The long-term health impact of mandatory school-based physical activity remains poorly understood. This study aimed to investigate the association between mandatory physical fitness test exposure and metabolic health outcomes in adolescents and adults. Repeated cross-sectional study utilized data from the National Health Information Database from 2009 to 2017. We conducted two age-based cohorts: a 35.5-year-old cohort who transitioned from full physical fitness test exposure in 2009 to no exposure in 2017, and a 45.5-year-old cohort who had been fully exposed to the physical fitness test. During the study period, the 35.5-year-old cohort showed pronounced increases in both obesity and central obesity. In males, the adjusted obesity prevalence increased from 41.5% to 50.8% in the 35.5-year-old cohort and from 38.2% to 45.8% in the 45.5-year-old cohort, with a greater absolute increase (9.3% vs. 7.6%; P interaction <0.0001). Central obesity increased from 20.4% to 31.0% in the 35.5-year-old cohort, and from 19.7% to 25.9% in the 45.5-year-old cohort (10.7% vs. 6.3%). In females, obesity and the prevalence of central obesity remained stable in the 45.5-year-old cohort. However, the 35.5-year-old cohort exhibited a steeper secular increase in the obesity and central obesity prevalences (from 19.0% to 23.7% and from 10.1% to 14.9%, respectively). The abolition of the mandatory physical fitness test was associated with a rapid obesity and central obesity increase. The long-term public health consequences of discontinuing mandatory physical activity programs needed for new strategies to mitigate the burden of metabolic diseases in younger generations.
Lee et al. (Fri,) studied this question.