Age- and Sex-Specific Physical Fitness Reference and Association with Body Mass Index in Hong Kong Chinese Schoolchildren.

There is lacking a population-based study on the fitness level of Hong Kong schoolchildren, and it seems that increasing childhood obesity prevalence has shifted the classification of healthy fitness, with 'underfit' as normal. This cross-sectional territory study aimed to develop an age- and sex-specific physical fitness reference using a representative sample of children aged 6-17 and to determine the associations with body mass index in schoolchildren. The study analyzed Hong Kong School Physical Fitness Award Scheme data covering grade 1 to grade 12 students' physical fitness and anthropometric measurements from 2017 to 2018. This reference was established without the impact due to COVID-19. Four aspects of physical fitness tests were measured using a standardized protocol, including (i) upper limb muscle strength, (ii) one-minute sit-up, (iii) sit-and-reach, and (iv) endurance run tests. The generalized additive model for location, scale, and shape was used to construct the reference charts. A Mann-Whitney U test was used to compare the mean differences in age, weight, and height, and a Pearson's chi-square test was used to examine the distributions of sex groups. A Kruskal-Wallis test was used to compare the group differences in BMI status, followed by the Dunn test for pairwise comparisons. A 5% level of significance was regarded as statistically significant. Data of 119,693 students before the COVID-19 pandemic were included in the analysis. The association between physical fitness level and BMI status varied depending on the test used, and there were significant differences in fitness test scores among BMI groups. The mean test scores of the obese group were lower in most of the tests for both boys and girls, except for handgrip strength. The underweight group outperformed the obese group in push-ups, one-minute sit-ups, and endurance run tests, but not in handgrip strength. In conclusion, a sex- and age-specific physical fitness reference value for Hong Kong Chinese children aged 6 to 17 years old is established, and this study demonstrated a nonlinear relationship between BMI status and physical fitness. The reference will help to identify children with poor physical fitness to offer support and guidance on exercise training. It also serves as a baseline for assessing the impact of the COVID-19 pandemic on Hong Kong students' physical fitness.

Results from the Hong Kong's 2022 report card on physical activity for children and adolescents

Background/objective This paper aimed to summarize the findings of the third (2022) Active Healthy Kids Hong Kong Report Card on Physical Activity for Children and Adolescents and evaluate the secular trends of physical activity related indicators. Methods Five behavioral indicators (Overall Physical Activity, Organized Sport and Physical Activity, Active Play, Active Transportation, and Sedentary Behavior), three outcome indicators (Physical Fitness, Sleep, and Obesity) and four sources of influence indicators (Family and Peers, School, Community and Environment, and Government) were assigned a letter grade (ranging from A+ to F or incomplete) based on the best available evidence following a harmonized approach developed by the Active Healthy Kids Global Alliance. Data sources included published journal articles, government reports, manual searches, and personal contacts;and consisted of both pre-COVID-19 and after-COVID-19 evidence. Results Grades for Overall Physical Activity (D−**) and Sedentary Behavior (D) deteriorated compared to the 2018 Report Card. The other three behavioral indicators, Organized Sport and Physical Activity, Active Play, and Active Transportation, were assigned B−, D, and B+, respectively. Physical Fitness (D), Sleep (C−), and Obesity (D−) obtained the same grades as in the 2018 Report Card. School (B) and Government (C+) grades slightly improved, while Community and Environment grade (B) was stable. Family and Peers was not graded due to insufficient evidence. Conclusions Despite slight improvements in influence indicators, physical activity and sedentary behavior have changed unfavorably for children and adolescents in Hong Kong. Strategic investments are needed to improve adoption and implementation of effective interventions.