{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:01:24Z","timestamp":1790146884727,"version":"4.0.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"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>Purpose<\/jats:title>\n                    <jats:p>To develop and validate a dynamic risk prediction model (Landmark Supermodel) for identifying college students at risk of physical fitness failure by senior year, and to determine the optimal intervention window through sequential risk updating.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 4,006 college students (2,745 males; 1,261 females) with four-year longitudinal physical fitness test data were included. Ten physical fitness indicators were assessed annually. Sex-stratified Landmark Supermodels were constructed at three landmark time points using Random Forest and XGBoost classifiers with 57 engineered features encompassing static snapshots, cumulative summaries, change trajectories, variability, and interaction terms. Model performance was evaluated by AUC, Brier score, calibration curves, and decision curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The Random Forest Landmark Supermodel achieved AUC of 0.842 (95% CI: 0.831\u20130.853) for males and 0.773 (95% CI: 0.737\u20130.818) for females. AUC improved from 0.751 (post-freshman) to 0.858 (post-sophomore) to 0.894 (post-junior) in males. At the junior-year landmark, risk stratification separated male students into high-risk (44.3% failure rate), medium-risk (6.7%), and low-risk (1.3%) groups. Vital capacity, endurance running performance, and BMI trajectories emerged as the most important predictive features.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Dynamic landmark risk prediction can accurately identify students at risk of physical fitness failure, with the sophomore year representing the optimal intervention window. The model provides an evidence-based tool for individualized early warning in physical education.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1921844","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:17:09Z","timestamp":1790144229000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dynamic risk prediction of physical fitness failure in college students: a four-year longitudinal landmark supermodel study"],"prefix":"10.3389","volume":"14","author":[{"given":"GuanYu","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Sport Science, Nanjing Normal University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XuPeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Physical Education, Nanjing University of Aeronautics and Astronautics","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Han","sequence":"additional","affiliation":[{"name":"School of Information and Software Engineering, University of Electronic Science and Technology of China","place":["Chengdu, China"]},{"name":"Electric Power Research Institute, State Grid Jiangsu Electric Power Co., Ltd.","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ZhenYu","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital with Nanjing Medical University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DanPing","family":"Shi","sequence":"additional","affiliation":[{"name":"Nanjing Yueyuan No.1 Primary School","place":["Nanjing, 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men","volume":"45","author":"H\u00f6gstr\u00f6m","year":"2016","journal-title":"Int J Epidemiol"},{"key":"ref7","doi-asserted-by":"crossref","DOI":"10.1093\/acprof:oso\/9780199929382.001.0001","volume-title":"Emerging Adulthood: The Winding Road from the Late Teens through the Twenties","author":"Arnett","year":"2014"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e039831","DOI":"10.1136\/bmjopen-2020-039831","article-title":"Mapping the evidence regarding school-to-work\/university transition and health inequalities among young adults: a scoping review protocol","volume":"10","author":"Matos Fialho","year":"2020","journal-title":"BMJ Open"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1016\/j.amepre.2014.07.035","article-title":"Change in weight and adiposity in college students: a systematic review and meta-analysis","volume":"47","author":"Fedewa","year":"2014","journal-title":"Am J Prev 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research","volume":"6","author":"Nagin","year":"2010","journal-title":"Annu Rev Clin Psychol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1186\/s13104-024-06967-6","article-title":"Exploring the correlation between body mass index and lung function test parameters: a cross-sectional analytical study","volume":"17","author":"Elsaidy","year":"2024","journal-title":"BMC Res Notes"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.jneb.2007.01.001","article-title":"Changes in weight and health behaviors from freshman through senior year of college","volume":"40","author":"Racette","year":"2008","journal-title":"J Nutr Educ Behav"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1109\/TKDE.2008.239","article-title":"Learning from imbalanced data","volume":"21","author":"He","year":"2009","journal-title":"IEEE Trans Knowl Data 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