Step it up: Promoting physical activity in school-aged children and adolescents in China

In this special issue of the Journal of Sport and Health Science, a series of articles describe the results of the 2016 Physical Activity and Fitness in China—The Youth Study. The results show a relatively high prevalence of sedentary behaviors, unhealthy weight, lower fitness levels, and lower levels of engagement in physical exercise and fitness activities than anticipated. Of additional concern are differences by sex, residence locale, and grade levels. While disappointing, there is room for optimism that these metrics can be improved in coming years.

Multiple health promotion efforts are underway in China designed to improve health systems and expand opportunities for all persons to become more physically active and physically fit. The activities reflect an ecological approach that involves multiple influences to improve physical exercise and physical fitness. As described by Sallis et al.,¹ the social environment, physical environment, and policies influence whether a person decides to engage in physical activity behaviors. These influences have the potential to bridge one's intrapersonal characteristics (e.g., age, sex, and self-motivation) with their perceptions of physical activity environments (e.g., accessibility, safety), characteristics of the places where people can be active (e.g., schools, neighborhoods, homes), and policies that govern access to exercise areas (e.g., zoning codes, pubic recreation investment).

Recent initiatives in China reflect a multilevel ecological approach to create active living communities that can improve physical exercise and physical fitness levels in children and adolescents. Guided by Healthy China 2030,2, 3 an outcome of the 9th Global Conference on Health Promotion,⁴ strategic goals and key indicators have been developed to guide health-promoting actions for Chinese populations. Central to the vision of promoting health through action, strategies call for environmental, community, educational, medical, and policy initiatives that invite all persons to be physically active and more physically fit.

Four activities within the strategic goal, “to increase the proportion of Chinese children and adolescents who engage in targeted levels of physical exercise and who meet the fitness standards (as defined in the National Physical Fitness Standards)”⁴ are identified. The first activity is to improve physical fitness services. The plan proposes having a network of public sports facilities in villages, townships, and county levels where people can be active within a 15 min walk from their homes. Combined with the networks, it is proposed that defined sports grounds of no less than 2.3 m² per capita be built for exercise and sports participation.

The second activity proposes a nationwide fitness campaign. Within the facilities and space developed, cultural, geographic, age- and gender-appropriate exercise opportunities and sports events should be offered to all persons. These opportunities could be provided through adoption of existing favored exercises and the development of new activities that offer all persons, especially children and adolescents, an intentional space to engage in health-enhancing and fitness-promoting physical exercise and sports.

The third activity is to promote physical exercise among priority groups. Teenage years show the greatest decline in exercise and sports participation, especially among girls.⁵ Various individual, social, and environmental factors can modify this decline. Opportunities to learn fundamental motor skills in pre-adolescence and sports skills in middle schools also can help to maintain lifelong physical activity habits.⁶ Assuring that students have access to daily physical education in schools and opportunities to develop sport skills in community settings are two ways students can learn new skills. This education, combined with easy access to networks of sports grounds with organized physical exercise and sports opportunities, achieving 60 min of daily physical exercise is possible.

The fourth activity is to integrate sports exercises with medical care decision-makers and to strengthen non-medical health interventions. As people seek medical care for various reasons, health care providers can be aware of physical exercise and fitness guidelines to help each patient engage in health-enhancing physical exercise.⁷ This is especially important for youth who are overweight and obese.

While necessary, national goals are not sufficient to assure that children and adolescents will engage in physical exercise at levels to improve their physical fitness. Parents and extended families, schools, parks and recreation departments, and other community organizations need to act intentionally to assure that youth have the opportunities to be physically active. In short, we need to “step it up” to get youth away from the screens and onto the playing fields.

Numerous examples of approaches to increase physical exercise and physical fitness in youth are available on the website. One example is the Youth Physical Activity Toolkit User Guide⁸ developed by the U.S. Centers for Disease Control and Prevention (CDC). The toolkit provides a set of handouts, videos, power point slides, and instructions for active games that engage students intellectually and physically. The CDC also provides ways that families, schools, and community organizations can intentionally encourage children and adolescents to increase their physical exercise. For example, schools can provide quality physical education by creating activities that are enjoyable and have students moving for at least 50% of the class time. Schools also can provide recess and physical activity breaks for children in lower grades. After school intramural sports activities can be effective in increasing exercise after school hours.⁹ Parents can incorporate physical activities into birthday parties, family gatherings, and family outings. They also can chose activity-oriented gifts such as jump ropes, bicycles, or fitness club memberships instead of gifts that promote sedentary behaviors.10, 11 As outlined in Healthy China 2030, communities can make changes that make it easier to be physically active and help children and adolescents find safe and accessible places where they can exercise.¹² Communities also can work with schools to increase out of school exercise opportunities and partner with other community groups to provide popular activities that promote physical fitness that are fun (e.g., youth sports, Youth Fitness Warriors¹³).

The relatively high prevalence of sedentary behaviors, unhealthy weight, lower fitness levels, and low engagement in physical exercise and fitness activities among Chinese children and adolescents meets the definition of a public health problem. It affects the health, function, and well-being of a large number of people and it has as its major impact, the reduction of the health of children and adolescents. Of concern are the differences in the study results observed by gender, residence locale, and grade levels as this reflects health disparities among some high-risk populations disproportionally to the rest of society. If not addressed as a community responsibility, participation in physical exercise, physical fitness levels, and rates of overweight and obesity will get worse in larger proportions of children. The best approach to reverse these concerns is for government agencies, community groups, families, and youth themselves to “step it up” by making prompt and coordinated efforts to help children and adolescents move away from their screens and onto the play grounds.

Competing interests

The author declares that she has no competing interests.