{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:29:12Z","timestamp":1787027352180,"version":"build-2736575974"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The decline in physical fitness among university students has become a global concern. Traditional single-metric evaluation methods, such as body mass index (BMI) alone, cannot comprehensively capture students\u2019 health status. This study aimed to establish a BMI\u2013Physical Fitness and Health (PFAH) cross-classification framework to identify distinct risk groups and their characteristics, providing evidence for targeted intervention strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted among 3,026 Chinese college students (1,435 males, 1,591 females; aged 18\u201322 years) assessed using the National Student Physical Fitness and Health Standard. Participants were cross-classified into eight groups according to BMI categories (normal, overweight, obese) and PFAH levels (good, pass, fail). Heat maps, radar charts, and receiver operating characteristic (ROC) curve analyses were used to visualize group features and identify key predictive indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The most prevalent group was normal-pass (52.1%), followed by normal-good (22.2%) and overweight-pass (11.6%). High-risk groups\u2014obesity-pass, normal-fail, overweight-fail, and obesity-fail\u2014accounted for 3.0%, 4.7%, 2.5%, and 3.0% of the sample, respectively. Each high-risk group exhibited distinct fitness deficiencies: the obesity-pass group had significantly elevated BMI (z = 2.45); the normal-fail group showed poor speed (50 m: z = 0.69); the overweight-fail group displayed reduced flexibility (sit-and-reach: z = \u20130.47) and muscular endurance (sit-ups: z = \u20130.45); and the obesity-fail group performed worst in cardiopulmonary endurance (1,000 m: z = 1.60; 800 m: z = 2.30) and muscular strength (pull-ups: z = \u20130.86). BMI, endurance (1,000 m\/800 m), and speed (50 m) were the strongest predictors for identifying high-risk males (AUC = 0.902, 0.801, 0.792) and females (AUC = 0.895, 0.874, 0.731).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The BMI\u2013PFAH cross-classification framework effectively distinguishes diverse risk profiles among university students, revealing hidden risk populations (normal BMI but failing fitness) that traditional BMI-based assessments might overlook. Based on these findings, targeted interventions should include weight management while maintaining fitness for the obesity-pass group, anaerobic and speed training for the normal-fail group, and comprehensive improvements in cardiopulmonary function, muscular strength, and flexibility for overweight\/obesity-fail groups. This framework provides a practical basis for developing evidence-based health education and personalized intervention strategies in higher education settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1660686","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T05:24:25Z","timestamp":1761801865000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Risk identification and improvement strategies for BMI and physical fitness and health grade cross-classification: a cross-sectional study based on Chinese college students"],"prefix":"10.3389","volume":"13","author":[{"given":"Hao","family":"Guo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br J Sports Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-015-1553-4","article-title":"Determinants of physical activity and sedentary behaviour in university students: a qualitative study using focus group discussions","volume":"15","author":"Deliens","year":"2015","journal-title":"BMC Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1001\/jama.2013.168118","article-title":"Prevalence and 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achievement in healthy adolescents","volume":"57","author":"Haverkamp","year":"2021","journal-title":"Psychol Sport Exerc"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1123\/japa.7.3.217","article-title":"Physical fitness, cognitive function, and health-related quality of life in older adults","volume":"7","author":"Wood","year":"1999","journal-title":"J Aging Phys Act"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1111\/mono.12133","article-title":"The history of physical activity and academic performance research: informing the future","volume":"79","author":"Castelli","year":"2014","journal-title":"Monogr Soc Res Child Dev"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.25236\/FER.2020.030505","article-title":"Health education in Chinese universities: status quo, problems and countermeasures","volume":"3","author":"Wang","year":"2020","journal-title":"Front Educ Res"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2498","DOI":"10.1001\/jama.2021.22208","article-title":"Prevalence and treatment of diabetes in China, 2013-2018","volume":"326","author":"Wang","year":"2021","journal-title":"JAMA"},{"key":"ref12","volume-title":"Definition, diagnosis and classification of diabetes mellitus and its