Cited by 225Physical Activity and HealthObesity, Physical Activity, DietRecreational Sport and Physical Activity

The DOI matches its Crossref record; 133 of the 138 references it cites were found in a registry or an index; 8 of the 168 sources its claims cite were checked for support.

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

Open access

Abstract

China is experiencing significant public health challenges related to social and demographic transitions and lifestyle transformations following unprecedented economic reforms four decades ago. Of particular public health concern is the fourfold increase in overweight and obesity rates in the nation’s youth population, coupled with the low prevalence of adolescents meeting recommended levels of physical activity. Improving the overall health of China’s more than 170 million children and adolescents has become a national priority. However, advancing nationwide health initiatives and physical activity promotion in this population has been hampered by the lack of a population-specific and culturally relevant consensus on recommendations for achieving these ends. To address this deficiency and inform policies to achieve Healthy China 2030 goals, a panel of Chinese experts, complemented by international professionals, developed this consensus statement. The consensus was achieved through an iterative process that began with a literature search from electronic databases; in-depth reviews, conducted by a steering committee, of the resulting articles; and panel group evaluations and discussions in the form of email correspondence, conference calls and written communications. Ultimately, the panel agreed on 10 major themes with strong scientific evidence that, in children and adolescents aged 6–17, participating in moderate to vigorous physical activities led to multiple positive health outcomes. Our consensus statement also (1) highlights major challenges in promoting physical activity, (2) identifies future research that addresses current knowledge gaps, and (3) provides recommendations for teachers, education experts, parents and policymakers for promoting physical activity among Chinese school-aged children and adolescents. This consensus statement aligns with international efforts to develop global physical activity guidelines to promote physical activity and health and prevent lifestyle-related diseases in children and adolescents. More importantly, it provides a foundation for developing culturally appropriate and effective physical activity interventions, health promotion strategies and policy initiatives to improve the health of Chinese children and adolescents.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This expert consensus statement synthesizes evidence and provides recommendations on physical activity and health for Chinese children and adolescents aged 6–17, developed by a steering committee and expanded expert panel. It concludes that 60+ min/day of moderate-to-vigorous physical activity yields multiple health benefits and calls for culturally relevant policies and interventions, while noting limited high-quality China-based evidence.

Key findings

  • The panel agreed on 10 major themes with strong scientific evidence that, in children and adolescents aged 6–17, moderate to vigorous physical activity leads to multiple positive health outcomes; guidelines recommend ≥60 min/day, including aerobic, muscle-strengthening and bone-strengthening activities at least 3 days/week.
  • Physical activity levels are low in Chinese youth: less than a quarter (22%) engage in daily physical activity lasting 60 min or more; 85.8% engage in sedentary behaviours longer than 2 hours/day; only 15%–34% meet recommended physical activity guidelines; only 3 in 10 achieve an “excellent” or “good” national physical fitness rating; and only 0.5% have ideal cardiovascular health.
  • Overweight and obesity increased fourfold between 1995 and 2014, with around 1 in 5 children and adolescents overweight or obese; 35%–37% reported more than 2 hours/day of screen time in 2016–2017; projected childhood overweight/obesity prevalence is 28% (or 49.5 million children) by 2030.
  • The consensus highlights challenges and barriers, research gaps, and messages for teachers, education experts, parents and policymakers, including limiting recreational and non-school screen time to no more than 2 hours/day and creating supportive environments for physical activity.

Methods

  • A steering committee (n=4) conducted a literature search and review, identified key topic areas and drafted the initial consensus; an expanded panel of experts (n=16) reviewed it, with iterative email exchanges, conference calls and written communications, and the final version incorporated input from all participating members.
  • Electronic database searches (EBSCO, CNKI, PubMed, Cochrane Library, EMBASE, SinoMed and Web of Science; no publication-date restrictions) yielded 17,851 potential articles; 81 articles were included. The main search was conducted on 1 January 2019, and the latest search on 25 February 2020. Studies on children with chronic disease conditions or disabilities were excluded.
  • The consensus used an expert consensus development approach involving group decision-making, selecting individual studies, systematic reviews, consensus statements and meta-analyses based on the steering committee’s best judgement.

