Article(id=1322607932676620711, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322607837742747790, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202503261, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1741795200000, receivedDateStr=2025-03-13, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793263904017, onlineDateStr=2026-10-29, pubDate=1761321600000, pubDateStr=2025-10-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793263904017, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793263904017, creator=13701087609, updateTime=1793263904017, updator=13701087609, issue=Issue{id=1322607837742747790, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='20', pageStart='3649', pageEnd='3840', issueExtLink='null', onlineDate='null', pubDate='1761321600000', pubDateStr='2025-10-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793263881383, creator='13701087609', updateTime=1793264238791, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322609336933794638, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322607837742747790, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322609336933794639, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322607837742747790, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3712, endPage=3718, ext={EN=ArticleExt(id=1322607934090101161, articleId=1322607932676620711, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The dose-response associations between physical activity, sedentary behavior, and mental health in primary and secondary school students, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the dose–response relationship between different levels of physical activity and sedentary time and mental health among primary and secondary school students, thereby providing a robust scientific basis for the effective prevention of mental health problems in children and adolescents.

Methods

A health survey was conducted among 3 982 students selected by convenience sampling from eight primary and secondary schools in Haizhu District, Guangzhou. Mental health status was compared between students with and without regular physical activity habits. Zero-inflated negative binomial (ZINB) models and generalized additive models (GAMs) were subsequently employed to analyze the dose–response relationship between physical activity, sedentary behavior, and mental health outcomes.

Results

Among the 3 982 participants, only 5.73% met the World Health Organization’s recommended levels of physical activity. Sedentary time was generally excessive, with only 25.24% of students reporting sedentary time of 3 hours or less per day. After stratified propensity score matching, significant differences in the number of days feeling unhappy were observed across all six matched groups between students with and without regular physical activity habits. Compared with ≤10 minutes of daily moderate-to-vigorous physical activity (MVPA), longer durations of MVPA and outdoor activity were associated with improved mental health outcomes, with greater benefits observed as activity duration increased (MVPA: 11–29 minutes: +21.55%, 30–59 minutes: +24.19%, ≥60 minutes: +25.86%; outdoor activity: 11–30 minutes: +23.81%, 31–44 minutes: +19.19%, 45–60 minutes: +25.42%, ≥60 minutes: +28.28%). In contrast, compared with ≤3 hours of sedentary time, longer durations of sedentary behavior were associated with poorer mental health (3–4 hours: -9.40%, 4–5 hours: -15.43%, >5 hours: -44.27%). The GAM analysis further confirmed the findings of the ZINB modeL.

Conclusion

A dose–response relationship exists between physical activity, sedentary behavior, and mental health among primary and secondary school students. Longer durations of physical activity are associated with greater mental health benefits, while prolonged sedentary time is linked to poorer mental health outcomes. These findings provide empirical support for optimizing youth-targeted physical activity interventions and mental health promotion policies.

, authors=Peng XU1, Jing-yi FAN2, Li-sha DUAN1, Li-ping XUE3, Yan-hui GAO4, Su-xia WANG1, authorsList=Peng XU, Jing-yi FAN, Li-sha DUAN, Li-ping XUE, Yan-hui GAO, Su-xia WANG, authorCompany=null, correspAuthors=Yan-hui GAO, Su-xia WANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322607938695446964, articleId=1322607932676620711, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=中小学生身体活动和久坐时间与心理健康剂量反应关系研究, columnId=1228016570031604578, journalTitle=现代预防医学, columnName=儿少卫生与妇幼保健, runingTitle=null, highlight=null, articleAbstract=
目的

探索不同身体活动和久坐时间与中小学生心理健康之间的剂量反应关系,为有效预防儿童青少年心理健康问题提供充实的科学依据。

方法

采用便利抽样法选取广州市海珠区8所中小学3 982名学生进行健康调查,比较心理健康在是否有规律运动的中小学生之间是否有差别;最后使用零膨胀负二项模型及广义加性模型分析中小学生身体活动和久坐时间与心理健康剂量反应关系。

