Evidence map›Paper›PMID 41715134›Full record

ArticleBMC medicine2026

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

Shan Cai, Jiaxin Li, Tianyu Huang, Yunfei Liu, Jiajia Dang, Ziyue Chen, Yihang Zhang, Ruolan Yang, Yang Yang, Ziyue Sun and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Shan CaiInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China.
Jiaxin LiInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China.
Tianyu HuangInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China.
Yunfei LiuInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China.
Jiajia DangInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China.
Ziyue ChenInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China.
Yihang ZhangInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China.
Ruolan YangInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China.
Yang YangInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China.
Ziyue SunInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China.
Peijin HuInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China.
Yanhui DongInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China. dongyanhui@bjmu.edu.cn.
Jun MaInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China.
Yi SongInstitute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China. songyi@bjmu.edu.cn.

Funding

National Key R&D Program of China 2024YFC2707901National Natural Science Foundation of China 82273654
6 · The paper itself

Abstract

backgroundThis 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.

methodsUsing 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.

resultsBoys' 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.

conclusionsThis 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.

Indexed as

Physical FitnessRural PopulationUrbanizationUrban PopulationAdolescentChildChinaFemaleHumansMaleSocioeconomic Disparities in HealthNutritionPediatricsPhysical fitnessUrbanization

Identifiers

PMID41715134
PMCPMC13023139

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.