident that parental involvement in youth sports plays a crucial role in adolescent mental and physical health. Regardless of family socioeconomic status, parents should actively engage in sports activities with their children, which is not only an important way to promote adolescents' health but also a manifestation of realizing health equity.

Evaluating the impact of motor quotient physical fitness training on health-related fitness indicators and obesity risk in children aged 7-8 years in Tianjin, China

This study aimed to evaluate the impact of Motor Quotient (MQ) physical fitness training on health-related fitness indicators and obesity risk in children aged 7-8 years in Tianjin, China. A total of 60 obese participants were randomly divided into an experimental group (N = 30) and a control group (N = 30). The intervention program focused on improving children's physical, behavioral, and task-related capabilities through structured MQ training. Key results indicated that the experimental group demonstrated significant improvements in Body Mass Index (BMI), with a reduction from 21.28 ± 1.15 kg/m² to 18.86 ± 1.24 kg/m² for boys (p < 0.001) and from 21.04 ± 1.54 kg/m² to 17.47 ± 1.07 kg/m² for girls (p < 0.001). Physical performance metrics improved substantially, including enhanced 2 × 30 m Shuttle Run times (boys: +12.97%, girls: +13.96%, both p < 0.001) and increased Plank duration (boys: +41.36%, girls: +35.26%, both p < 0.01), reflecting improved cardiovascular endurance and core strength. Significant gains were also observed in task-related motor skills, such as Hand-eye Coordination, Behavior Imitation, and Reaction capability (all p < 0.001). Behavioral adaptations included higher scores in exercise behavior (p < 0.01), while strong correlations were found between BMI and cardiovascular fitness indicators, such as the 20 m Backward Run (r = 0.974, p < 0.001). These findings highlight the effectiveness of MQ training in reducing obesity risk and improving multidimensional fitness outcomes. The program demonstrates significant potential as a practical and evidence-based strategy to promote health-related fitness and motor development in children.

Extracurricular physical exercise and self-education expectations among Chinese teenagers

Drawing on data from 16,540 seventh and ninth graders from the China Education Survey (CES), the study employs descriptive statistics and Ordinal Logistic Regression (Ologit) models. These methods dissect the variances in self-education expectations among different youth groups and unravel the effects and heterogeneity of after-school physical exercises on these expectations. The study has two main findings: First, there is a marked difference in self-education expectations between adolescents who engage in extracurricular physical exercise and those who do not. Specifically, the group participating in these activities shows a 20.62% higher expectation than their non-participating peers, male students exhibit a 26.57% increase in self-education expectations, while female students show a 15.21% increase. Then, the impact of extracurricular physical exercise on self-education expectations is significantly influenced by cognitive abilities, academic performance, health status, confidence level, and family factors. The most pronounced effects are observed in self-confidence (b = 0.6490, p < 0.01), cognitive ability (b = 0.2363, p < 0.01), and health status (b = 0.1541, p < 0.01). The findings suggest that interventions to increase physical exercise among adolescents should be sensitive to the diverse needs of different demographic groups and consider the key role of familial background and socio-economic conditions.

Stress buffering effects of physical activity in adolescents: the moderating role of physical activity attitudes

BACKGROUND

Adolescents may experience stressful life events and associated physical and psychological symptoms of stress. Physical activity has a buffering effect on stress. However, whether physical activity attitudes modulate stress, and the relationship between physical activity attitudes, physical activity, and stress symptoms is unclear. The present study focuses on whether adolescent stress events predict stress symptoms, whether physical activity buffers stress, and whether this stress-buffering effect is enhanced when attitudes toward physical activity are positive.

METHODS

A stratified and cluster sampling method was used to select 2420 junior high school students from nine provinces from each of the three economic zones (with high GDP level, medium GDP level, and low GPD level) of eastern, western, and central China and the Adolescent Self-Rating Life Events Checklist, the Calgary Symptoms of Stress Inventory, the Physical Activity Rating Scale, and the behavioral attitude dimension of the Physical Activity Attitude Scale were used to investigate adolescent stress events, stress symptoms, physical activity, and physical activity attitudes respectively. There are 1,190 boys and 1,230 girls from seventh to ninth grade 12-15 years old.

RESULTS

Adolescents' stress events and stress symptoms showed a significant positive correlation (r = 0.479, P < 0.01). The more stressful events adolescents have, the more pronounced stress symptoms become. The interaction term between the total amount of physical activity and stress events was not influential on stress symptoms (P = 0.461), and neither was the distinction between high and moderate physical activity levels (Ph = 0.248, Pm = 0.245). There was a moderating effect of physical activity attitudes on stress buffering for moderate physical activity levels (P < 0.01). The moderating effect was stronger when adolescents had positive attitudes toward physical activity.

CONCLUSIONS

Adolescent physical activity can buffer the effects of stress events on stress symptoms when physical activity attitudes are positive, revealing that stimulating adolescents' physical activity initiative can promote physical activity to buffer stress.

Could physical activity promote indicators of physical and psychological health among children and adolescents? An umbrella review of meta-analyses of randomized controlled trials

BACKGROUND

We performed an umbrella review to synthesize evidence on the effects of physical activity (PA) interventions on indicators of physical and psychological health among children and adolescents, including body mass index (BMI), blood pressure (BP), depressive symptoms, and cognitive function.

METHODS

PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from inception through 31 July 2023. We included meta-analyses of randomized controlled trials exploring the effects of PA interventions on BMI, BP, depressive symptoms, or cognitive function in healthy or general children and adolescents. Standard Mean Difference (SMD) was calculated for continuous outcome indicators, while Relative Risk (RR) was calculated for categorical outcome indicators.

RESULTS

A total of 21 meta-analyses were included. The evidence for the effects of PA interventions on reducing BMI [n = 68,368, SMD = - 0.04, 95% confidence interval (CI) = - 0.07 to - 0.01, P = 0.012, I2 = 46.6%], relieving diastolic BP (n = 8204, SMD = - 1.16, 95% CI = - 2.12 to - 0.20, P = 0.018, I2 = 83.1%), preventing depressive symptoms (n = 5146, SMD = - 0.21, 95% CI = - 0.31 to - 0.12, P < 0.001, I2 = 29.0%), and promoting cognitive function (n = 19,955, SMD = 0.40, 95% CI = 0.27-0.54, P < 0.001, I2 = 88.0%) was all weak but significant (class IV evidence). Subgroup analyses demonstrated that school-based and after-school PA interventions, curricular PA interventions, and PA interventions emphasizing enjoyment were more effective in reducing BMI, while curricular PA and sports programs achieved greater executive function.

CONCLUSION

PA interventions could weakly reduce BMI, relieve BP, prevent depressive symptoms, and promote cognitive function in general children and adolescents. Targeted interventions on PA should be a priority to promote physical and psychological health for children and adolescents, especially the curricular PA emphasizing enjoyment in the school settings.

The Effect of Taekwondo on Depression: A Meta-Analysis

Background

Depression is a prevalent mental health disorder with adverse effects on both physical and psychological health. Taekwondo is posited to exert a positive influence on depression, yet its efficacy warrants further verification.

Methods

This study employed meta-analysis to quantify the intervention effect of Taekwondo on depression. Concurrently, based on subgroup analysis results, an optimal intervention program was suggested. Multiple databases were searched, including English (Web of Science, PubMed), Chinese (CNKI, WANFANG DATA), and Korean (RISS, KISS, DBPIA), to retrieve randomized controlled trials (RCTs) studying Taekwondo's impact on depression, published up to Jan 2024. The Cochrane bias risk tool version 2 (RoB 2.0) was utilized for literature bias risk assessment. Comprehensive Meta-Analysis software facilitated the meta-analysis, subgroup analysis, and publication bias evaluation.

Results

Fifteen articles, encompassing 1945 participants, were included in the study. The primary findings indicated a significant reduction in depression risk due to Taekwondo intervention (Effect Size [ES]=-0.635, P<0.001). Subgroup analysis revealed the most substantial intervention effects in elderly individuals (ES=-1.025, P=0.004) and women (ES=-1.114, P=0.009). Taekwondo exercises, when conducted over 12 wk (ES=-0.922, P<0.001), three times per week (ES=-0.729, P<0.001), for 60 min per session (ES=-0.980, P=0.003), and at low intensity (ES= -1.777, P=0.024), yielded the greatest depression mitigation effects.