结果

3 982名中小学生仅有5.73%的达到世界卫生组织身体活动指南的推荐量;中小学生久坐时间普遍过长,3小时及以下仅占25.24%;进行倾向性评分分层匹配后,6组内的不开心天数在是否规律运动之间均有差别;与10分钟及以内相比,每天中高强度身体活动和户外时间增加均能改善中小学生的心理健康状况,同时随着时间增加,改善中小学生心理健康收益越大(中高强度身体活动:11~29分钟收益21.55%、30~59分钟收益24.19%和1小时及以上收益25.86%,户外活动:11~30分钟收益23.81%、31~44分钟收益19.19%、45~60分钟收益25.42%和1小时及以上收益28.28%);相反,与3小时及以下相比,中小学生随着静坐时间增加心理健康状况越差(3~4小时收益-9.40%、4~5小时收益-15.43%和5小时以上收益-44.27%)。广义加性模型的结果进一步验证了零膨胀负二项模型的结果。

结论

中小学生身体活动和久坐时间与心理健康呈剂量反应关系,运动时间越长心理健康收益越大,久坐越长心理健康状况越差。本研究为优化青少年运动干预策略和心理健康促进政策提供了实证支持。

, authors=徐鹏1, 范静宜2, 段丽莎1, 薛丽萍3, 郜艳晖4, 王素侠1, authorsList=徐鹏, 范静宜, 段丽莎, 薛丽萍, 郜艳晖, 王素侠, authorCompany=null, correspAuthors=郜艳晖, 王素侠, authorNote=

徐鹏(1993—),男,硕士,研究实习员,研究方向:公共卫生与预防医学

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王素侠和郜艳晖为共同通信作者。王素侠,E-mail: ;
郜艳晖,E-mail:
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Basic characteristics of primary and secondary school students

, figureFileSmall=null, figureFileBig=null, tableContent=
项目例数(%)项目例数(%)
年级身体状态
1~3年级1 715(43.07)好3 590(90.16)
4~6年级1 411(35.43)一般或较差392(9.84)
7~9年级856(21.50)家庭平均月收入(元)
性别≤8 0001 001(25.14)
男2 111(53.01)8 001~16 0001 205(30.26)
女1 871(46.99)>16 0001 776(44.60)
家庭结构每周剧烈运动天数(天)
核心家庭2 440(61.28)0736(18.48)
主干家庭1 130(28.38)11 003(25.19)
联合/重组/单亲412(10.35)2~31 341(33.68)
家长教育程度≥4902(22.65)
初中及以下562(14.11)平均每天户外活动时间(min)
高中/中专766(19.24)≤10445(11.18)
大专937(23.53)11~301 404(35.26)
本科及以上1 717(43.12)31~44784(19.69)
辅导班45~60469(11.78)
上辅导班3 353(84.20)≥60880(22.10)
不上辅导班629(15.80)平均每天静坐时间(放学后)(h)
规律运动≤31 005(25.24)
是2 610(65.54)3~41 062(26.67)
否1 372(34.46)4~5909(22.83)
接触二手烟>51 006(25.26)
是827(20.77)每天中高强度时间(min)
否3 155(79.23)≤101 659(41.66)
照顾孩子起居11~291 534(38.52)
父母照顾3 297(82.80)30~59561(14.09)
祖父母照顾596(14.97)≥60228(5.73)
其他人照顾89(2.24)
), ArticleFig(id=1322607948669501941, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607932676620711, language=CN, label=表1, caption=

中小学生基本特征

, figureFileSmall=null, figureFileBig=null, tableContent=
项目例数(%)项目例数(%)
年级身体状态
1~3年级1 715(43.07)好3 590(90.16)
4~6年级1 411(35.43)一般或较差392(9.84)
7~9年级856(21.50)家庭平均月收入(元)
性别≤8 0001 001(25.14)
男2 111(53.01)8 001~16 0001 205(30.26)
女1 871(46.99)>16 0001 776(44.60)
家庭结构每周剧烈运动天数(天)
核心家庭2 440(61.28)0736(18.48)
主干家庭1 130(28.38)11 003(25.19)
联合/重组/单亲412(10.35)2~31 341(33.68)
家长教育程度≥4902(22.65)
初中及以下562(14.11)平均每天户外活动时间(min)
高中/中专766(19.24)≤10445(11.18)
大专937(23.53)11~301 404(35.26)
本科及以上1 717(43.12)31~44784(19.69)
辅导班45~60469(11.78)
上辅导班3 353(84.20)≥60880(22.10)
不上辅导班629(15.80)平均每天静坐时间(放学后)(h)
规律运动≤31 005(25.24)
是2 610(65.54)3~41 062(26.67)
否1 372(34.46)4~5909(22.83)
接触二手烟>51 006(25.26)
是827(20.77)每天中高强度时间(min)
否3 155(79.23)≤101 659(41.66)
照顾孩子起居11~291 534(38.52)
父母照顾3 297(82.80)30~59561(14.09)
祖父母照顾596(14.97)≥60228(5.73)
其他人照顾89(2.24)
), ArticleFig(id=1322607948736610806, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607932676620711, language=EN, label=Table 2, caption=

