Changing landscape of physical fitness and urban–rural inequalities: evidence from 1.2 million children and adolescents over 20 years of urbanization

This study revealed substantial shifts in physical fitness among Chinese children and adolescents, characterized by early declines followed by stabilization and partial improvements. Meanwhile, the urban-rural inequalities have narrowed, indicating progress toward equity. However, as urbanization progressed, older adolescents and those with overweight and obesity exhibited slower gains in physical fitness, necessitating targeted interventions.