Conclusion

Taekwondo is an effective means to alleviate depression, particularly in older women. The study recommends a low-intensity Taekwondo exercise regimen, consisting of 60-minute sessions, three times weekly for 12 wk, as an optimal exercise prescription for best outcomes.

Association between moderate-to-vigorous physical activity trajectories and academic achievement in Chinese primary school children: a 3-year longitudinal study

BACKGROUND

Past cross-sectional studies have reported a positive association between moderate-to-vigorous physical activity (MVPA) and academic achievement in children and adolescents. Despite this, the influence of variations in MVPA over time on academic achievement remains yet to be definitively understood. Therefore, this study aims to track the patterns of MVPA and examine how they are associated with academic achievement over a three-year period among Chinese primary school students.

METHODS

The longitudinal study examined the MVPA and academic achievement of a cohort of 202 primary school children over a three-year period. MVPA was assessed via accelerometers and analysed using Compositional Data Analysis (CoDA). Academic achievement was quantified using standardised test scores in reading, mathematics, and language. Group-Based Trajectory Models (GBTMs) were used to identify patterns of MVPA. Covariates such as demographics, sleep duration, and attitudes towards sports were adjusted in the Generalized Estimating Equations (GEEs) used to examine associations with academic achievement. All statistical analyses were conducted using R and SAS 9.4 software.

RESULTS

This study identified three distinct MVPA trajectories: Low (74.8%), Decline (13.2%), and High (12.0%). At baseline, the High MVPA group had better academic achievement with mean scores of 89.8 in reading, 94.5 in mathematics, and 94.7 in language, compared to the Low MVPA group with mean scores of 80.4, 83.0, and 84.9, respectively. After adjustment for confounders, GEE models showed significant associations between MVPA trajectories and improved academic achievement. Compared to the Low MVPA group, the Decline MVPA group exhibited significant score increases in reading (β = 4.11, 95% CI: 1-7.21) and mathematics (β = 2.79, 95% CI: 0.09-5.5). The High MVPA group exhibited significant score increases in reading (β = 11.3, 95% CI: 7.93-14.67), mathematics (β = 12.32, 95% CI: 9.61-15.02), and language (β = 11.53, 95% CI: 8.99-14.06). Additionally, notable gender differences in MVPA trajectories were observed, and a positive association was found between favorable sports attitudes and improved academic achievement.

CONCLUSIONS

This study reveals three distinct MVPA trajectories among Chinese primary school children and demonstrates that those with high MVPA trajectories showcase superior academic achievements, particularly in reading, mathematics, and language. This highlights the vital role of MVPA in supporting academic excellence.

Short bouts and long-term exercise reduce sedentary-induced bone loss and microstructural changes by modulating bone formation and resorption in healthy young male rats

Although the toxic effect of Sedentary behavior (SED) on bone health has been demonstrated in the previous study, the underlying mechanisms of SED, or break SED to bone health remain unclear. In this study, we aim to investigate the effects of sedentary behavior (SED) on bone health, as well as the potential favor effects of moderate to vigorous physical activity (MVPA) and periodic interruptions of SED. To simulate SED, we used small Plexiglas cages (20.0 × 9.0 × 10.0 cm) to restrict animal movement. Short bursts of exercise to break SED and continuous long-term exercise were also designed. After an 8-weeks period of SED, we observed decreased bone mass and bone microstructure. Specifically, there was a notable decrease in the bone mineral density (BMD), bone surface (BS) and cortical thickness (Ct.Th) significantly reduced in cortical bone. In the trabecular bone, parameters such as trabecular separation (Tb.Sp), trabecular number (Tb.N), BS, connectivity density (Conn.D), BS/BV, bone volume/tissue volume (BV/TV), degree of anisotropy (DA), and structural model index (SMI) were also significantly reduced. In addition, we detected an increase in serum tartrate-resistant acid phosphatase (TRAP) levels in SED rats at both 4 and 8 weeks. At 8 weeks, the osteoclast number and surface with TRAP-staining were significantly increased, however, the OPG mRNA and proteins level were significantly decreased. After daily short bouts exercise and long-term exercise, we observed improvements in bone mass and microstructure. These improvements included increasing BMD and BV/TV of cortical bone, and improving Conn.D, BV/TV, DA and SMI of trabecular. Meanwhile, we found that, at 4 and 8 weeks, there was an increase in serum ALP. At 8 weeks, the mineralized nodules surface with Alizarin Red S-staining, and OPG mRNA and proteins level in bone tissue were significantly increased. Our findings suggest that SED leads to alterations in the bone mass and microstructure, which are associated with the changes in the OPG protein and bone remodeling. Exercise, whether in short daily bouts or continuous long-term sessions, can ameliorate the harmful effects of SED. Similarly, the changes in bone mass and microstructure from exercise are also associated with the changes in the OPG protein and bone remodeling by upregulated osteoblast activity to bone formation. Overall, our findings indicate the importance of physical activity in maintaining bone health and preventing the negative impacts of prolonged SED.

Antioxidant taurine inhibits chondrocyte ferroptosis through upregulation of OGT/Gpx4 signaling in osteoarthritis induced by anterior cruciate ligament transection

OBJECTIVE

The aim of this study was to investigate the potential molecular mechanisms by which taurine protects against cartilage degeneration.

METHODS

The anterior cruciate ligament transection (ACLT) surgery was used to construct an animal model of osteoarthritis (OA). Metabolomics was used to identify characteristic metabolites in osteoarthritic chondrocytes. Transcriptomics and metabolomics were used to explore potential mechanisms by which the small molecule metabolite taurine protects against inflammatory chondrocyte damage. Cell transfection and small molecule inhibitors/agonists were used to validate the molecular mechanisms by which taurine protects inflammatory chondrocytes in vitro. Finally, adeno-associated virus and small molecule inhibitors/agonists were used to validate the molecular mechanisms by which taurine protects against cartilage degeneration in vivo.

RESULTS

Metabolomic assays identified taurine as a possible key metabolic molecule in the progression of OA. Transcriptomics and metabolomics revealed that O-GlcNAc transferase (OGT)-dependent O-GlcNAcylation and Gpx4-dependent ferroptosis may mediate the inflammatory protective effects of taurine on chondrocytes, which was further confirmed by gain and loss of function in vitro. Subsequently, further experiments indicated that the possible existence of a direct binding site for Gpx4 and OGT proteins, which provides evidence for the presence of O-GlcNAc modification of Gpx4 protein. Finnaly, we demonstrated that Gpx4-dependent ferroptosis and OGT-dependent O-GlcNAcylation may be potential mechanisms by which taurine protects against cartilage degeneration in vivo.

CONCLUSION

Antioxidant taurine inhibits chondrocyte ferroptosis through upregulation of OGT/Gpx4 signaling. Supplementation with taurine, a safe nonessential amino acid, may be a potential therapeutic strategy for OA.

Association between excessive screen time and falls, with additional risk from insufficient sleep duration in children and adolescents, a large cross-sectional study in China

Objective

Falls is a major global public health issue that occur in all age groups. However, the association between screen time, sleep duration and falls in children and adolescents remains unclear.

Methods

This study included children and adolescents who participated in the 2017 Nutrition and Health Surveillance of Children and Lactating Mothers in China. Screen time, sleep duration and falls in the past 12 months were assessed using baseline questionnaires completed by the participants. We utilized a multivariate logistic regression model to estimate the association between screen time, sleep duration, and falls in children and adolescents. Stratified analyses and sensitivity analyses were performed using the same modelling strategies.

Results

A total of 564 participants (5.7%) self-reported falls in the past 12 months. Multivariate logistic regression analysis revealed that high screen time (> 2 h per day) was associated with a higher incidence of falls (cOR:1.46, 95% CI: 1.22-1.74, p < 0.001). The combination of high screen time and low sleep duration was associated with an increased risk of falls compared to the recommended low screen time and high sleep duration group (cOR: 1.62, 95% CI: 1.25-2.09, p < 0.001). After adjusting for relevant covariates, the associations remained significant (aOR: 1.30, 95% CI: 1.08-1.56, p = 0.006; aOR: 1.43, 95% CI: 1.10-1.87, p = 0.008).

Conclusion

Our study demonstrates that both high screen time and the combination of high screen time and low sleep duration were associated with an increased risk of falls. Interventions to promote healthy physical development should commence in early childhood to decrease the incidence of fall injuries in children and adolescents.