Zero-Inflated Negative Binomial Model

, figureFileSmall=null, figureFileBig=null, tableContent=
模型a计数模型零模型
收益(%)bβ系数标准误P值收益(%)β系数标准误P值
模型1
中高强度时间(min)
≤10RefRefRefRef
11~2921.55-0.240.065.74×10-583.12-1.780.830.03
30~5924.19-0.280.088.56×10-495.36-3.071.960.12
≥6025.86-0.300.120.02-55.590.441.160.70
模型2
户外活动时间(min)
≤10RefRefRefRef
11~3023.81-0.270.093.06×10-3-10.100.100.770.90
31~4419.19-0.210.100.04-29.230.260.970.79
45~6025.42-0.300.117.13×10-318.74-0.211.070.85
≥6028.28-0.330.101.14×10-3-56.020.440.780.57
模型3
每天静坐时间(h)
≤3RefRefRefRef
3~4-9.400.090.080.2636.21-0.450.760.55
4~5-15.430.140.080.0792.05-2.532.840.37
>5-44.270.370.084.45×10-658.71-0.880.660.18
), ArticleFig(id=1322607949034406391, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607932676620711, language=CN, label=表2, caption=

零膨胀负二项模型

, figureFileSmall=null, figureFileBig=null, tableContent=
模型a计数模型零模型
收益(%)bβ系数标准误P值收益(%)β系数标准误P值
模型1
中高强度时间(min)
≤10RefRefRefRef
11~2921.55-0.240.065.74×10-583.12-1.780.830.03
30~5924.19-0.280.088.56×10-495.36-3.071.960.12
≥6025.86-0.300.120.02-55.590.441.160.70
模型2
户外活动时间(min)
≤10RefRefRefRef
11~3023.81-0.270.093.06×10-3-10.100.100.770.90
31~4419.19-0.210.100.04-29.230.260.970.79
45~6025.42-0.300.117.13×10-318.74-0.211.070.85
≥6028.28-0.330.101.14×10-3-56.020.440.780.57
模型3
每天静坐时间(h)
≤3RefRefRefRef
3~4-9.400.090.080.2636.21-0.450.760.55
4~5-15.430.140.080.0792.05-2.532.840.37
>5-44.270.370.084.45×10-658.71-0.880.660.18
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中小学生身体活动和久坐时间与心理健康剂量反应关系研究
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徐鹏 1 , 范静宜 2 , 段丽莎 1 , 薛丽萍 3 , 郜艳晖 4 , 王素侠 1
现代预防医学 | 儿少卫生与妇幼保健 2025,52(20): 3712-3718
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现代预防医学 |儿少卫生与妇幼保健 2025 , 52 (20) : 3712 -3718
中小学生身体活动和久坐时间与心理健康剂量反应关系研究
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徐鹏1, 范静宜2, 段丽莎1, 薛丽萍3, 郜艳晖4 , 王素侠1
作者信息
  • 1.蚌埠医科大学第一附属医院临床试验研究中心,安徽 蚌埠 233000;
  • 2.蚌埠医科大学第一附属医院预防保健科;
  • 3.广东省第二人民医院;
  • 4.暨南大学基础医学与公共卫生学院
通讯作者:
王素侠和郜艳晖为共同通信作者。王素侠,E-mail: ;
郜艳晖,E-mail:
作者简介:

徐鹏(1993—),男,硕士,研究实习员,研究方向:公共卫生与预防医学

The dose-response associations between physical activity, sedentary behavior, and mental health in primary and secondary school students
Peng XU1, Jing-yi FAN2, Li-sha DUAN1, Li-ping XUE3, Yan-hui GAO4 , Su-xia WANG1
Affiliations
  • The First Affiliated Hospital of Bengbu Medical University, Clinical Trial Research Center, Bengbu Medical University, Bengbu, Anhui 233000, China
出版时间: 2025-10-25 doi: 10.20043/j.cnki.MPM.202503261
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目的

