Association of healthy lifestyle and physical fitness in children: a nationwide population-based cross-sectional study

Abstract

Objective Although a healthy lifestyle is closely linked to various health outcomes in children and adolescents, its specific connection to physical fitness remains poorly understood. Methods This nationwide cross-sectional study evaluated data from 60,177 children across 27 provinces in China from 2015 to 2016. Health Lifestyle Score (HLS) assessed four key lifestyle factors: healthy eating, sufficient sleep, regular physical activity, and limited screen time. Multiple linear regression models and restricted cubic spline assessed the association between HLS and general physical fitness, with individual lifestyle factors also examined independently. Results Higher HLS was significantly associated with better general physical fitness. Positive correlations were observed for each lifestyle factor with physical fitness: healthy eating (β, 0.49; 95% CI, 0.39 to 0.59), sufficient sleep (β, 0.12; 95% CI, 0.04 to 0.20), regular physical activity (β, 0.40; 95% CI, 0.34 to 0.46) and low screen time (β, 1.34; 95% CI, 1.24 to 1.45). Limited screen time showed the strongest association, followed by healthy eating. Improvements in the Physical Fitness Index and individual adaptability climbed steadily with each added healthy lifestyle factor. Conclusion Future strategies should integrate screen time reduction, dietary improvements, increased physical activity, and adequate sleep to maximize health benefits in this population.