Determinants of childhood obesity in China

Over the past four decades, China has witnessed an important nutritional transition, characterised by a heightened overnutrition burden among children. The country now has the largest population of children with obesity globally. In this paper, we review the epidemiology of childhood obesity in China, its determinants, and risk factors, with a particular focus on school-aged children. Evidence unveils substantial variations across age, gender, and region. We describe multilevel obesogenic determinants, including macro-level social, cultural, and environmental factors; meso-level factors related to schools and communities; and micro-level factors tied to families and individuals from the perinatal-infant stage to childhood and adolescence. The primary drivers of childhood obesity appear to be rooted in the broader macro-level social, economic, and technological environment; obesogenic factors, which have affected school, community, and family environments; and accelerated unhealthy behaviour uptake. Identifying and characterising the catalysts behind the rise in childhood obesity in China is imperative for the development of scalable, effective, and tailored prevention, control, and intervention strategies.

Longitudinal relationships between physical activity, body appreciation, and proactive coping in college students: A cross-lagged panel model

Previous studies have found a significant relationship between physical activity and proactive coping, but the directionality of the relationship and its underlying mechanisms remain unclear. The present study examined the longitudinal relationships between physical activity, proactive coping, and body appreciation. A total of 376 college students (265 males, 111 females; Mage = 22.55, SD = 2.26) were recruited for this three-wave survey. The results of cross-lagged panel models showed that physical activity positively predicted proactive coping in the future and that body appreciation had a positive reciprocal relationship with physical activity and proactive coping, respectively. However, the effect of proactive coping on physical activity was not significant. These findings provide support for helping adults cope with threats such as stress by recognizing the key role of physical activity.

A historical review of promotions of physical activity for adolescents in China from 1949 to 2020

Promotions of physical exercise for adolescents have become key elements of the country's national sports and health campaigns in China. Specifically, these promotions have gone through four stages including Initial Institutionalization, Standardization and Legalization, Solidification and Publicization, and Comprehensiveness and Diversification, which are interpreted based on the Multiple Streams Framework with discussions of the role and dynamism of the problem streams, political streams, and policy streams included. The results reveal that the political streams, reified by the will of the governing party and the central government in particular, play a leading role in policy transformations. Consequently, identifications of existing problems and subsequent adoption of proper measures emerge as the key to generating policy developments in the promotion of physical exercise for adolescents in China.

Associations between number of steps and health outcomes in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Today's public health discourse prioritizes the health and well-being of children and adolescents. As step counts include both light and moderate-to-vigorous physical activities, and monitoring steps has become a popular method for assessing daily physical activity, it is critical to gain a better understanding of how measuring daily steps may contribute to overall health in children and adolescents. The aim of this study was to thoroughly review the studies that investigated the associations between daily number of steps (DNoS) and health outcomes (HO) in children and adolescents.

METHODS

Electronic searches were conducted in PubMed, Google Scholar, Cochrane, MEDLINE, Web of Science, SPORTDiscus (2000 -January 2024.). Key terms such as number of steps, daily steps, average steps, physical activity, health outcomes were used. The primary outcomes were (1) body composition/obesity risk factors; (2) cardiorespiratory fitness (CRF); and (3) cardiovascular risk factors. Secondary outcomes were psychological/psychosocial parameters (sleep habits, i.e. quality of life). We assessed the methodological quality of each trial using AXIS quality assessment tool. In instances where continuous data emanated from two or more trials, a meta-analysis was undertaken.

RESULTS

The main findings of this systematic review and meta-analysis are that an increased number of DNoS is associated with better HO in children and adolescents, as evidenced by improvements in body mass index (BMI), body weight, waist circumference, body fat percentage, and cardiorespiratory fitness (i.e., VO2max). However, due to a dearth of studies and conflicting results from current studies, no inferences can be drawn about the correlations between DNoS and sleep quality, quality of life, or cardiovascular risk factors (i.e., blood pressure). Across most of the studies, the average correlation between the DNoS and HO reflected a small, but significant, association with a small effect size.

CONCLUSIONS

Our findings highlight the importance of daily physical activity, as evidenced by the association between the number of steps and health outcomes in children and adolescents.

TRIAL REGISTRATION

PROSPERO # CRD42024523729.

Physical Activity and Lifestyle Behaviors in Children and Adolescents

A sedentary lifestyle, unfavorable body composition, and low muscle strength are strong predictors of morbidity and mortality and an independent determinant contributing to the development of many chronic diseases [...].

Energy Costs of 37 Physical Activities in Chinese Children and Adolescents Aged 9-17 Years with Obesity

BACKGROUND/OBJECTIVE

Obtaining data on the energy expenditure of physical activity (PA) in children and adolescents with obesity is crucial for promoting health in this population through exercise. However, relevant research is limited. This study aimed to determine the energy expenditure characteristics of 37 diverse PAs in children and adolescents with obesity and examine the association between obesity and energy expenditure (EE) characteristics within this cohort.

METHODS

Three hundred and ninety-seven children and adolescents with obesity aged 9-17 performed various PAs. PA intensity, EE, and body fat (BF) percentage were measured.

RESULTS

The resting oxygen uptake (VO2) and resting energy expenditure (REE) of children and adolescents with obesity were 4.23 (3.72-4.84) ml/kg/min and 0.020 (0.018-0.023) kcal/kg/min, respectively, with significant differences between boys and girls (p < 0.05). The metabolic equivalent of task (MET) values for the PAs ranged from 1.12 to 8.14 METs. Regression analyses revealed an inverse association with age, BMI, and percentage BF increased, with resting VO2, REE, and average PA energy expenditure (PAEE) during PAs.

CONCLUSIONS

(1) Resting VO2 was lower in children and adolescents with obesity than those with normal weight and higher than in adults. (2) Of the measured PA intensities, 8 were light, 17 were moderate, and 5 were vigorous intensity. (3) The increase in the degree of obesity and age further decreased VO2 and EE both at rest and during PA. Our results can provide precise guidance for the exercise of children and adolescents with obesity and serve as a reference for the development of physical activity guidelines and compendiums. Future research should further diversify the types of PAs measured.

The Modifying Effects of Lifestyle Behaviors on the Association Between Drinking Water Micronutrients and BMI Status Among Children and Adolescents Aged 7~17: A Population-Based Regional Surveillance in 2022

BACKGROUND

This study aims to investigate the potential modifying effects of lifestyle behavior on the association between drinking water micronutrients and body mass index (BMI) in a large population of children and adolescents.

METHODS

Data of the present analysis came from a comprehensive regional large-scale surveillance study in 2022, involving 172,880 children and adolescents (50.71% boys vs. 49.29% girls) aged seven to seventeen. A restricted cubic spline (RCS) analysis was utilized to examine the exposure-response association of regular drinking water indices (including fluoride, nitrate nitrogen, pH, chloride, sulfates, and total dissolved solids (TDS), total hardness (TH), and chemical oxygen demand (COD)) with BMI. Generalized linear model and logistic regression were conducted to relate BMI and quartiles of drinking water micronutrients.

RESULTS

Our findings reveal a nonlinear association between nitrate nitrogen (P for nonlinear < 0.001) and pH (P for nonlinear < 0.001) with BMI. High TH and COD levels significantly increase BMI. Notably, fluoride and chloride were associated with BMI Z-scores but not with overweight and obesity (OB). The BMI Z-score showed a more pronounced association with low and high pH levels in girls. For urban participants, increased TH levels were associated with a higher risk of OB. This study also found that adopting healthy lifestyles could mitigate the negative effects of fluoride, chloride, and sulfate on BMI Z-scores.

CONCLUSIONS

This large surveillance study provides new insights into the complex interplay between drinking water micronutrients and BMI in children and adolescents. The association of various drinking water parameters on BMI varies, necessitating ongoing focus on their effects, particularly among girls and urban individuals. Healthy lifestyle behavior could mitigate the effects of fluoride, chloride, and sulfate on BMI Z-score.

Associations between adherence to 24-Hour Movement Guidelines with continuous metabolic syndrome score among Chinese children and adolescents

OBJECTIVES

The objective of this study was to evaluate the associations between adherence to 24-Hour Movement Guidelines (24-HMG) with continuous metabolic syndrome score (cMetS) among Chinese children.

STUDY DESIGN

Cross-sectional study.

METHODS

We conducted a cross-sectional study among 4604 children aged 6-17 years from Shenzhen, China. The 24-HMG was constructed using the self-report information on moderate-to-vigorous physical activity (MVPA), screen time (ST), and sleep duration. The cMetS was calculated based on waist circumference, homoeostatic model assessment for insulin resistance, mean arterial blood pressure, high-density lipoprotein cholesterol, and triglyceride. Multivariate linear regression models were used to assess the associations between adherence to recommendations of 24-HMG and cMetS.