探索不同身体活动和久坐时间与中小学生心理健康之间的剂量反应关系,为有效预防儿童青少年心理健康问题提供充实的科学依据。

方法

采用便利抽样法选取广州市海珠区8所中小学3 982名学生进行健康调查,比较心理健康在是否有规律运动的中小学生之间是否有差别;最后使用零膨胀负二项模型及广义加性模型分析中小学生身体活动和久坐时间与心理健康剂量反应关系。

结果

3 982名中小学生仅有5.73%的达到世界卫生组织身体活动指南的推荐量;中小学生久坐时间普遍过长,3小时及以下仅占25.24%;进行倾向性评分分层匹配后,6组内的不开心天数在是否规律运动之间均有差别;与10分钟及以内相比,每天中高强度身体活动和户外时间增加均能改善中小学生的心理健康状况,同时随着时间增加,改善中小学生心理健康收益越大(中高强度身体活动:11~29分钟收益21.55%、30~59分钟收益24.19%和1小时及以上收益25.86%,户外活动:11~30分钟收益23.81%、31~44分钟收益19.19%、45~60分钟收益25.42%和1小时及以上收益28.28%);相反,与3小时及以下相比,中小学生随着静坐时间增加心理健康状况越差(3~4小时收益-9.40%、4~5小时收益-15.43%和5小时以上收益-44.27%)。广义加性模型的结果进一步验证了零膨胀负二项模型的结果。

结论

中小学生身体活动和久坐时间与心理健康呈剂量反应关系,运动时间越长心理健康收益越大,久坐越长心理健康状况越差。本研究为优化青少年运动干预策略和心理健康促进政策提供了实证支持。

中小学生  /  身体活动  /  久坐  /  心理健康  /  剂量反应
Objective

To investigate the dose–response relationship between different levels of physical activity and sedentary time and mental health among primary and secondary school students, thereby providing a robust scientific basis for the effective prevention of mental health problems in children and adolescents.

Methods

A health survey was conducted among 3 982 students selected by convenience sampling from eight primary and secondary schools in Haizhu District, Guangzhou. Mental health status was compared between students with and without regular physical activity habits. Zero-inflated negative binomial (ZINB) models and generalized additive models (GAMs) were subsequently employed to analyze the dose–response relationship between physical activity, sedentary behavior, and mental health outcomes.

Results

Among the 3 982 participants, only 5.73% met the World Health Organization’s recommended levels of physical activity. Sedentary time was generally excessive, with only 25.24% of students reporting sedentary time of 3 hours or less per day. After stratified propensity score matching, significant differences in the number of days feeling unhappy were observed across all six matched groups between students with and without regular physical activity habits. Compared with ≤10 minutes of daily moderate-to-vigorous physical activity (MVPA), longer durations of MVPA and outdoor activity were associated with improved mental health outcomes, with greater benefits observed as activity duration increased (MVPA: 11–29 minutes: +21.55%, 30–59 minutes: +24.19%, ≥60 minutes: +25.86%; outdoor activity: 11–30 minutes: +23.81%, 31–44 minutes: +19.19%, 45–60 minutes: +25.42%, ≥60 minutes: +28.28%). In contrast, compared with ≤3 hours of sedentary time, longer durations of sedentary behavior were associated with poorer mental health (3–4 hours: -9.40%, 4–5 hours: -15.43%, >5 hours: -44.27%). The GAM analysis further confirmed the findings of the ZINB modeL.

Conclusion

A dose–response relationship exists between physical activity, sedentary behavior, and mental health among primary and secondary school students. Longer durations of physical activity are associated with greater mental health benefits, while prolonged sedentary time is linked to poorer mental health outcomes. These findings provide empirical support for optimizing youth-targeted physical activity interventions and mental health promotion policies.

