Promoting physical activity among Chinese youth: No time to wait.

Dear Editor,

In the December 2016 issue of Journal of Sport and Health Science, Dr. Barbara E. Ainsworth highlighted a global view of youth physical activity (PA) based on the results from the Global Matrix 2.0. Joining 38 countries on 6 continents, China, as the most populous country in the world, has for the first time presented its 2016 Report Card on 9 indicators of PA. Unfortunately, China's inaugural Report Card shows an F rating assigned to both the overall PA level and sedentary behaviors for children and youth in China, which is even lower than the average grade of D assessed for the rest of the world. Only 19.7% of children and adolescents (boys: 21.6%; girls: 17.6%) in China met the recommended PA guidelines, defined as being physically active at least 60 min daily. More than 75% of youths were sedentary at least 2 h daily (weekdays: 75.2%; weekends: 88.6%). These numbers on the levels of insufficient PA are very similar to the global findings.

It has been well documented that regular PA of moderate intensity has significant health benefits for young people and that the lack of PA is one of the predominant risk factors associated with many non-communicable chronic diseases (NCDs) in their later lives. The World Health Organization (WHO) has identified physical inactivity as the fourth leading risk factor for global mortality. For nearly 400 million Chinese youths, physical inactivity leads not only to a decrease in physical fitness but also to an increase in obesity and NCDs, which may cause tremendous individual, family, and social problems.

In response to the challenges related to young people's PA and health, the Chinese government in the past decade has issued a series of policies and planned interventions (2007: No. 7; 2012: No. 53; and 2016: No. 27). In 2006, the Ministry of Education, the General Administration of Sport in China, and the Central Committee of the Chinese Communist Youth League carried out the “Sunshine Physical Exercise Project” to promote at least 60 min of physical exercise, school wide, for every school-aged child. In addition, the Physical Education Curriculum for Chinese Basic Education has been reformed 4 times in the past 2 decades in an effort to enhance students' physical fitness and health through PA. However, evidence from recent PA surveys and physical fitness testing indicate that these policies and reforms have not brought about significant positive changes in the overall PA levels and physical fitness of young people in China.

In Global Matrix 2.0, Slovenia was awarded the highest grade for overall PA among the 38 participating countries, a success that is possibly attributable to the country's practice of conducting regular nationwide school-based physical fitness assessments. The results are kept up to date and are subsequently used to inform policies on the implementation of evidence-based PA programs. Similar efforts also exist in China. For example, nationwide physical fitness testing has been conducted since 1954. In 2014, the new China National Standard of Students' Physical Fitness was released, which prescribed annual compulsory physical fitness testing for every student from the primary school grades through university or college. However, information from these large-scale fitness assessments has not been effectively used to transform or guide the implementation of evidence-based school PA programs.

There are some action steps that must be taken to ensure the success of PA and health promotion in Chinese schools. The first step in designing and implementing effective policies and interventions for increasing young people's PA is to understand its current status. Although China's physical fitness testing system has been around for many years, nationwide longitudinal surveillance data on PA among children and adolescents in China is still lacking. Most Chinese studies on PA are cross-sectional and non-population based in design and involve the use of diverse outcome measures; these design deficiencies have made it difficult to track and monitor the overall levels of PA among Chinese young people. Therefore, there is an urgent need to establish a surveillance system that systematically monitors PA and sedentary behaviors at the local and national levels. To achieve this goal, a collaborative, coordinated effort that involves various central and local government authorities is needed.

The second step is to understand the key determinants and correlates of young people's PA in China. Based on socio-ecological models, the determinants of PA can be summarized as having 5 components: individual, interpersonal, environmental, regional and national, and global. Much research on identifying the determinants and the correlates of young people's PA has been conducted in the US and European countries. This line of research is significantly underdeveloped in China. To address this limitation, researchers at the Shanghai University of Sport, in collaboration with researchers from the Ministry of Education of China, are conducting analyses of the national surveillance data to examine the prevalence of PA and the relationships between social contextual factors and PA among children and youth. Once completed, findings from the analyses are expected to provide important policy-level information to guide decision-making in promoting community-wide PA strategies and initiatives for Chinese children and youth.

As indicated by Dr. Barbara E. Ainsworth, the grades from the Global Matrix report cards reflect a late start in recognizing physical inactivity as a global public health problem. Indeed, China has had an even later start because the importance of being physically active has not yet been fully appreciated. WHO member-states have agreed to reduce physical inactivity by 10% by 2025, and the newly released “Healthy China 2030” blueprint clearly states that children should engage at least 1 h of PA daily in school. Thus, there is an urgent need for (1) establishing a nationwide PA surveillance system to facilitate monitoring PA levels of Chinese children and youth, (2) encouraging the study of determinants and correlates of PA, and (3) assisting in the design and implementation of evidence-based school interventions for increasing the PA level of nearly 400 million Chinese youth. If the F grade China received for the PA level of this population is to be changed, there is no time to wait!

Competing interests

The author declares that he has no competing interests.