RESULTS

Among the participants, 563 (12.23%) students adhered to 3 recommendations of the 24-HMG. We found that adhering to more recommendations was negatively associated with cMetS (P for trend: <0.001). For specific combinations, meeting the ST + MVPA recommendations was negatively associated with cMetS (coefficients [β]: -0.686; 95% confidence interval [CI]: -1.148, -0.223). Individuals who adhered to all recommendations had a lower cMetS (β: -0.693; 95% CI: -1.147, -0.238) than those who met none of the recommendations.

CONCLUSIONS

Our study showed that adherence to more recommendations of the 24-HMG was associated with lower levels of cMetS in Chinese children and adolescents.

Understanding psychological symptoms among Chinese college students during the COVID-19 Omicron pandemic: Findings from a national cross-sectional survey in 2023

During the Omicron pandemic in late 2022, this study surveyed Chinese students via an online questionnaire to assess their mental health status, prevalence of psychological symptoms, and associated factors. A nationwide cross-sectional survey of 4254 participants was conducted in seven regions of China from January 5 to February 9, 2023. Scales were utilized respectively to measure depressive symptoms, anxiety symptoms, post-traumatic stress disorder (PTSD) symptoms, and perceived social support. Descriptive, univariate, and multivariable analyses were performed to identify associated factors. Protective factors against depressive symptoms include regular exercise and robust social support networks, while risk factors involve excessive alcohol consumption, comorbidities, Omicron infection, and irregular sleep patterns. Risk factors for anxiety symptoms include comorbidities, Omicron infection, living alone, and irregular sleep patterns, while social support emerges as a protective factor. For PTSD symptoms, regular exercise and strong social support systems are identified as protective measures, with risks associated with comorbidities, Omicron infection, and poor sleep quality. Students are particularly vulnerable during the pandemic due to their lifestyle and academic pressures. It's essential to bolster their social support and promote healthier habits.

Association of physical activity, screen time and sleep with substance use in children and adolescents: a large sample cross-sectional study

Background

24-h movement guidelines (24-HMG) play an important role in various demographics such as early years, children, youth, and the older adult. Nevertheless, most existing research exploring the links between socioeconomic factors, dietary intake, and substance use with sleep patterns, physical activity (PA), and sedentary behavior (SB) has been conducted in high-income Western countries.

Purpose

Hence, this study seeks to investigate the relationship between adherence to the 24-HMG and smoking and alcohol use behaviors among children and adolescents in China.

Methods

A comprehensive survey, in collaboration with the Municipal Education Commission, was carried out across primary and middle schools in Shenzhen, China. Sleep duration was gauged using the Pittsburgh Sleep Quality Index (PSQI), screen time was assessed with items adapted from the Health Behavior of School-aged Children (HBSC) survey, and PA was measured using a single item adapted from the HBSC survey. Results were presented as odds ratios (ORs) with 95% confidence intervals (CIs), considering p-values below 0.05 as statistically significant.

Results

Among the sample, 51.9% were boys and 48% were girls. Those who did not meet any guidelines had a higher probability of smoking (OR = 1.62 [95% CI: 1.03, 2.56], p = 0.037) among children and adolescents. Conversely, meeting one (OR = 0.94 [95% CI: 0.61, 1.52], p = 0.874) or two guidelines (OR = 0.84 [95% CI: 0.52, 1.34], p = 0.459) showed no significant impact. The data displayed an inverse correlation between the number of guidelines adhered to and the likelihood of alcohol use among children and adolescents: none (OR = 2.07, p < 0.001), one guideline (OR = 1.40, p = 0.006), and two guidelines (OR = 1.22, p = 0.106).

Conclusion

Not meeting guidelines elevates smoking and alcohol use risks in children and adolescents, whereas following more guidelines lowers these risks, highlighting the importance of guideline adherence in reducing substance use.

Early-life body mass index and the risk of six cardiovascular diseases: A Mendelian Randomization study

BACKGROUND

Observational studies consistently indicate an association between early-life body mass index (BMI) and several cardiovascular diseases (CVDs). However, the causal relationship remains uncertain. The primary objective of this study was to assess the causal relationship between early-life BMI and six types of CVDs using the Mendelian Randomization (MR) approach.

METHODS

The dataset for this study was derived from large-scale, summary-level Genome-Wide Association Studies. Specifically, the following datasets we used, early-life BMI (n = 61 111, age = 2-10), heart failure (HF) dataset (n = 977 323), atrial fibrillation (AF) dataset (n = 1 030 836), coronary artery disease (CAD) dataset (n = 184 305), peripheral artery disease (PAD) dataset (n = 243 060), deep venous thrombosis (DVT) dataset (n = 1 500 861) and myocardial infarction (MI) dataset (n = 638 000). Multiple MR methods were utilized to evaluate the causal relationship between exposure and outcomes, accompanied by sensitivity analysis.

RESULTS

Early-life BMI positively correlates with the risk of developing the six distinct CVDs included in this study. Specifically, elevated BMI during childhood is associated with a 31.9% risk for HF (Odds ratio [OR] = 1.319, 95% CI [1.160 to 1.499], p = 2.33 × 10-5), an 18.3% risk for AF (R = 1.183, 95% CI [1.088 to 1.287], p = 8.22 × 10-5), an 14.8% risk for CAD (OR = 1.148, 95% CI [1.028 to 1.283], p = 1.47 × 10-2), a 40.5% risk for PAD (OR = 1.405, 95% CI [1.233 to 1.600], p = 3.10 × 10-7) and 12.0% risk for MI (OR = 1.120, 95% CI [1.017 to 1.234], p = 2.18 × 10-2). Interestingly, the risk for deep venous thrombosis only increased by 0.5% (OR = 1.005, 95% CI [1.001 to 1.008], p = 2.13 × 10-3).

CONCLUSION

Genetically inferred early-life BMI is significantly associated with six distinct CVDs. This indicates that elevated early-life BMI is a significant risk factor for multiple cardiovascular disorders.

Effects of aquatic and land high-intensity interval trainings on selected bio- and physiological variables among obese adolescents

Background

Obesity among adolescents have become a global public health problem. Exercises can effectively improve the bio-physiological factors of obese adolescents. High-intensive interval training (HIIT) has been applied to obese adolescents. Studies have reported that the Aquatic environment may bring the same or more positive exercise effects as the land environment. Therefore, the purpose of this study was to examine the effects of aquatic and land interventions on selected bio-and physiological variables among obese adolescences.

Methods

Twenty-eight obese adolescents who met the requirements participated in and completed this study. The participants were randomly assigned to Aquatic HIIT group (n=17) or Land HIIT group (n=11) for a four-week exercise intervention, 3 time/week. Each Intervention program was one-hour long, including 20 minutes of warm-up, 30 minutes of HIIT and 10 minutes of stretching and relaxation. Bio- and physiological variables including Anthropometry and body composition, Physical Function and blood pressure, and Lipid metabolism indexes were collected before and after the Aquatic and Land interventions.

Results

After four weeks of exercise interventions, the body mass, BMI, body fat rate, waist circumference, hip circumference and body water content were significantly reduced (p<0.05), and the lean body mass were significantly increased (p<0.05) in both groups. Both group exhibited significant effects in decreasing, systolic blood pressure (p<0.05), diastolic blood pressure (p<0.01), and increasing vital capacity and total energy consumption (p<0.05). The Aquatic HIIT group showed significant effects on reducing Rest heart rate (p<0.05), but no significant changes in Rest heart rate in Land HIIT group (p=0.364). The low-density lipoprotein cholesterol in both groups was significantly decreased (p<0.05). Moreover, the Aquatic HIIT group had significant better improvements (p<0.05) in lean body mass, waist circumference, waist-to-hip ratio, vital capacity and total energy consumption than Land HIIT group did.

Conclusions

The results of the present study demonstrated that in a short-term (4 weeks) both Aquatic and Land HIIT interventions may improve the body composition, physical function, blood pressure and low-density lipoprotein cholesterol (LDL-C) of overweight and obese adolescents. Furthermore, the Aquatic HIIT may be superior than the Land HIIT in weight control among the obese adolescents.

Gender Difference of the Association Between Sleep Duration and Myopia Among Children and Adolescents

Purpose

With girls typically exhibiting higher rates of myopia than boys, however, the mechanisms behind this gender difference remain unclear. This study aims to investigate the gender disparities in the relationship between myopia, sleep duration, physical activity, and BMI.