Primary and secondary school students  /  Physical activity  /  Sedentary  /  Mental health  /  Dose-response
徐鹏, 范静宜, 段丽莎, 薛丽萍, 郜艳晖, 王素侠. 中小学生身体活动和久坐时间与心理健康剂量反应关系研究. 现代预防医学, 2025 , 52 (20) : 3712 -3718 . DOI: 10.20043/j.cnki.MPM.202503261
Peng XU, Jing-yi FAN, Li-sha DUAN, Li-ping XUE, Yan-hui GAO, Su-xia WANG. The dose-response associations between physical activity, sedentary behavior, and mental health in primary and secondary school students[J]. Modern Preventive Medicine, 2025 , 52 (20) : 3712 -3718 . DOI: 10.20043/j.cnki.MPM.202503261
儿童和青少年的心理健康问题越来越成为人们日常关注的焦点,心理健康问题影响着全球10~20%的儿童和青少年,占全球疾病负担很大一部分[1]。联合国儿童基金会在2019年发布的《致全世界儿童的一封公开信》显示,在过去30年中,心理健康障碍在18岁以下人群中呈逐步上升趋势[2]。在中国,儿童青少年面临的心理压力日益增加,心理健康问题成为儿童青少年最主要的疾病负担之一,近25%青少年表示感到轻度或重度抑郁,至少有三千万17岁以下的儿童青少年面临情绪或行为问题[3]。此外,有证据表明,成年人的心理健康问题有相当大一部分起源于生命早期(即儿童青少年时期)[4-5],这种情况的长期影响远远超出了童年和青春期。因此,解决儿童青少年心理健康问题刻不容缓。
众所周知,身体活动被作为公认的预防心理疾病最好的方法之一。2020年联合国世界卫生组织发布的《WHO guidelines on physical activity and sedentary behaviour》指出:5-17岁儿童青少年一星期每天至少运动60分钟,每周至少3天剧烈强度有氧运动,同时应尽可能限制久坐时间[6]。然而,一项2010年全国学生体质与健康调研中发现:中国中小学生每天锻炼超过1小时仅占22.7%[7]。运动能够预防多种心理疾病,定期锻炼能明显减少抑郁、焦虑和惊恐障碍的症状[8-10]。有证据显示,儿童青少年的体育活动与心理健康之间有很明显的关联[11]。儿童青少年的久坐时间大部分来自于娱乐和学习视屏时间,视屏时间与儿童青少年的心理健康呈负相关[11],同时长时间久坐与较高的心理困扰和较低的自尊有关[12]。吴丽晶[13]等人发现,小学生的抑郁症状与身体活动不足、视屏时间过长相关。
虽然,已有较多的国内外文献研究身体活动和久坐行为与心理健康之间的关系,但是,关于身体活动和久坐行为与心理健康之间的剂量反应关系研究较少。本文通过对广州市海珠区的8所中小学进行健康问卷调查,探索不同身体活动和久坐时间与中小学生心理健康之间的剂量反应关系,为有效预防儿童青少年心理健康问题提供充实的科学依据。
本研究采用便利抽样法,选取广州市海珠区内交通便利、配合度高的8所中小学。《中小学生健康调查问卷》通过问卷星平台在2021年3月9日到4月8日之间发放到广州市海珠区内的8所中小学(问卷由家长根据学生真实情况填写)。本研究为横断面调查,样本量计算已在之前研究中进行描述:样本量计算公式为:,其中p为疾病的现患率,q=1-p,d为容许误差,Z1-α/2为检验统计量;根据文献获得焦虑、抑郁症状现患率为20.1%,容许误差设置d=0.1p,检验水准α=0.05,代入公式计算得样本量为1 446[14]。本研究采用便利抽样,在此样本量的基础上增加1/2,最终估算样本量约为2 169。
在正式调查前,本问卷先在本区的一所小学进行预调查,然后根据预调查所发现的问题以及同行专家的意见和建议进行修订。共收到问卷4 633份,经处理排除651份不合格问卷,最后纳入分析的问卷为3 982份。排除标准:1)姓名重复,多次提交者保留最后一次提交数据;2)逻辑矛盾(运动时间>8小时,不开心天数超过30天);3)填写时间<300秒。所有参与者均知情同意。本研究获得广东省第二人民医院医学伦理委员会批准(2021-SB-389)。
