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Beginning in 2011, the Nutrition Improvement Program for Rural Compulsory Education Students (NIPRCES) was established to enhance the nutrition and health of students in rural areas and promote educational equity. The central government offers nutritional meal subsidies to compulsory education students, aged 6–15 years, in underdeveloped counties. Monitoring and evaluation have been conducted annually from 2012 to 2017 and in 2019 and 2021. Additionally, data regarding the nutritional and health status of students in the national pilot areas have been regularly collected from 2012 to 2021. NIPRCES has effectively mitigated growth retardation and anemia among rural children (1).
The current study also aimed to explore whether the implementation of NIPRCES has positively impacted children’s physical fitness, which is strongly associated with their growth. Optimal physical fitness provides numerous physiological and psychological benefits, offers protection against potential stressors, and prevents many chronic diseases (2). The primary objective was to evaluate changes in physical fitness among Chinese rural children and adolescents during the implementation of NIPRCES. Utilizing rope skipping counts as the indicator, an increase in children’s performance was observed from 2013 to 2021. In 2021, the counts varied among students based on age, gender, area, and region. This study offers valuable scientific evidence for policymakers to develop effective strategies aimed at improving the physical fitness of children and adolescents.
From 2012 to 2019, key monitoring was conducted in the rural areas of 50 national pilot counties of the NIPRCES across 22 provincial-level administrative divisions (PLADs) in western and central China. In 2021, both rural and urban areas of 70 national pilot counties, 60 local pilot counties of the NIPRCES, and 30 non-pilot counties conducted key monitoring in eastern, western, and central China. This study used data on students’ physical fitness extracted from end-of-semester physical education class test results in 2013, 2014, 2015, 2016, 2017, 2019, and 2021. In each key monitoring county, two primary and two secondary schools were selected. For each grade, from 1st grade (children aged 6–7 years in primary school) to 9th grade (children aged 14–15 years in junior high school), one class of approximately 40 students was chosen. Exam items in physical education classes included the standing long jump, 50-meter dash, and rope skipping, among others. Rope skipping was selected as the physical fitness indicator in this study (recorded as counts/minute) since all students from 1st to 9th grade test rope skipping in China.
For cross-sectional analysis, all data in 2021 were used. For comparisons from 2013 to 2021, data in 2021 were selected as representing the rural areas in key monitoring counties in central and western China. Rope skipping counts were described by median, 25th percentile (P25), and 75th percentile (P75) for each year. Non-parametric Wilcoxon or Kruskal-Wallis rank sum tests were employed to determine differences between groups. When differences between groups were statistically significant, the Dwass-Steel-Critchlow-Fligner test was used for pairwise comparisons between groups. The inspection level was set at α=0.05. All analyses were conducted using SAS (version 9.4, SAS Institute Inc., Cary, NC, USA).
Table 1 shows the median, P25 and P75 of rope skipping counts among students by gender, grade, and region for each year from 2013 to 2021. Students’ rope skipping counts displayed a general increasing trend, from 77 counts/min in 2013 to 89 counts/min in 2021, marking an increase of 15.6%. Between 2013 and 2021, the counts for male improved by 14 counts, which was more than the improvement for female (11 counts). Ninth-grade students experienced an increase of 38 counts, considerably higher than students in other grades (7–29 counts). Moreover, students in the western regions demonstrated an increase of 14 counts, surpassing those in the central regions (8 counts).
Variable 2013 2014 2015 2016 2017 2019 2021 P value* N M P25 P75 N M P25 P75 N M P25 P75 N M P25 P75 N M P25 P75 N M P25 P75 N M P25 P75 Total 42,107 77 49 102 43,534 81 56 108 37,641 85 58 109 24,709 81 56 105 31,519 86 61 108 45,710 82 59 107 100,243 89 60 118 <0.0001 Gender Male 21,852 72 42 98 22,581 78 50 102 19,555 81 53 106 12,716 78 52 101 16,183 83 59 104 23,633 80 56 105 51,659 86 57 115 <0.0001 Female 20,255 81 56 107 20,953 86 62 112 18,086 88 62 112 11,993 86 61 109 15,336 87 65 110 22,077 85 61 110 48,584 92 65 120 <0.0001 Grade 1 5,276 36 20 60 5,512 43 21 71 4,492 44 21 73 3,117 46 25 75 3,676 47 27 75 6,160 48 24 75 12,052 50 28 77 <0.0001 2 6,230 56 32 79 6,253 62 36 84 4,759 62 35 87 3,611 64 38 85 4,345 68 42 89 6,360 68 45 88 13,996 68 44 91 <0.0001 3 6,119 73 46 94 6,482 77 55 98 5,473 77 53 98 3,671 78 56 98 4,90 79 59 99 6,608 78 56 99 14,480 80 56 102 <0.0001 4 6,333 82 59 105 6,579 87 68 108 5,371 86 64 108 3,785 85 64 104 4,724 86 65 108 6,620 85 64 105 14,701 89 65 111 <0.0001 5 6,300 89 65 112 6,645 92 72 120 5,499 94 72 116 3,716 92 68 113 4,921 90 70 114 6,300 90 69 111 14,894 99 77 123 <0.0001 6 6,414 88 68 113 6,639 96 76 124 5,644 96 75 120 3,773 96 75 118 5,113 97 77 120 6,475 95 74 115 14,753 104 81 130 <0.0001 7 1,849 97 78 129 1,815 104 78 133 2,232 103 79 133 982 100 76 121 1,327 105 89 123 2,408 117 82 148 4,982 126 95 150 <0.0001 8 1,861 102 78 137 1,762 106 79 142 2070 110 88 135 1,138 102 79 140 1,373 103 87 126 2,471 117 84 151 4,858 130 98 155 <0.0001 9 1,725 106 80 140 1,847 110 80 147 2,101 102 85 140 916 105 84 150 1,350 107 95 140 2,308 121 82 155 5,527 144 103 163 <0.0001 Region Central 10,295 79 48 106 12,496 84 57 108 9,180 82 57 109 9,079 88 67 111 7,767 86 63 108 14,274 85 61 107 32,938 87 59 112 <0.0001 Western 31,812 76 49 100 31,071 80 55 108 28,461 85 58 109 15,630 78 50 101 23,752 85 60 108 31,436 81 57 107 67,305 90 62 120 <0.0001 Abbreviation: N=number; M=median; P25=25th percentile; P75=75th percentile.