Patients and Methods

A total of 3138 primary and secondary school students were included. Mplus 8.3 was used to perform the multiple mediation analysis.

Results

Sleep duration was indicated to directly affect myopia (β=0.273, 95% CI=0.184-0.356) and through physical activity, BMI, physical activity and BMI three significantly mediation pathways, respectively. In terms of gender, the mediating direct effect of sleep duration on myopia of boys was 66.96%, which is much higher than that of girls' 50.91%. And the mediating indirect effect of sleep duration on myopia through physical activity and BMI are 32.65% and 12.10% respectively among girls, both of which are significantly higher than that of boys.

Conclusion

The study found that there are significant differences in the impact of sleep duration on myopia in children and adolescents of different genders. In this regard, while paying attention to the sleep duration of children and adolescents, special attention should also be paid to the indirect impact of girls' physical activity and BMI on myopia, and targeted measures should be formulated according to children of different genders to effectively protect the eye health of children and adolescents.

Proportion, Correlates and the Associations of Meeting 24-h Movement Guidelines With Mental Well-Being and Psychological Distress: A Cross-Sectional Study of 10 589 Chinese Students

BACKGROUND

The increased trends in psychological distress and mental illness have been of great significance in public health concerns. The study aimed to investigate the proportion and correlates of meeting 24-h movement guidelines (including moderate to vigorous physical activity, screen time and sleep duration) and the associations between 24-h movement guidelines met and mental well-being and psychological distress in a large sample of Chinese students.

METHODS

All participants received a physical examination and filled out questionnaires in this study. Chi-square tests were used to analyse the proportion of reaching 24-h guidelines by gender and logistic regression was used to analyse correlates of meeting 24-h guidelines. Two binary logistic regression models were used to analyse the association between meeting 24-h guidelines and mental well-being and psychological distress. The back-propagation artificial neural network was used to describe the importance of the independent variables.

RESULTS

The findings revealed a generally low rate of meeting the 24-h movement guidelines, particularly concerning moderate to vigorous physical activity (16.5%). Meeting all three guidelines was related to better mental health in both boys and girls. Particularly, meeting screen time guideline and meeting sleep duration guideline appeared to be more important on mental outcomes, compared to meeting moderate to vigorous physical activity guideline. Compared with boys, girls were more susceptible to the influences of 24-h movement guidelines on mental health.

CONCLUSIONS

Meeting all three components of the 24-h movement guidelines was associated with the most favourable mental health outcomes for both boys and girls. Thus, maintaining a daily balance of sufficient physical activity, limited screen time, and adequate sleep is crucial for enhancing the mental health status of students.

The effects of physical activity on adolescents' depression: evidence from China

Background

Depression is becoming a common threat to the mental health of Chinese adolescents. As an intermediate stage between being healthy and having depression, identifying factors influencing depressive may contribute to providing more options for the prevention and treatment of depression.

Objective

The study aims to explore the effects of physical activity on adolescent depression, focusing on the times and hours of activity per week.

Methods

The study used a cross-sectional dataset collected in Ruyang County, Henan Province in September 2022, including a sample of 5,629 adolescents in 31 compulsory public schools in the county. We utilized Ordinary Least Squares (OLS) to analyze the impact of physical activity on adolescents' depression scores, and probit model to analyze the influence of physical activity on adolescents' depression. To examine whether there is a U-shaped relationship between physical activity and depression, we included the squared terms of times and hours of activity in models.

Results

The results showed that: (1) The times of physical activity significantly reduces Chinese adolescent depression. An increase in physical activity by one time per week is associated with a mean decrease of 0.354 points in depression scores (p < 0.01). However, an increase of one time of physical activity per week is associated with an average 1% increase in the likelihood of experiencing depression(p < 0.05), while the hours of physical activity was statistically insignificant. (2) Physical activity has a U-shaped (not linear) relationship with adolescent depression, with 7-8 times per week or 7-9 h of physical activity per week being the optimal range.

Conclusion

The study found that increasing the frequency of physical activity positively impacts adolescent depression, while increasing the hours does not show a significant association. Furthermore, a U-shaped relationship exists between times of activity, hours of activity, and adolescent depression, suggesting that moderate activity is optimal.

Using shanghai municipal data to examine whether student sacrifice exercise in response to academic pressure

The competitive education environment in Mainland China pressure many students to take up after-school lessons, cutting into their leisure time and exercise less, setting a path towards a more sedentary lifestyle. We use a survey on sports consumption for Shanghainese adolescent ages 6 to 17 to examine whether they sacrifice sports activity as they advance through the grade. We found that students a year older exercise 16.2 fewer minutes per week, 1.38 percent less likely to spend on sports training, 1.42 percent more likely to watch sports events, 1.90 percent more likely to buy more sports related goods. Our result shows that students substitute sports activities with more expenditure on sports products and events. When older adolescent exercise less, we are concerned that it may contribute to rising obesity and a more sedentary lifestyle.

Exploring the Multifaceted Influences on Childhood Nutritional Status: A Study Conducted in South Punjab, Pakistan

Introduction The double burden of malnutrition (DBM) in Pakistan is a rising concern affecting school-going children, marked by coexisting under- and over-nutrition within the same population. Key influences include shifts in dietary habits, socioeconomic status, and lifestyle changes due to rapid urbanization. With a focus on Multan, Pakistan, the study seeks to assess the proportion of underweight and overweight students while identifying the risk factors and sociodemographic characteristics associated with this incidence. The aim is to guide future health interventions addressing this multidimensional health challenge. Materials and methods This study, adopting a descriptive cross-sectional research design, collected data from female teenage students through interviews and anthropometric measurements. A total of 300 participants were randomly selected from a comprehensive school list representing diverse urban and rural settings. Participants' weight and height were measured to calculate their body mass index (BMI), categorizing them into underweight, normal weight, and overweight groups. The relevant risk factors were collected through an interview questionnaire. Collected data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), with the results stratified according to socioeconomic, dietary, and psychosocial factors and compared across different weight categories. Results The study collected data from 300 students, revealing a correlation between socioeconomic status, dietary habits, and BMI. Parental occupation significantly affected nutritional status, with children of laborers primarily falling within normal and underweight categories. Dietary habits like frequency of fast food and milk or dairy consumption showed notable associations with nutritional status. Psychosocial factors such as peer or teacher comments about weight and outdoor sports participation also influenced the students' nutritional status. However, factors like family income, video game hours, and the presence of pets at home did not show significant associations with nutritional status. Conclusions The study illustrates a multi-faceted association between socioeconomic status, dietary habits, and BMI among schoolchildren in Multan, Pakistan, emphasizing the need for comprehensive interventions.

[Status and pathways of factors influencing physical activity time among elementary and junior high school students in Beijing]

OBJECTIVE

To describe the current distribution of daily physical activity time among elementary and junior high school students in Beijing, and to analyze the influencing factors and pathways at the individual, family, school and community levels.

METHODS

Data were drawn upon from a cross-sectional investigation in Beijing in 2023, and a total of 3 157 elementary and junior high school students were included in the final analysis. Questionnaire was used to collect data on basic characteristics, overall and in-school physical activity time per day, the number of sports mastered, perceived physical activity benefits and barriers scales, perceived family, school, and community physical activity supportive environment scales. Log-binomial regression model was used to analyze the associations between physical activity time and influencing factors, and structural equation modeling was used for the path analysis of the influencing factors.

RESULTS

The reported rates of ≥2 hours of overall physical activity per day and ≥1 hour of physical activity in school per day among elementary and junior high school students in Beijing in 2023 were 33.1% and 64.8%, respectively. The associations between the number of sports mastered by students and the reported rate of ≥2 hours of overall physical activity per day showed a typical dose-response relationship (P-trend<0.001). The perceived physical activity benefits-to-barriers ratio (PR=1.24, 95%CI: 1.20-1.28), scores of perceived family, school, and community physical acti-vity supportive environment scales were all positively associated with the reported rate of ≥2 hours of overall physical activity per day (PR=1.51, 95%CI: 1.38-1.66; PR=1.50, 95%CI: 1.37-1.64; PR=1.21, 95%CI: 1.16-1.27). The structural equation modeling showed that the number of sports mastered by the students (β=0.11, P<0.001), perceived physical activity benefits-to-barriers ratios (β=0.15, P<0.001), and scores of supportive environment scales consisting of family, school, and community (β=0.13, P<0.001) were associated with the reported rates of ≥2 hours of overall physical activity per day directly. In addition, the scores of supportive environment scales could indirectly influence the reported rates of ≥2 hours of overall physical activity per day by influencing the number of sports mastered by the students (β=0.21, P<0.001) and the perceived physical activity benefits-to-barriers ratio (β=0.56, P<0.001), while the number of sports mastered by the students could indirectly influence the reported rates of ≥2 hours of overall physical activity per day by influencing the perceived physical activity benefits-to-barriers ratios (β=0.05, P=0.003). The influencing factors and pathways of the reported rates of ≥1 hour of physical activity in school per day were similar with those of the reported rates of ≥2 hours of overall physical activity per day described above.