问卷主要内容包括:身体活动和久坐行为、中小学生基本特征以及心理健康状况。具体内容如下:
(1)身体活动和久坐行为:每天中高强度运动时间(10分钟及以内、11~29分钟、30~59分钟和1小时及以上)、平均每天户外活动时间以及平均每天静坐时间。
(2)基本特征:年级(1~3年级、4~6年级和7~9年级)、性别(男和女)、家庭结构(核心家庭、主干家庭和联合/重组/单亲家庭)、照顾孩子起居(父母、祖父母和其他人)、家长教育程度(初中及以下、高中/中专、大专和本科及以上)、家庭平均月收入(≤8 000元、8 001~16 000元和>16 000元)、辅导班(上辅导班和不上辅导班)、每周剧烈运动天数(0天、1天、2或3天和4天及以上)、接触二手烟(是,否)和身体状态(好,一般)。
(3)心理健康状况:家长根据孩子真实情况回答“过去30天内,您的孩子有多少天有不开心的状况(包括但不限于抑郁、焦虑、压抑等情绪)”自报所得。
本文首先使用频数和百分比描述人群特征分布,并使用频数分布直方图描述不开心天数。其次,为了探索是否规律运动对中小学生心理健康的影响,本文使用倾向性评分分层法对中小学生是否规律运动进行了分层匹配,然后使用非参数秩和检验检验两组间不开心天数是否有差别。最后,由于结局变量包含大量0计数(见图1),超过模型所预测范围,因此本文使用了零膨胀负二项回归模型探究身体活动和静坐与中小学生心理健康的剂量反应关系。为了零膨胀负二项回归模型的稳定性,将中小学生不开心天数超过99分位的数值等于第99分位。所有的协变量均纳入模型进行调整。此外,将中小学生每天中高强度身体活动时间和平均每天久坐时间作为定量变量,使用广义加性模型拟合不同身体活动时间与中小学生心理健康的非线性关系。本文使用R软件4.0版对数据进行处理和特征描述;使用R软件4.0版中的MatchIt包进行倾向性评分分层法,ggplot2包进行作图,pscl包建立零膨胀负二项回归模型,mgcv包构建广义加性模型。
从表1可以看出小学生占大部分(78.5%),男生(53.01%)稍多于女生;家庭结构以核心家庭为主(61.28%),主要是父母照顾孩子起居(82.80%);大部分中小学生都上辅导班(84.20%),每周至少进行2天剧烈运动中小学生较多(56.33%),但是仅有5.73%的中小学生达到世界卫生组织身体活动指南的推荐量;中小学生久坐时间普遍过长,3小时及以下仅占25.24%。
中小学生心理健康在是否有规律运动习惯之间是否有差别方面,在未进行倾向性评分匹配时,无规律运动习惯的中小学生不开心天数明显高于有规律运动习惯的中小学生(P<0.000 1);进行倾向性评分分层匹配后,6组内的不开心天数在是否规律运动之间均有差别(匹配组1:P=0.000 6,匹配组2:P=0.001 0,匹配组3:P<0.000 1,匹配组4:P=0.031 1,匹配组5:P=0.005 9,匹配组6:P=0.002 8),有规律运动习惯的中小学生明显改善心理健康。见图2。
由表2可知,零膨胀负二项模型的计数模型显示,与10分钟及以内相比,每天中高强度身体活动和户外时间增加均能改善中小学生的心理健康状况,同时随着时间增加,改善中小学生心理健康收益越大(中高强度身体活动:11~29分钟收益21.55%、30~59分钟收益24.19%和1小时及以上收益25.86%,户外活动:11~30分钟收益23.81%、31~44分钟收益19.19%、45~60分钟收益25.42%和1小时及以上收益28.28%);相反,与3小时及以下相比,中小学生随着静坐时间增加心理健康状况越差(3~4小时收益-9.40%、4~5小时收益-15.43%和5小时以上收益-44.27%)。
从平滑曲线可以看出,中小学生不开心天数随着每天中高强度身体活动时间增加而降低,在40分钟后曲线平缓;对于每天久坐时间与中小学生不开心天数关系,随着每天久坐时间增加,不开心天数平缓曲线呈线性上升。见图3。
本次对广州市海珠区的3 982名中小学生的健康调查发现,运动达到一周平均每天中高强度运动1小时以上的中小学生仅占5.73%,远远低于一项全国调查:34.10%儿童青少年满足中高强度运动1小时以上[15];同时,平均每天久坐时间3小时及以上的中小学生占74.76%,远远高于美国43.0%的学生在平均上学日每天玩视频或使用电脑超过3小时以上[16]。然而在规律运动习惯上,有65.54%的中小学生有规律运动习惯,且规律运动确实减少了心理不开心的天数,提升心理健康状况,这也与美国一项大型横断面研究结果一致[8]。虽然有超过一半的中小学生有规律运动的习惯,但是运动时间不足和久坐时间过长问题十分严重,本区的教育管理机构和卫生部门应该关注学生身体活动不足和久坐时间过长问题,以预防学生出现过多的心理健康问题。
