Background: The effect of cardiorespiratory fitness (CRF) on the relationship of physical activity (PA), and physical literacy (PL) in 8–12 Pakistani children are largely unknown. Therefore, this study aims to examine the mediating role of CRF in the relationship between PA and PL in this demographic.Methods: This cross-sectional study involved 1,360 children aged 8–12 (mean age = 10.00, SD = 1.41 years) from 85 higher secondary schools in South Punjab, Pakistan. Data were collected during the 2020–2021 academic year using the Canadian Assessment of Physical Literacy-2 (CAPL-2) protocol to assess physical activity (PA), Body Mass Index (BMI), and PL levels. CRF was measured using the PACER (Progressive Aerobic Cardiovascular Endurance Run) test. Descriptive statistics, independent samples t-tests, Chi-squared tests, and Generalized Additive Models for Location, Scale, and Shape (GAMLSS) were used for age and sex-specific CAPL-2 scoring. Associations among components were evaluated through Pearson's correlation, multivariate logistic regression, and mediation analyses.Results: The study revealed that boys had significantly higher scores in CRF, PA, and PL across all age groups compared to girls (p < 0.001), with boys' scores being 20%, 10%, and 14% higher, respectively, than those of girls. Conversely, overweight children showed significantly reduced PA and PL levels (p < 0.001). An inverse correlation was found between BMI and CRF (r² linear = 0.022; quadratic = 0.028). CRF scores had significant negative correlations BMI (r = −0.143) and positive associations with MVPA, PA, DB, and PL (r ranging from 0.241 to 0.624). CRF was observed to partially mediate the association between MVPA and PL. The direct impact of PA on PL was significant and meaningful (β = 0.002, p < .001). Additionally, the indirect effect of PA on PL through CRF was also significant (β = 0.001, p < .001), indicating that CRF serves as an important mediator in this relationship. The combined total effect of PA on PL, which includes both direct and mediated pathways, was robust and highly significant (β = 0.003, p < .001).Conclusion: The study revealed a strong positive correlation between CRF, PA, and PL, but a negative one with BMI in South Punjab children aged 8–12. Notably, CRF and PA emerged as significant predictors of PL levels in this population. Consequently, interventions that are both systematic and targeted towards improving these factors should be implemented as strategies to enhance children's PL levels and promote physically active behaviors.

(1) Background: Physical literacy (PL) is a multidimensional concept, since it fosters lifetime engagement in physical activities and reduces obesity; however, empirical evidence is lacking to support this association. This study first aimed to establish PL levels stratified by normal weight children and children with overweight and obesity. Furthermore, this study determined a correlation between PL domains and BMI by weight status among South Punjab school children. (2) Methods: This cross-sectional study involved 1360 (Boys: 675 and Girls: 685) children aged 8 to 12, and was conducted using CAPL-2. T-tests and chi-square were used to determine the difference between categorical variables, with MANOVA used to compare weight statuses. Spearman correlation was employed to determine the correlation between variables; p < 0.05 was considered significant. (3) Results: Normal weight children had significantly higher PL and domain scores, except for the knowledge domain. Most children with normal weights were at the achieving and excelling levels, while children with overweight and obesity were at the beginning and progressing levels. The correlation among PL domains in normal and overweight and obese children ranged from weak to strong (r = 0.001 to 0.737), and the knowledge domain was inversely correlated with the motivation domain (r = −0.023). PL and domain scores were inversely correlated to BMI, except for the knowledge domain. (4) Conclusions: Children with normal weight tend to have higher PL and domain scores, while those with overweight or obesity tend to have lower scores. There was a positive relationship between normal weight and higher PL and domain scores, and an inverse relationship was observed between BMI and higher PL scores.