Limitations

  • Stated: there were limited high-quality Chinese-based studies and a paucity of research in certain health areas, so evidence was drawn primarily from international studies predominantly based on Caucasian populations.
  • Stated: the consensus is based on the panel’s best judgement rather than a quantitative synthesis such as meta-analysis; future updates should consider the GRADE process. It focuses on Chinese school-aged children and adolescents without disabling conditions and does not offer consensus for those with physical disabilities; limitations in available evidence may restrict absolute conclusions.
  • Evident from the text: many themes rely on “some evidence,” “preliminary evidence,” “insufficient evidence” or inconsistent findings (for example, physical activity and overweight/obesity independent of calorie intake, and school/community-based obesity prevention), so the strength of evidence varies across recommendations.

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Integrity signals

Registry

Crossref · 10.1136/bjsports-2020-102261

Cites

133 of 133 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

85 Not checked yet · 8 Own method · 5 Own interpretation · 4 No basis given · 1 Supported · 1 Supported so far · 1 Partly supported · accuracy not yet measured

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Show all 64 claims

  • It may state two separate claims as one. 29
  • Probably not a substantial claim. 20
41 of 41
  • The paper relies on this without support.

    There is a lack of a population-specific and culturally relevant consensus on recommendations for physical activity and health in Chinese children and adolescents.

    “However, advancing nationwide health initiatives and physical activity promotion in this population has been hampered by the lack of a population-specific and culturally relevant consensus on recommendations for achieving these ends.”
  • The paper relies on this without support.

    This consensus statement is the very first of its kind for children and adolescents in China.

    “These experts developed and finalised this physical activity and health consensus statement, which is the very first of its kind for children and adolescents in China.”
  • The paper relies on this without support.

    Motivation and compliance for actively engaging in (or changing) health-related behaviours are significantly impacted by sociocultural standards and traditions.

    “However, motivation and compliance for actively engaging in (or changing) health-related behaviours are significantly impacted by sociocultural standards and traditions.”
  • The paper relies on this without support.

    The science underlying current physical activity guidelines has generally been derived from a narrow set of populations (primarily North American and European) and is unlikely to drive wide-scale changes in activity behaviour in other cultures.

    “Although the science underlying current guidelines may be compelling, generally it has been derived from a narrow set of populations (primarily North American and European) and it is unlikely to drive wide-scale changes in activity behaviour in other cultures.”
  • The paper relies on this without support.

    Evidence from international studies predominantly based on Caucasian populations is applicable to Chinese children and adolescents.

    “Due to the limited number of high-quality Chinese-based studies and the paucity of research in certain areas of health, evidence for this consensus was drawn primarily from international studies that were predominantly based on Caucasian populations.”
  • The paper relies on this without support.

    There is a significant lack of school and community-based physical activity interventions or programmes that can guide and aid the development of national physical activity guidelines for Chinese children and adolescents.

    “There is a significant lack of school and community-based physical activity interventions or programmes that can guide and aid the development of national physical activity guidelines for Chinese children and adolescents.”
  • The paper relies on this without support.

    Currently, there is a lack of school-based physical activity policies and initiatives established on a local, provincial or national scale that can effectively promote, impact and sustain school-level physical activities for children and adolescents inside and outside school settings.

    “Currently, there is a lack of school-based physical activity policies and initiatives established on a local, provincial or national scale that can effectively promote, impact and sustain school-level physical activities for children and adolescents inside and outside school settings.”
  • The paper relies on this without support.

    Given the major emphasis in China on academic excellence over physical education and recreational physical activity, there is a significant cultural challenge in changing attitudes and expectations of parents and schools with regard to meeting recommended physical activity or physical fitness levels.

    “Given the major emphasis in China on academic excellence over physical education and recreational physical activity, there is a significant cultural challenge in changing attitudes and expectations of parents and schools with regard to meeting recommended physical activity or physical fitness levels.”
  • The paper relies on this without support.

    There is a lack of partnerships in which a wide variety of organisations (eg, schools, parents, public education, private organisations, community groups) can collaborate to promote physical activity for children and adolescents.