零膨胀负二项模型结果显示,中高强度身体活动和户外活动时间与心理健康之间呈剂量反应关系,且运动时间越长,心理健康增加效益越多。身体活动和户外活动在1小时以上的健康效应最大,这也与2020年世界卫生组织发布的身体活动指南对儿童青少年推荐的运动量要求一致(即一周平均每天至少运动60分钟)[6]。大量文献表明,中高强度身体活动不仅与儿童青少年身体健康有关[17-18],也与儿童青少年心理健康相关[19-20]。模型结果还显示,中小学生课外平均每天静坐时间与心理健康之间也呈剂量反应关系,静坐在平均每天5小时以上对健康状况危害最大,长时间久坐会导致儿童青少年肥胖[21]和多种心理健康问题[12, 22-23]。一项来自上海17 624名小学生的横断面调查发现中高强度身体活动与心理不佳呈负相关,长时间久坐使用屏幕与心理不佳呈正相关[21]。因此,中小学生在参加身体活动时还需要保持足够长的运动时间,同时也要尽可能减少久坐时间,最大化预防心理相关疾病。
广义加性模型的平滑曲线结果显示,随着中小学生每日中高强度身体活动时间的增加,其自报的不开心天数呈下降趋势。该下降趋势在活动时间达到约40分钟后趋于平缓,随后略有上升,整体呈现U型变化趋势。该发现与一项关于中国中小学生家长身体活动水平与其子女焦虑和抑郁症状评分关系的研究结果基本一致[14]。此外,《柳叶刀》发表的一项基于美国成年人大样本的横断面调查亦表明,身体活动时间与不开心天数之间存在类似的U型曲线关系[8],进一步支持了本研究的发现。值得注意的是,该美国研究对象为成年人,而本研究聚焦于中国中小学生群体,为理解中国未成年人身体活动与心理健康之间的剂量–反应关系提供了新的证据。另据平滑曲线结果显示,中小学生每日久坐时间越长,其不开心天数亦呈逐步增加趋势,此发现进一步验证了零膨胀负二项回归模型关于静坐时间与心理健康之间负面关联的结论。
本研究的优点是使用了倾向性评分分层法,减少了混杂因素的影响;同时使用零膨胀负二项模型,解决了结局变量大量零存在问题;探索了身体活动和久坐时间与儿童青少年心理健康之间的剂量反应关系。最大的局限性是本研究是一项横断面调查,无法确定因果关系,不能做出因果推断。一项队列研究表明身体活动和心理健康之间联系可能是双向的[24],即不运动可能是不良心理健康的症状,也可能是不良心理健康原因。此外,本研究的身体活动和久坐行为是参与者自报所得,存在回忆偏倚,可能会高估或低估自身的身体活动[25]。未来的研究,可采用客观的三轴身体活动监测仪来测量身体活动和久坐情况,并且开展纵向研究来进一步确定身体活动和久坐时间与中小学生心理健康之间剂量反应的因果关系。
  • 蚌埠医科大学科研课题(2023byzd152sk)
  • 广东省医学科研基金(B2022035)
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2025年第52卷第20期
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doi: 10.20043/j.cnki.MPM.202503261
  • 接收时间:2025-03-13
  • 首发时间:2026-10-29
  • 出版时间:2025-10-25
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  • 收稿日期:2025-03-13
基金
蚌埠医科大学科研课题(2023byzd152sk)
广东省医学科研基金(B2022035)
作者信息
    1.蚌埠医科大学第一附属医院临床试验研究中心,安徽 蚌埠 233000;
    2.蚌埠医科大学第一附属医院预防保健科;
    3.广东省第二人民医院;
    4.暨南大学基础医学与公共卫生学院

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王素侠和郜艳晖为共同通信作者。王素侠,E-mail: ;
郜艳晖,E-mail:
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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