{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:12:46Z","timestamp":1787760766318,"version":"build-2784847793"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"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>\n                      To explore the relationship between physical health and physical fitness index (PFI) in adolescents aged 10 to 19 in Shandong Province. We aimed to offer evidence to support the local implementation of the\n                      <jats:italic>National Student Physical Health Standard<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data were obtained from 51,764 adolescents aged 10 to 19 through the Shandong Student Physical Fitness and Health Surveys conducted in 2015, 2016, 2017, and 2020. Assessment of physical fitness included five core items: 50 running, sit and reach, standing long jump, 1,000 running\/800 running, and pull-ups\/sit-ups, which were then used to calculate the overall PFI. Body Mass Index (BMI) is defined according to the thresholds specified in t\n                      <jats:italic>he National Student Physical Health Standards (2014 Revision)<\/jats:italic>\n                      , categorized by gender and grade level: underweight, normal weight, overweight\/obese. Socioeconomic data come from provincial statistical yearbooks. We used generalized additive models and logistic regression analyses to examine the associations between PFI and BMI and between PFI and the prevalence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Normal-weight individuals had the greatest fitness, and fitness declined in underweight and overweight groups. There was an inverted \u201cU\u201d-shaped curve relationship between BMI-Z and PFI. With comparable BMI, PFI changes was higher in females than males. The PFI and the prevalence of overweight\/obese showed a consistent upward trend over the years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Females outperformed males in physical fitness, and fitness levels have improved over time. However, the prevalence of overweight\/obese continues to rise, indicating a persistent imbalance between muscle and fat. This suggests that the region may be facing a \u201cdevelopment\u2013health paradox.\u201d<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1694201","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T06:35:29Z","timestamp":1772433329000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Physical health and fitness index in Chinese adolescents: a four-year cross-sectional study in Shandong Province"],"prefix":"10.3389","volume":"14","author":[{"given":"Linlin","family":"Huang","sequence":"first","affiliation":[{"name":"School of Youjiang Medical College for Nationalities of Public Health","place":["Baise, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junxiang","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Youjiang Medical College for Nationalities of Public Health","place":["Baise, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiling","family":"Wei","sequence":"additional","affiliation":[{"name":"School of Youjiang Medical College for Nationalities of Public Health","place":["Baise, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Guo","sequence":"additional","affiliation":[{"name":"School of Youjiang Medical College for Nationalities of Public Health","place":["Baise, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/sj.ijo.0803774","article-title":"Physical fitness in childhood and adolescence: a powerful marker of health","volume":"32","author":"Ortega","year":"2008","journal-title":"Int J Obes"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1016\/S0140-6736(16)30054-X","article-title":"Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19\u00b72 million participants","volume":"387","year":"2016","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"S9","DOI":"10.1016\/j.jadohealth.2024.04.015","article-title":"Trends in adolescent health: successes and challenges from 2010 to the present","volume":"75","author":"Beckwith","year":"2024","journal-title":"J Adolesc Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1016\/S2213-8587(19)30075-0","article-title":"Economic development and the nutritional status of Chinese school-aged children and adolescents from 1995 to 2014: an analysis of five successive national surveys","volume":"7","author":"Dong","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1080\/02701367.2019.1603768","article-title":"The relationships between weight status and physical fitness-among Chinese children and youth","volume":"90","author":"Zhang","year":"2019","journal-title":"Res Q Exerc Sport"},{"key":"ref6","year":"2021"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"11","DOI":"10.3760\/cma.j.cn112150-20220906-00881","article-title":"Epidemiology and prediction of overweight and obesity among children and adolescents aged 7-18 years in China from 1985 to 2019","volume":"57","author":"Dong","year":"2023","journal-title":"Zhonghua Yu Fang Yi Xue Za Zhi"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"411","DOI":"10.19723\/j.issn.1671-167X.2024.03.006","article-title":"Comparative research on the relationship between body mass index and physical fit-ness index among the Uygur, Kazakh and Han ethnic college students. 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