Chin Med J (Engl). 2026 Jul 5;139(13):1975-1983. doi: 10.1097/CM9.0000000000003868. Epub 2025 Nov 26.
ABSTRACT
BACKGROUND: Physical activity (PA) is a key modifiable factor for elevated blood pressure (EBP). We aimed to clarify the evolving relationships between PA and EBP in childhood or adolescence by examining multilevel factors within an ecological model.
METHODS: National data were extracted from 2010, 2014, and 2019 cycles of the Chinese National Survey on Students' Constitution and Health, using a multistage stratified cluster sampling design. We defined EBP by the updated Chinese reference standards and obesity by sex- and age-specific body mass index (BMI) cutoffs. Inadequate PA was defined as <1 h/day; ecological factors at society-, school-, and individual-level were collected through a questionnaire. Multilevel logistic regression, interaction analyses, and population-attributable fractions were used to evaluate associations between multilevel ecological factors related to PA and EBP.
RESULTS: We included 642,386 participants (7-18 years). The EBP prevalence increased from 13.6% to 17.9% alongside increasing obesity, while inadequate PA decreased in prevalence. Inadequate PA was associated with EBP in 2010, with the odds ratio (OR) of 1.17 (95% confidence interval [CI]: 1.04, 1.21) but attenuated during 2010-2019. The multilevel factors related to PA displayed interactions to reduce EBP risk (P for interaction <0.05). At the societal-level, urban residence was protective against EBP, whereas a lack of exercise facilities increases the odds. At the school-level, inadequate physical education and sports competitions, coupled with unhealthy dietary lifestyles at the individual-level, contributed to EBP (P <0.05). The contributions of individual-level ecological factors related to PA decreased but of societal- and school-level increased on EBP, independent of obesity.
CONCLUSIONS: A rise in EBP burdens during 2010-2019 contrasted with an increase in PA. PA-related ecological factors across society-, school-, and individual-level exhibited complex interactions on EBP. Although the impact of individual-level lifestyles on EBP was waning and obesity remained a primary concern, there was increased recognition of societal- and school-level's ecological factors related to PA during 2010-2019. Promoting PA requires a comprehensive approach that addresses both facilitating and inhibiting factors, which is crucial for healthy blood pressure (BP).
PMID:42401992 | DOI:10.1097/CM9.0000000000003868