    “There is a lack of partnerships in which a wide variety of organisations (eg, schools, parents, public education, private organisations, community groups) can collaborate to promote physical activity for children and adolescents.”
  • The paper relies on this without support.

    There is a lack of information on potential barriers to promoting and implementing physical activity policies in school and/or community settings.

    “There is a lack of information on potential barriers to promoting and implementing physical activity policies in school and/or community settings.”
  • The paper relies on this without support.

    Practice and promotion of physical activity for Chinese children and youth has not been given a high public health priority at the school, community and policy level.

    “Despite a wealth of evidence about the health benefits of physical activity for children and adolescents, practice and promotion of physical activity for Chinese children and youth has not been given a high public health priority at the school, community and policy level.”
  • The paper relies on this without support.

    Promoting physical activity requires policies.

    “Promoting physical activity requires policies.”
  • The paper relies on this without support.

    Physical inactivity and low levels of physical activity are a global public health problem associated with an array of negative health outcomes for school-aged children and adolescents.

    “Physical inactivity and low levels of physical activity are a global public health problem associated with an array of negative health outcomes for school-aged children and adolescents.”
  • The paper relies on this without support.

    China has not been immune to this global concern as evidenced by inadequate levels of physical activity and energy imbalance among its approximately 170 million children and adolescents.

    “China has not been immune to this global concern as evidenced by inadequate levels of physical activity and energy imbalance among its approximately 170 million children and adolescents.”
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Citations

Cites

Research works printed but not linked: 2

  1. 2017, Chinese children and adolescents physical activity guidelines, Chin J Evid Based Pediatr, 12, 401
  2. García-Hermoso, 2019, Exercise, health outcomes, and pædiatric obesity: a systematic review of meta-analyses, J Sci Med Sport, 22, 76, 10.1016/j.jsams.2018.07.006 · DOI · Paper page

Cited by

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Metadata

Authors
Chen, P., Wang, D., Shen, H., Yu, L., Gao, Q., Mao, L., Jiang, F., Luo, Y., Xie, M., Zhang, Y., Feng, L., Gao, F., Wang, Y., Liu, Y., Luo, C., Nassis, G. P., Krustrup, P., Ainsworth, B. E., Harmer, P. A., & Li, F.
Affiliations
  • Shanghai University of Sport (CN)
  • Ministry of Education of the People's Republic of China (CN)
  • Nanjing Medical University (CN)
  • Shanghai Municipal People's Government (CN)
  • Nanjing University (CN)
  • Shanghai Municipal Education Commission (CN)
  • Shanghai Jiao Tong University (CN)
  • Shenzhen University (CN)
  • General Administration of Sport of China (CN)
  • Tianjin University of Sport (CN)
  • China Institute of Sport Science (CN)
  • Air Force Medical University (CN)
  • Sixth Affiliated Hospital of Sun Yat-sen University (CN)
  • Shanghai Municipal Center For Disease Control Prevention (CN)
  • University of Southern Denmark (DK)
  • Willamette University (US)
  • Oregon Research Institute (US)
Corresponding author
Chen, Peijie
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2020-05-29
Volume
54
Issue
22
Pages
1321-1331
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
OpenAlex
W3028904203
Cited by
225
References
138
Citations by year
2026: 39 · 2025: 60 · 2024: 47 · 2023: 28 · 2022: 31 · 2021: 19 · 2020: 1
FWCI
11.88
Type
journal article
Language
en
Open access
Locations
  • British Journal of Sports Medicine (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by-nc)
  • HighWire Press Open Archive (submittedVersion)
Funders
The National Social Science Fund of China (19ZDA352)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Social Sciences › Life-span and Life-course Studies › Recreational Sport and Physical Activity
Keywords
physical activity, children and adolescents, physical activity guidelines, moderate-to-vigorous physical activity, childhood obesity, overweight, physical activity promotion, physical activity interventions, health promotion policy, Healthy China 2030, lifestyle-related diseases, Chinese youth
MeSH terms
Healthy Lifestyle, Academic Success, Adolescent, Child, China, Cognition, Environment, Health Policy, Humans, Physical Fitness, Social Class, Exercise, Healthy People Programs, Overweight, Pediatric Obesity

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