CONCLUSION

The daily physical activity time among elementary and junior high school students in Beijing in 2023 fell short of meeting the national requirement. There was a need to build a supportive environment consisting of family, school, and community for physical activity, to promote the students ' sports skills, to establish the idea of independent physical activity, and to ensure that primary and secondary school students were given one hour of physical activity time every day, both inside and outside the school.

Trends of physical activity and recreational screen time among Chinese children and adolescents: a national study from 2017 to 2019

BACKGROUND

The prevalence of physical inactivity and sedentary behavior among children and adolescents is a growing public health concern. This study aims to examine the trends in Physical Activity (PA) and Recreational Screen Time (RST) amongst children and adolescents in China, considering variations in genders, school levels, areas (urban versus rural), and regions (north versus south). The findings provide a foundation to guide policy and strategy making for future health promotion and development.

METHODS

An annual national cross-sectional survey was conducted in China from 2017 to 2019 cumulatively involving 52,503 (48% female) children and adolescents from grades 4 to 12 (aged 12.72 ± 2.12). Data on PA and RST were collected through self-administered questionnaires. Weighted least squares regression was used to analyze the trends and differences in PA and RST among the participants' profiles.

RESULTS

There was an annual decreased in PA compliance rate of approximately 3.43% (95% CI: 0.79-6.08%) for primary school students, primarily among males residing in rural areas, and in northern regions. Middle school students experienced a yearly decrease of about 5.23% (95% CI: 2.55-7.92%) in PA compliance across all genders, regions, and urban areas. Similarly, the RST compliance rates for primary school students declined by approximately 3.18% (95% CI: 1.57-4.78%) annually for all genders and areas, but only in the northern regions.

CONCLUSIONS

This research highlights a downward trend in PA and RST compliance amongst Chinese children and adolescents, with variations based on school level, gender, area, and region. Urgent policies and interventions are imperative to promote PA while mitigating excessive RST within these populations.

Health effect of public sports services and public health services: empirical evidence from China

There is no clear explanation for the extraordinary rebound in China's population mortality over the past decade. This paper utilizes panel data from 31 Chinese provinces from 2010 to 2020 to determine the distinct impacts of public sports services (PSS), public health services (PMS), and their interaction on population mortality. Empirical results show that public sports services significantly reduce mortality. Every unit increase in public sports services reduces mortality by about 2.3%. It is characterized by delayed realization. Public health services were surprisingly associated with a rebound in mortality. Further studies found strong health effect from interaction of public sports and health services. The effect was significantly strengthened in areas with fewer extreme temperatures or developed economy. The findings have important policy implications for the high-quality development of public sports and health services. It also emphasizes integration of sports and medicine and mitigates health risks associated with extreme temperatures.

The effects of exercise training on inflammatory markers in children and adolescents: A systematic review and meta-analysis

INTRODUCTION AND AIM

Exercise training is effective for improving cardiometabolic health in children and adolescents, but less is known about its impact on inflammatory markers. We therefore, undertook a systematic review and meta-analysis to investigate the role of exercise training on pro-inflammatory cytokines including interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) in children and adolescents.

METHOD

A comprehensive search was conducted in three electronic databases including PubMed, Web of Science, and Scopus, from inception to December 2023 to identify exercise trials with and without control groups, involving participants with mean ages ranging from ≥ 6 to < 18 years, of age with measurements of at least one of the following pro-inflammatory cytokines IL-6, TNF-α, or CRP. Standardized mean differences (SMD) and 95 % confidence interval (ICs) were calculated using random effects models.

RESULTS

Thirty-eight studies involving 2043 children and adolescents were included. The results show that exercise training resulted in significant reductions in IL-6 [SMD: -0.44; 95 % CI: -0.68, -0.21; P = 0.001] and CRP [SMD: -0.28; 95 % CI: -0.41, -0.16; P = 0.001], but not TNF-α [SMD: -0.15; 95 % CI: -0.38, -0.07; P = 0.19]. Subgroup analyses showed that IL-6 and CRP were reduced with aerobic training in adolescents, as was CRP with high-intensity interval training.

CONCLUSION

These results provide evidence that exercise training is effective for reducing IL-6 and CRP in adolescents, but not in children, and any benefits may be modulated by the type of exercise performed.

Longitudinal Associations Between Physical Activity and Depressive Symptoms in Chinese Children: Evidence from the Tongji Mental Health Cohort Study

BACKGROUND

We aimed to examine the associations between depressive symptoms and physical activity parameters (e.g., intensity, frequency, and duration) among Chinese school-aged children.

METHOD

Participants in this study were extracted from the Tongji Mental Health Cohort Study. The baseline survey was conducted in June 2020 involving 2588 school-aged children from two primary schools in Hubei Province, China. A total of 2435 children were followed up successfully in December 2020. The Children's Depression Inventory Short Form (CDI-S) was applied to evaluate depressive symptoms among school-aged children. The Physical Activity Rating Scale-3 (PARS-3) was adopted to estimate children's physical activity parameters including the intensity, frequency, and duration. Generalized estimation equation models were used to explore the longitudinal associations between physical activity and depressive symptoms among school-aged children.

RESULTS

Engaging in moderate levels of physical activity (OR, 0.800; 95%CI, 0.692-0.924) or high levels of physical activity (OR, 0.808; 95%CI, 0.689-0.947) in the baseline survey was associated with a reduced risk of developing depressive symptoms in the follow-up survey compared with children engaging in low levels of physical activity. Stratified analyses revealed that the associations between physical activity and depressive symptoms exhibited a significant correlation among boys and children in the older age group (11-12 years). Our findings showed that engaging in physical activity more than once a week, with each session lasting 20 min or longer, was related to significant reductions in depressive symptoms by 43.8% and 22.3%, respectively.

CONCLUSION

Self-reported physical activity is positively associated with improved mental health among Chinese school-aged children, especially when considering parameters such as frequency and duration. The association between vigorous-intensity physical activity and depressive symptoms in children should be cautiously interpreted. Future research should continue to explore the effects of vigorous-intensity physical activity on depressive symptoms in children.

Exploring the relationship among soccer-related knowledge, attitude, practice, and self-health in Chinese campus soccer education

China has promoted campus soccer for over a decade due to its potential health benefits. The study aimed to explore soccer knowledge (SK), soccer attitude (SA), soccer practice (SP), and health status among Chinese freshmen and sophomore undergraduates who had received campus soccer education. Of the 7419 participants, 1,069 were valid and included in the analysis. Structural equation modeling (SEM) results indicated SK is positively associated with SA (p < 0.001), but negatively with SP (p < 0.01). SA was positively linked to SP (p < 0.001). SK indirectly affected SP through SA (Z = 13.677). Random forest-tree-structured Parzen estimators (RF-TPE) with SHAP indicated SP holds primary importance with a strong negative impact on health. Additionally, differences in rankings for SK, SA, and SP were observed among gender and urban-rural groups. These results reveal current campus soccer education is suboptimal to health promotion.

Health benefits of short Taichi Qigong exercise (STQE) to University Students' core strength, lower limb explosive force, cardiopulmonary endurance, and anxiety: A Quasi experiment research

BACKGROUND

College students' physical fitness has declined over the past decades. Taichi Qigong exercise offers numerous health benefits and could serve as a suitable option for them. Traditional programs, however, are time-consuming and necessitate long-term commitments. Therefore, a more cost-effective intervention is needed.

METHODS

The study enrolled a total of 31 students who actively participated in a 5-week STQE program, consisting of three 60-minute sessions per week. Physical and mental health assessments included the Plank test, vital capacity measurement, 1000/800 m run test, standing jump, and the Zung Self-Rating Scale. Data analysis was performed using SPSS.

