王俊宇1，武胜勇2，梁译心1，杨永3，吴俊4，谢婷5，庄洁1，6
(1.上海体育大学，上海 200438；2.海军军医大学，上海 200438；3.巢湖学院，安徽 巢湖 238024；4.上海市六一小学，上海 200438；5.成都市新桥小学校，四川 成都 610031；6.上海市学生体质健康研究中心，上海 200438)
摘 要：探讨学龄儿童中高强度身体活动(MVPA)变化类型特征，并分析其与随访末次全身性肥胖及中心性肥胖新发风险的纵向关联。在上海市分层选取3所小学，并在各校随机抽取三年级班级纳入研究对象；经基线筛选，纳入身体质量指数(BMI)与腰围身高比(WHtR)均正常者142名，完成2年随访并获得3个测量时点的有效数据。各测量时点使用ActiGraph GT3X+三轴加速度计连续7天客观监测MVPA，并同步测量身高、体重与腰围，计算BMI与WHtR以判定全身性肥胖与中心性肥胖。基于3次MVPA重复测量结果采用K-means聚类识别MVPA变化类型；以末次测量全身性肥胖与中心性肥胖新发为结局，采用二元Logistic回归估计不同MVPA变化类型的肥胖发生风险，并调整性别、年龄、睡眠状况及父母受教育程度等协变量。结果显示：学龄儿童MVPA变化可识别为渐进下降型(57.0%)、快速下降型(16.9%)与稳定保持型(26.1%)。多因素回归表明，与渐进下降型相比稳定保持型全身性肥胖新发风险显著降低(OR=0.24，95%CI：0.06~0.94)，中心性肥胖新发风险也显著降低(OR=0.32，95%CI：0.12~0.84)，快速下降型与渐进下降型差异无统计学意义。协变量分析表明，女童与睡眠充足者两类肥胖新发风险均较低，且年龄增加与中心性肥胖新发风险降低相关。研究认为，学龄儿童MVPA变化以下降型为主，维持相对稳定且较高的MVPA水平与较低的全身性肥胖及中心性肥胖新发风险相关，且睡眠充足具有独立保护作用。实践中应将防止MVPA下降与促进活动维持作为干预重点，并同步强化睡眠保障以提升儿童体重管理的综合效能。
关 键 词：体质健康；中高强度身体活动；全身性肥胖；中心性肥胖；前瞻性队列；学龄儿童
中图分类号：G804 文献标志码：A 文章编号：1006-7116(2026)04-0144-07
Association of moderate-to-vigorous physical activity changing patterns with emerging risks on general and central obesity in school-aged children:
A 2-year prospective cohort study
WANG Junyu1，WU Shengyong2，LIANG Yixin1，YANG Yong3，WU Jun4，XIE Ting5，ZHUANG Jie1，6
(1.Shanghai University of Sport，Shanghai 200438，China；2.Naval Medical University，Shanghai 200438，China；3.Chaohu University，Chaohu 238024，China；4.Shanghai Liuyi Primary School，Shanghai 200438，China；5.Chengdu Xinqiao Primary School，Chengdu 610031，China；6.Shanghai Student Physical Health Research Center，Shanghai 200438，China)
Abstract: To explore characteristics of changing patterns on moderate-to-vigorous physical activity (MVPA) in school-aged children, and examine their longitudinal association with emerging risks on general and central obesity at the final follow-up. Three primary schools was stratified chosen in Shanghai and third-grade classes randomly selected within each school. Children with normal body mass index (BMI) and waist-to-height ratio (WHtR) under baseline screening were included (n=142), and valid data acquired by following for 2 years with three measurement waves. At each wave, MVPA was objectively assessed using ActiGraph GT3X+ accelerometers worn for 7 consecutive days, and height, weight, and waist circumference were measured to asses BMI and WHtR as well as general and central obesity. MVPA changing patterns were identified using K-means clustering on the three repeated MVPA measurements, and emerging risks on general and central obesity at the final wave were defined using BMI- and WHtR-based criteria, respectively. Binary logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for obesity incidence across MVPA change patterns, simultaneously adjusting for related covariates including sex, age, sleep status, and parental education. Results show that three MVPA changing patterns in school-aged children were identified, namely gradual decline (57.0%), rapid decline (16.9%), and stable maintenance (26.1%). Multi-factor regression results presented that compared with the gradual-decline pattern, the stable-maintenance pattern was associated with a lower risk of incident general obesity (adjusted OR=0.24, 95% CI: 0.06~0.94) and incident central obesity (adjusted OR=0.32, 95% CI: 0.12~0.84), whereas the rapid-decline pattern showed no significant difference. Analyses with covariates exhibits that girls and sufficient sleep were independently associated with lower risks of both outcomes, and older age was associated with a lower risk of incident central obesity. The study holds that MVPA changing tended to decline during the school-aged children, and maintaining a relatively stable and higher MVPA level was associated with a lower emerging risk on general and central obesity, and sufficient sleep will presents an independent protective effect. In practice, interventions should prioritize preventing MVPA decline, supporting sustained activity, and also promoting adequate sleep to enhance comprehensive efficacy on childhood weight management.
Keywords: physical health；moderate-to-vigorous physical activity；general obesity；central obesity；prospective cohort study；school-aged children