complications","year":"1999"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1016\/j.pcad.2018.07.008","article-title":"Role of physical activity and fitness in the characterization and prognosis of the metabolically healthy obesity phenotype: a systematic review and meta-analysis","volume":"61","author":"Ortega","year":"2018","journal-title":"Prog Cardiovasc Dis"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"819","DOI":"10.2147\/DMSO.S237550","article-title":"The impact of BMI categories on metabolic abnormality development in Chinese adults who are metabolically healthy: a 7-year prospective 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An integrative review","volume":"35","author":"Stimson","year":"2024","journal-title":"Health Promot J Austr"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"87","DOI":"10.3200\/JACH.54.2.87-94","article-title":"College students' motivation for physical activity: differentiating men's and women's motives for sport participation and exercise","volume":"54","author":"Kilpatrick","year":"2005","journal-title":"J Am Coll Heal"},{"key":"ref22","volume-title":"Male group fitness participation trends, barriers, and needs as discovered through literary review and university survey: the Ohio State University","author":"McGovern","year":"2012"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12966-015-0173-9","article-title":"Changes in weight, physical activity, sedentary behaviour and dietary intake during the transition to higher education: a prospective study","volume":"12","author":"Deforche","year":"2015","journal-title":"Int J Behav Nutr Phys Act"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"158","DOI":"10.3390\/ijerph19010158","article-title":"Physical activity and physical fitness among university students\u2014a systematic review","volume":"19","author":"Kljajevi\u0107","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"37","DOI":"10.3200\/JACH.56.1.37-42","article-title":"The prevalence of physical activity maintenance in a sample of university students: a longitudinal study","volume":"56","author":"Irwin","year":"2007","journal-title":"J Am Coll Heal"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"7","DOI":"10.61838\/kman.aitech.2.2.2","article-title":"Comparing the physical fitness conditions of boys' school students in the city of Kashan","volume":"2","author":"Sayyah","year":"2024","journal-title":"AI Tech Behav Soc Sci"},{"key":"ref27","first-page":"1165","article-title":"Pulmonary function is related to basic physical fitness and physical activity in college students","volume":"38","author":"Bae","year":"2021","journal-title":"J Korean Appl Sci Technol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1038\/oby.2008.584","article-title":"Obesity is associated with altered lung function independently of physical activity and fitness","volume":"17","author":"Steele","year":"2009","journal-title":"Obesity"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1161\/CIRCULATIONAHA.108.189702","article-title":"Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: a scientific statement from American Heart Association Council on epidemiology and prevention, interdisciplinary Committee for Prevention (formerly the expert panel on population and prevention science)","volume":"118","author":"Kumanyika","year":"2008","journal-title":"Circulation"},{"key":"ref30","first-page":"103","article-title":"Low-intensity exercise as a treatment intervention in obese adults","volume-title":"Handbook of obesity intervention for the lifespan","author":"Verschell","year":"2008"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1791","DOI":"10.7752\/jpes.2020.04243","article-title":"Effect of high intensity functional training and traditional resistance training on aerobic, anaerobic, and musculoskeletal fitness improvement","volume":"20","author":"Mcweeny","year":"2020","journal-title":"J Phys Educ Sport"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"165","DOI":"10.21767\/1791-809X.100676","article-title":"Resistance training for health and performance","volume":"1","author":"Kraemer","year":"2002","journal-title":"Curr Sports Med Rep"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"953","DOI":"10.2165\/00007256-200131140-00001","article-title":"Prescription of resistance training for healthy populations","volume":"31","author":"Hass","year":"2001","journal-title":"Sports Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"3887","DOI":"10.1080\/09638288.2024.2439017","article-title":"Progressive resisted exercise program combined with aerobic exercise on osteoporotic systemic lupus erythematous patients: a prospective randomized controlled trial","volume":"47","author":"Eladl","year":"2024","journal-title":"Disabil Rehabil"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1139\/apnm-2020-0972","article-title":"Aerobic training, resistance training, or their combination as a means to fight against excess weight and metabolic syndrome in obese students\u2014which is the most effective modality? 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