RESULTS

Following the STQE intervention, participants showed improvement in core strength (28.1 seconds in the Plank test, P = .025) and lower limb explosive force (6.52 cm in the standing jump test, P = .011), accompanied by a decrease in anxiety levels (a reduction of 3.41 in the Zung Self-Rating Scale, P = .039). However, no significant improvements were observed in cardiopulmonary endurance, as evidenced by a non-significant increase of 237.84 mL in vital capacity (P = .134) and a non-significant reduction of 1.6 seconds in the 1000/800 m run test (P = .764).

CONCLUSION

The study suggests that the STQE program effectively improves core strength, lower limb explosive force, and reduces anxiety levels among university students.

The relationship between nighttime exercise and problematic smartphone use before sleep and associated health issues: a cross-sectional study

OBJECTIVE

Physical exercise has the potential to mitigate addictive behaviors and relevant health issues. However, the nighttime exercise has not been studied regarding this research topic. This study aims to explore the association between nocturnal physical exercise and problematic smartphone use before sleep, as well as related health issues.

METHODS

To explore the association between nighttime physical exercise and problematic smartphone use before sleep as well as related health issues, we conducted a cross-sectional survey among 1,334 college students. Their daily exercise behaviors (including timeframe, rationale, frequency, and duration), smartphone use before sleep, sleep quality, smartphone addiction, anxiety, and depression were measured by questionnaires. The associations were assessed using generalized linear models.

RESULTS

Our findings indicate that nearly 70% of participants chose to perform exercise at nighttime. Among these individuals who exercised at nighttime, the frequency and duration of nighttime exercise were significantly associated with decreased probabilities of smartphone use before sleep. Additionally, the frequency and duration of nighttime exercise were associated with lower levels of smartphone addiction and anxiety disorders.

CONCLUSION

Nighttime Exercise behaviors can effectively reduce sleep delays caused by problematic smartphone use before bedtime. These findings contribute to understanding the potential effects of nighttime exercise on problematic smartphone use and relevant health issues. Future research should employ more precise methodologies to examine these associations.

Translational studies of exosomes in sports medicine - a mini-review

This review in sports medicine focuses on the critical role of exosomes in managing chronic conditions and enhancing athletic performance. Exosomes, small vesicles produced by various cells, are essential for cellular communication and transporting molecules like proteins and nucleic acids. Originating from the endoplasmic reticulum, they play a vital role in modulating inflammation and tissue repair. Their significance in sports medicine is increasingly recognized, particularly in healing athletic injuries, improving articular cartilage lesions, and osteoarthritic conditions by modulating cellular behavior and aiding tissue regeneration. Investigations also highlight their potential in boosting athletic performance, especially through myocytes-derived exosomes that may enhance adaptability to physical training. Emphasizing a multidisciplinary approach, this review underlines the need to thoroughly understand exosome biology, including their pathways and classifications, to fully exploit their therapeutic potential. It outlines future directions in sports medicine, focusing on personalized treatments, clinical evaluations, and embracing technological advancements. This research represents a frontier in using exosomes to improve athletes' health and performance capabilities.

Clustering of Multilevel Factors Among Children and Adolescents: Associations With Health-Related Physical Fitness

BACKGROUND

To identify the clustering characteristics of individual-, family-, and school-level factors, and examine their associations with health-related physical fitness.

METHODS

A total of 145,893 Chinese children and adolescents aged 9-18 years participated in this cross-sectional study. The 2-step cluster analysis was conducted to identify clusters among individual-, family-, and school-level factors. Physical fitness indicator was calculated through sex- and age-specific z scores of forced vital capacity, standing long jump, sit-and-reach flexibility, body muscle strength, endurance running, and body mass index.

RESULTS

Three, 3, and 5 clusters were automatically identified at individual, family, and school levels, respectively. Students with low physical fitness indicator were more likely to be in the "longest sedentary time and skipping breakfast" cluster (odds ratio [OR] = 1.18; 95% confidence interval [CI], 1.12-1.24), and "physical inactivity and insufficient protein consumption" cluster (OR = 1.07; 95% CI, 1.02-1.12) at individual level, the "single children and high parental education level" cluster (OR = 1.15; 95% CI, 1.10-1.21), and "no physical activity support and preference" cluster (OR = 1.30; 95% CI, 1.25-1.36) at family level, and the "physical education occupied" cluster (OR = 1.06; 95% CI, 1.01-1.11), and "insufficient physical education frequency" cluster (OR = 1.16; 95% CI, 1.08-1.24) at school level. Girls were more vulnerable to individual- and school-level clusters, while boys were more susceptible to family clusters; the younger students were more sensitive to school clusters, and the older students were more susceptible to family clusters (P-interaction < .05).

CONCLUSIONS

This study confirmed different clusters at multilevel factors and proved their associations with health-related physical fitness, thus providing new perspective for developing targeted interventions.

Physical Activity Is Associated with Physical Fitness and Executive Function among School Children in the Jiangxi Region of China

Previous studies have suggested that a positive relationship exists between physical activity (PA), physical fitness, and cognitive function in children and adolescents. However, research remains limited on the relationship among these three variables in Chinese individuals not living in big cities or specific regions. Therefore, this study investigated the association of PA with physical fitness and cognitive function (specifically, executive function) among 1100 children aged 9-12 years living in the Jiangxi region of China. Participants' PA levels were measured using the PA questionnaire for older children. Physical fitness was assessed based on cardiorespiratory endurance, muscle strength, muscular endurance, flexibility, and body mass index (BMI). Executive function was assessed using the Behavior Rating in Inventory of Executive Function questionnaire. Data were analyzed using one-way analyses of variance, Scheffé tests, one-way analyses of covariance, and Pearson's correlation coefficients. The results showed that PA is significantly associated (p < 0.01) with cardiorespiratory endurance (r = 0.460), muscular endurance (r = 0.270), muscle strength (r = 0.190), BMI (r = -0.114), and executive function (r = -0.140). Moreover, all components of physical fitness and executive function differed significantly based on PA level, with and without age and sex as covariates (p < 0.05). Overall, our results highlight the importance of higher PA levels during childhood to improve physical fitness and cognitive function. Including the goal of improving health-related fitness factors, such as cardiorespiratory endurance and muscle strength, is particularly important in PA programs for children.

Appropriate Vestibular Stimulation in Children and Adolescents-A Prerequisite for Normal Cognitive, Motor Development and Bodily Homeostasis-A Review

The structural development of the vestibular part of the inner ear is completed by birth but its central connections continue to develop until adolescence. Their development is dependent on vestibular stimulation-vestibular experience. Studies have shown that vestibular function, modulated by experience and epigenetic factors, is not solely an instrument for body position regulation, navigation, and stabilization of the head and images but also influences cognition, emotion, the autonomous nervous system and hormones. To emphasize the importance of appropriate vestibular stimulation, we present a literature review of its effect on bodily homeostasis, cognition and emotion.

Prevalence of malnutrition and its associated factors among 18,503 Chinese children aged 3-14 years

Background

Child malnutrition places a major burden on global public health. We aimed to estimate the prevalence of child malnutrition and identify its potential factors among children aged 3-14 years from Beijing and Tangshan.

Methods

We cross-sectionally recruited 18,503 children aged 3-14 years from September 2020 to January 2022, according to a stratified cluster random sampling strategy. Child malnutrition was defined according to the World Health Organization criteria. Data were analyzed by STATA software and R language.

Results

The prevalence of malnutrition among 18,503 children was 10.93%. After multivariable adjustment, seven factors significantly associated with child malnutrition were parental education (adjusted odds ratio, 95% confidence interval, p: 1.52, 1.40 to 1.67, <0.001), family income (1.23, 1.16 to 1.30, <0.001), fast food intake frequency (1.14, 1.06 to 1.21, <0.001), night meals intake frequency (1.09, 1.04 to 1.15, <0.001), eating speed (1.01, 1.01 to 1.02, <0.001), maternal obesity (0.97, 0.95 to 0.99, <0.001), and paternal obesity (0.97, 0.96 to 0.98, <0.001). The seven significant factors had better prediction performance (area under the receiver operating characteristic, 0.956) for child malnutrition.

Conclusion

Approximately 10% of Chinese children aged 3-14 years were in malnutrition status, and seven factors were found to be significant predictors for child malnutrition.

