title: BMI, leisure-time physical activity, and physical fitness in adults in China: results from a series of national surveys, 2000-14.
abstract: Obesity, physical inactivity, and reduced physical fitness contribute to the rising burden of chronic diseases in China. We investigated these factors in Chinese adults over a 14-year period (2000-14) using data from randomised national surveys.
  
  
  
  We did four national surveys in 2000, 2005, 2010, and 2014 among Chinese adults aged 20-59 years. We used BMI to assess underweight (<18·5 kg/m(2)), overweight (≥23·0 to <27·5 kg/m(2)), and obesity (≥27·5 kg/m(2)). Central obesity was defined as a waist circumference greater than 90 cm in men and greater than 85 cm in women. We assessed leisure-time physical activity (LTPA) by whether or not participants had completed the recommended minimum 150 min of moderate or 75 min of vigorous exercise per week. Indices for assessment of physical fitness were forced vital capacity, resting heart rate, hand grip strength, sit and reach distance, and time standing on one leg.
  
  
  
  151 656 (78%) of 193 440 adults responded to the survey in 2000, 163 386 (84%) in 2005, 154 931 (80%) in 2010, and 146 703 (76%) in 2014. The prevalence of obesity increased from 8·6% in 2000, to 10·3% in 2005, 12·2% in 2010, and 12·9% in 2014 (estimated increase 0·32% per year, 95% CI 0·30-0·33; p<0·0001). The equivalent estimates were 37·4%, 39·2%, 40·7%, and 41·2% for overweight (estimated increase 0·27% per year, 95% CI 0·25-0·30; p<0·0001) and 13·9%, 18·3%, 22·1%, and 24·9% for central obesity (estimated increase 0·78% per year, 0·76-0·80; p<0·0001). The prevalence of overweight, obesity, and central obesity increased with age (all p<0·0001) and was higher in men than in women (all p<0·0001). We noted a simultaneous decrease in the prevalence of underweight (estimated decrease of 0·06% per year, 95% CI 0·04-0·07; p<0·0001). The proportion of adults meeting the minimum LTPA recommendation increased over time (17·2% in 2000, 18·1% in 2005, and 22·8% in 2014), with the estimated prevalence change per year being 0·33% (95% CI 0·24-0·42; p<0·0001) for underweight people, 0·50% (0·47-0·53; p<0·0001) for normal-weight people, 0·37% (0·34-0·40; p<0·0001) for overweight people, and 0·06% (0·00-0·13; p=0·044) for obese people. We noted deteriorations over time in all measures of physical fitness in normal-weight adults (all p<0·0001), apart from resting heart rate (p=0·69).
  
  
  
  Despite increased participation in LTPA, we noted increases in overweight or obesity and a decrease in physical fitness in Chinese adults. Continued nationwide interventions are needed to promote physical activity and other healthy lifestyle behaviours in China.
  
  
  
  National Physical Fitness Surveillance Center and Ministry of Science and Technology of the People's Republic of China.
authors.affiliation: Sports for All, China Institute of Sport Science, Beijing, China; China Anti-Doping Agency, Beijing, China. Electronic address: tianye@chinada.cn.
authors.forename: Ye
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Sports for All, China Institute of Sport Science, Beijing, China.
authors.forename: Chongmin
authors.initials: C
authors.lastname: Jiang
authors.affiliation: Sports for All, China Institute of Sport Science, Beijing, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
authors.affiliation: Sports for All, China Institute of Sport Science, Beijing, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Cai
authors.affiliation: Sports for All, China Institute of Sport Science, Beijing, China.
authors.forename: Yanfeng
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Exercise Biology Research Center, China Institute of Sport Science, Beijing, China.
authors.forename: Zihong
authors.initials: Z
authors.lastname: He
authors.affiliation: Sports for All, China Institute of Sport Science, Beijing, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Wang
authors.affiliation: Sports for All, China Institute of Sport Science, Beijing, China.
authors.forename: Dongming
authors.initials: D
authors.lastname: Wu
authors.affiliation: Sports for All, China Institute of Sport Science, Beijing, China.
authors.forename: Fubaihui
authors.initials: F
authors.lastname: Wang
authors.affiliation: Sports for All, Shanghai Institute of Sport Science, Shanghai, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Liu
authors.affiliation: Sports for All, Si Chuan Institute of Sport Science, Chengdu, China.
authors.forename: Zhongtao
authors.initials: Z
authors.lastname: He
authors.affiliation: Sports for All, Zhe Jiang Institute of Sport Science, Hangzhou, China.
authors.forename: Ping
authors.initials: P
authors.lastname: An
authors.affiliation: Sports for All, Yun Nan Institute of Sport Science, Kunming, China.
authors.forename: Munan
authors.initials: M
authors.lastname: Wang
authors.affiliation: Sports for All, Jiang Su Institute of Sport Science, Nanjing, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Tang
authors.affiliation: Sports for All, Fu Jian Institute of Sport Science, Fuzhou, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Sports for All, Gui Zhou Institute of Sport Science, Guiyang, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Sports for All, Jiang Xi Institute of Sport Science, Nanchang, China.
authors.forename: Shaojun
authors.initials: S
authors.lastname: Lv
authors.affiliation: Sports for All, Guang Dong Institute of Sport Science, Guangzhou, China.
authors.forename: Weihai
authors.initials: W
authors.lastname: Zhou
authors.affiliation: Sports for All, Shan Dong Institute of Sport Science, Jinan, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.affiliation: Sports for All, Shan Xi Institute of Sport Science, Xian, China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Lan
authors.affiliation: Sports for All, Gansu Institute of Sport Science, Lanzhou, China.
authors.forename: Xinping
authors.initials: X
authors.lastname: Yang
authors.affiliation: Sports for All, Ning Xia Institute of Sport Science, Yinchuan, China.
authors.forename: Linxia
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Foreign Languages, Beijing Sport University, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Tian
authors.affiliation: Exercise Biology Research Center, China Institute of Sport Science, Beijing, China.
authors.forename: Zhuangzhuang
authors.initials: Z
authors.lastname: Gu
authors.affiliation: Department of Epidemiology, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, IN, USA.
authors.forename: Yiqing
authors.initials: Y
authors.lastname: Song
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA.
authors.forename: Tianyi
authors.initials: T
authors.lastname: Huang
authors.affiliation: Department of Sport and Physical Activity, Edge Hill University, Ormskirk, Lancashire, UK.
authors.forename: Lars R
authors.initials: LR
authors.lastname: McNaughton
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002681:China / Q000453:epidemiology; D015444:Exercise; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D010809:Physical Fitness; D011795:Surveys and Questionnaires; D055815:Young Adult