* Comparison of rope skipping counts from 2013 to 2021.Table 1. Rope skipping counts per minute among Chinese students in rural areas, 2013–2021.
In 2021, the number of rope-skipping counts demonstrated variation based on age, gender, residential area, and region. Among 1st to 6th grade primary school students, female exhibited higher counts than male, while counts appeared similar for both genders in 7th and 8th grades but were lower for female in the 9th grade (Figure 1A). First-grade students from urban areas demonstrated 11 more counts than their counterparts in rural areas, representing the largest difference among all grade levels (ranging from 2 to 7 counts; Figure 1B). Throughout the primary school years, students from eastern China consistently had higher counts compared to those from central and western China. In contrast, during the junior high school period, this difference was reversed (Figure 1C). All identified differences were deemed statistically significant (P<0.05).
Figure 1.Rope skipping counts among students by gender, residential area, region, and age in 2021. (A) by gender and age; (B) by residential area type and age; (C) by region and age.
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This study indicated that the implementation of NIPRCES led to improvements in children’s and adolescents’ physical fitness, as evidenced by enhanced rope skipping performance. Nevertheless, there were still marked disparities in scores among students from different regions and areas.
In the present study, rope skipping counts were selected as a measure of students’ physical fitness, given that this activity engages the entire body (upper and lower regions) and calls for rhythm, coordination, agility, speed, and strength. As students engage in rope skipping, they must maintain continuous arm rotation and coordinate their bodies during rhythmic, repetitive vertical hops (3). The body also needs to re-establish balance and generate propelling force throughout successive jumps. Previous research has demonstrated the benefits of rope skipping for both cardiovascular and respiratory systems (4).
In the NIPRCES study, our approach to enhancing students’ health was through the implementation of school feeding programs. Evidence has demonstrated that these programs positively impact the physical fitness of children and adolescents, as well as their overall athletic performance. A two-year intervention that involved increasing children’s intake of eggs and dairy products during school breakfasts effectively improved their strength (as measured by broad jump scores) and endurance [based on their performance in the 50 (8-meter round trip) test] of children and adolescents in China (5). Cintineo’s research also indicated that protein supplementation led to increased muscle volume, muscle fiber cross-sectional area, muscle strength, and muscle explosiveness (6). By increasing the consumption of meat and eggs, which are rich sources of high-quality protein, NIPRCES’s school feeding program may have aided in improving the muscle strength and rope-skipping performance of participating students.
In addition to NIPRCES, the Chinese government has placed significant emphasis on enhancing physical activity among compulsory education students. The national policy, “Notice on School Physical Education Under the Current Epidemic Situation,” was introduced in 2023. This policy highlighted the need for public health practitioners to increase efforts in promoting nutrition and physical education to improve students’ habits and overall physical fitness. Moving forward, NIPRCES will persist in its efforts to promote and maintain the nutritional and physical well-being of children in targeted counties throughout the nation.
This study faced several limitations. First, the investigation solely utilized rope skipping as an indicator of physical fitness. In future research, additional assessments, such as the 50-meter dash, standing long jump, and sit-and-reach, should be incorporated to provide a comprehensive evaluation of children and adolescents’ physical fitness. Second, the accuracy of the results may be influenced by students’ attitudes during the physical examinations, potentially leading to biased outcomes.
In conclusion, the findings from the present study suggest that children’s and adolescents’ physical fitness has improved during the NIPRCES period. Nonetheless, disparities in physical fitness levels were observed among children and adolescents across various regions and areas. Consequently, it is imperative that future policies implement comprehensive strategies aimed at enhancing children’s health and reducing these discrepancies.
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No conflicts of interest.
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Project teams from China CDC, provincial, city, and county level CDCs and Departments of Education, local school staff, and all participants. Feitong Wu for comments and suggestions.
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