"11 for Health" in China - Effects on physical fitness in 9-11-year-old schoolchildren

ABSTRACTPrevious studies have shown that the school-based physical activity programme entitled "11 for Health" has been effective in improving the physical fitness, well-being and overall health profile of European children. The main purpose of the present study was to examine whether the "11 for Health" programme can have a positive impact on the physical fitness of primary school pupils in China. A total of 124 primary school pupils aged 9-11 years were included in the experiment, randomly divided into the experimental group (EG, n = 62) and the control group (CG, n = 62). EG carried out three weekly 35-minute sessions of small-sided football for a total of 11 weeks. All data were analysed by a mixed ANOVA with the Student-Newman-Keuls post hoc test. The results showed greater improvements (p<0.001) in EG than CG in relation to systolic blood pressure (-2.9 vs +2.0 mmHg). Moreover, greater improvements (all p<0.05) were observed in postural balance (13 vs 0%), standing long jump (5.0 vs 0.5%), 30-metre sprint (4.1 vs 1.3%) and Yo-Yo IR1C running performance (17% vs 6%). In both EG and CG, physical activity enjoyment was observed to be higher (P<0.05) compared to the start of the intervention with increases of 3.7 and 3.9 AU respectively. In conclusion, the study revealed that the "11 for Health" programme has positive effects on aerobic and muscular fitness, and it appears to be a relevant tool in the physical activity promotion in the Chinese school system.

Comparison of percutaneous vertebroplasty and conservative treatment for one level thoracolumbar osteoporotic compression fracture in a 3-year study

The efficacy of Mesh optimized versus standard percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures. Grid optimization (102 cases; 38 men, 64 women aged 67.3 ± 8.5) and traditional PVP groups (94 cases) were identified from 196 PVP patients treated from May 2016 to 2019. The optimal puncture site and angle forced bone cement into both groups before surgery. The main indexes were operation time, X-ray fluoroscopy times, bone cement injection volume, leakage, VAS, and injured vertebrae height. Preoperative general data were equivalent between groups (P > 0.05). All patients survived surgery without spinal cord injury, incision infection, pulmonary embolism, or death. The mesh optimization group had improved operation time (34.8 ± 6.5 min), fluoroscopy times (29.5 ± 5.5), bone cement injection volume (5.3 ± 2.1 ml), and bone cement permeability greater (3.9 percent; 4/98) than the standard PVP group (P < 0.05). Similarly, the grid optimization group had superior VAS scores (1.1 ± 0.6; 1.0 ± 0.3; and 0.9 ± 0.2) than the standard PVP group at 3 days, 3 months, and the last follow-up visit (P < 0.05). On day three after surgery, both had similar heights of injured vertebra's anterior and middle edges (P > 0.05). However, in the mesh optimization group, measurements improved to 1.8 ± 0.4 mm and (1.8 ± 0.3) mm by month three and to 1.7 ± 0.3 mm at last follow-up (P < 0.05). Mesh-optimized PVP with a mesh locator treats osteoporotic vertebral compression fractures more safely and effectively than regular PVP.

Long-term trends and urban-rural disparities in the physical growth of children and adolescents in China: an analysis of five national school surveys over three decades

BACKGROUND

China's rapid economic growth has brought opportunities for improved health and growth of children and adolescents. We sought to explore the long-term trends and urban-rural inequalities in physical growth (specifically height and BMI) among school-aged children and adolescents in China to identify policy priorities for a healthier generation.

METHODS

We used the 1985, 1995, 2005, 2014, and 2019 cycles of the Chinese National Survey on Students' Constitution and Health from primary and secondary schools in 30 mainland provinces, autonomous regions, and municipalities. We analysed height and BMI data for 7, 12, and 18 year old children and adolescents of Han ethnicity. Children and adolescents who had complete data on age, sex, location, weight, and height were included. All surveys used a multi-stage stratified random cluster sampling method and were nationally representative. A univariate kernel density estimation was used to plot the distribution of height and BMI. Quantile regression was used to examine associations between urban and rural locations and the primary outcomes of height and BMI at specific quantiles of distribution (5th, 25th, 50th, 75th, and 95th).

FINDINGS

Across the five surveys (in 1985, 1995, 2005, 2014, and 2019), 313 973 children and adolescents were included. From 1985 to 2019, the height and BMI distribution curves shifted to the right for each age group and sex, with the BMI curve becoming more dispersed. Median height in adolescents aged 18 years increased by 3·8 cm (95% CI 3·4-4·1) in boys in urban areas and 5·7 cm (5·3-6·1) in boys in rural areas, and 2·7 cm (2·4-3·0) in girls in urban areas and 3·7 cm (3·4-4·0) in girls in rural areas. Children in urban areas were taller than those in rural areas at every quantile, but the magnitude of this disparity narrowed by 2019. In 2019, the median height of boys in urban areas were 1·4 cm (1·0-1·8) greater in those aged 7 years, 2·5 cm (1·9-3·1) greater in those aged 12 years, and 1·1 cm (0·6-1·5) greater in those aged 18 years than their rural counterparts, whereas the median height of girls in urban areas were 1·1 cm (0·7-1·4) greater in those aged 7 years, 1·6 cm (1·1-2·1) greater in those aged 12 years, and 1·1 cm (0·7-1·5) greater in those aged 18 years than rural girls. Over this period, urban-rural differences in BMI disappeared at the lowest quantile, but persisted at higher quantiles. In 2019, the urban-rural differences in BMI for boys aged 12 years were 0·6 kg/m2 (95% CI 0·3-0·8) at the median, 1·0 kg/m2 (0·6-1·4) at the 75th quantile, and 0·7 kg/m2 (0·1-1·3) at the 95th quantile; for girls aged 12 years, 0·3 kg/m2 (0·1-0·5) at the median, 0·5 kg/m2 (0·2-0·8) at the 75th quantile, and 0·9 kg/m2 (0·3-1·5) at the 95th quantile; for boys aged 18 years, 0·6 kg/m2 (0·4-0·8) at the median, 0·8 kg/m2 (0·5-1·2) at the 75th quantile, and 0.7 kg/m2 (0·0-1·5) at the 95th quantile; and for girls aged 18 years, 0·2 kg/m2 (0·1-0·4) at the median, 0·5 kg/m2 (0·3-0·8) at the 75th quantile, and 1·0 kg/m2 (0·5-1·5) at the 95th quantile.

INTERPRETATION

Across three decades, school-aged children and adolescents in China have increased in height and BMI, with less disparity between urban and rural locations. Investments are needed to improve the affordability of healthy foods to help children and adolescents in rural areas reach their potential maximum height. Meanwhile, these changes in BMI necessitate tailored strategies according to urban-rural settings to contain the increase in overweight and obesity and promote optimal growth for children and adolescents.

FUNDING

Capital's Funds for Health Improvement and Research, and National Natural Science Foundation of China.

Adherence to 24-Hour Movement Guidelines in Relation to the Risk of Overweight and Obesity Among Children and Adolescents

PURPOSE

Adherence to overall 24-hour Movement Guidelines (24HGs) has been associated with childhood obesity in cross-sectional studies. However, few longitudinal studies have examined such associations, especially in China. We aimed to explore prospective associations between adherence to recommendations of 24HGs and risks of developing overweight and obesity among children and adolescents.

METHODS

We included participants (aged 6-17 years) without overweight and obesity at enrollment from the China Health and Nutrition Survey in 2004-2011 surveys and followed them till 2015. We assigned one point each to the adherence of guidelines for moderate-to-vigorous physical activity, recreational screen time and sleep, and summed them up to indicate the overall level of adherence to 24HGs (range: 0-3 points). The primary outcome was the first occurrence of overweight or obesity. Multivariable cox proportional hazard models were used to evaluate the corresponding associations.

RESULTS

Among 1,382 participants (mean age: 10.3 ± 3.2 years; 48.4% girls), a total of 152 (11%) individuals were identified as incident overweight and obesity during an average of 4.7 years of follow-up. Compared with participants nonadherent to any of the guidelines, those adhering to one (hazard ratio [HR] = 0.38, 95% confidence interval [CI]: 0.21-0.71, p < .01), two (HR = 0.49, 95% CI: 0.28-0.88, p = .02), and three (HR = 0.40, 95% CI: 0.17-0.91, p = .03) recommendations had significantly lower risks of developing overweight and obesity.

DISCUSSION

Children and adolescents who met any recommendations of 24HGs had significantly lower risks of developing subsequent overweight and obesity. Setting achievable goals such as adopting at least one recommendation could be considered in future public health recommendations to accelerate progress in childhood obesity prevention.