Background: Physical literacy (PL) encompasses an individual’s motivation, confidence, physical competence, and knowledge, all of which foster lifelong engagement in physical activities. In developing countries like Pakistan, there is a pressing need to assess PL status using culturally valid tools. This study aims to evaluate PL among children aged 8–12 in South Punjab, Pakistan while developing normative reference curves and exploring factors influencing PL. Methods: A cross-sectional study was conducted with 1,360 students (mean age = 10.00, SD = 1.41 years) from 85 schools, using a culturally adapted and validated version of the CAPL-2 tool. The CAPL-2 scoring system was validated to align with the population and cultural context. Statistical analyses, including t-tests, Chi-squared tests, Pearson’s correlation, multivariate logistic regression, and Classification and regression tree methods, were performed to identify factors associated with PL classifications, with significance set at p < 0.05. The Generalized Additive Models for Location, Scale, and Shape were used to create age- and sex-specific PL normative reference curves. Result: The study revealed significant influences of gender, socioeconomic status (SES), and locality on PL. Boys consistently scored higher in PL across all domains compared to girls, with significant differences (p < 0.001) in all but the knowledge and understanding domain (p = 0.160). Boys’ PL scores were 6% higher overall, with a 7% and 5% advantage in the daily behavior and physical competence domains, respectively. Children from low SES and rural settings exhibited significantly higher PL scores than their middle/high SES and urban counterparts (p < 0.001). Walking to school was positively correlated with higher PL scores, while children traveling by car had the lowest scores (p < 0.001). Anthropometric differences between genders were noted, further emphasizing the disparities in physical competence. Most participants (71.6%) fell into the "Beginning" or "Progressing" PL categories, with females predominantly in these lower stages. Conclusion: This study reveals that gender, SES, and locality significantly impact PL among children in South Punjab, Pakistan. Boys, lower SES groups, and rural children showed higher PL scores, with everyday activities like walking to school positively contributing to PL development. These findings emphasize the need for targeted, demographically sensitive interventions to enhance PL in the region.

Background: The physical health of adolescents is crucial for the prosperity and sustainable development of a nation. Developing specific growth standards is essential for prioritizing the wellbeing of the youth of Pakistan. This study aimed to establish normative standards for height, weight, and body mass index (BMI) among 12- to 16-year-olds in South Punjab, facilitating accurate health assessments and tailored interventions.Method: This study utilized a cross-sectional design and stratified random sampling to select 2,970 adolescents (49.73% boys and 50.26% girls) aged 12–16 years from South Punjab, Pakistan. Anthropometric measurements, including height, weight, and BMI, were collected. The data were stratified by age and sex, and smoothed percentile curves were computed using the LMS method, which incorporates the L (γ-lambda), M (μ-mu), and S (δ-sigma) parameters. The results were compared to international references to provide a comprehensive analysis.Results: The results highlight sex-specific trends in anthropometric indicators among adolescents. Boys exhibited higher mean values in height (160.50 ± 11.50 cm), weight (45.02 ± 9.78 kg), and BMI (17.30 ± 2.41) than girls (158.57 ± 9.34 cm, 41.00 ± 7.89 kg, and 16.29 ± 2.82, respectively). Growth patterns indicate boys grow faster in height and weight between ages 12 and 14, whereas girls show slower annual increases. Comparative analysis with international standards reveals that boys’ height and weight were generally lower than international medians (P50th), whereas girls’ height was comparable or higher. BMI values for both sexes were lower than international norms, reflecting unique regional growth patterns.Conclusion: This research establishes updated age- and sex-specific normative reference standards for adolescents in South Punjab, Pakistan. The study revealed that Pakistani adolescent boys exhibit higher mean values in height, weight, and BMI than girls, with faster growth rates between ages 12 and 14. Compared to international standards, Pakistani adolescents show lower BMI values, highlighting unique regional growth patterns. These standards have practical applications in screening, monitoring, and health strategy planning, contributing to efforts to promote a healthier future for the population. Future studies are recommended to utilize these local growth references for health surveillance and treatment in the local population.

Objective: This study aims to develop and validate age- and sex-specific normative reference standards for muscular strength (MS) using the LMS (Lambda–Mu–Sigma) method and to establish Health Benefit Zones (HBZs) for Pakistani adolescents aged 12–16 years.Methods: A cross-sectional study was conducted with 2,970 adolescents (49.7% boys, 50.3% girls) selected through stratified random sampling from 60 public high schools across three divisions of South Punjab. Anthropometric indicators and muscular strength were measured following standardized protocols. Using the LMS, age- and sex-specific normative reference values and smoothed percentile curves (3rd, 10th, 35th, 50th, 65th, and 90th) were developed. Five Health Benefit Zones (Very Poor, Poor, Medium, Good, and Excellent) were derived from these percentile ranges to classify strength levels. The robustness of the generated standards was examined through internal cross-validation using a back-generation procedure to confirm high predictive accuracy.Results: Boys demonstrated significantly higher muscular strength than girls across all ages (p < 0.001), with strength increasing progressively with age in both sexes. At age 16, median MS reached 35.47 kg for boys and 20.18 kg for girls. LMS-derived percentile reference values and percentile curves illustrated consistent age- and sex-related growth trends. Approximately 40% of participants fell within the “poor” or “very poor” HBZs. MAPE values remained below ±0.05, indicating excellent model fit. Compared to international benchmarks, adolescents from South Punjab exhibited lower MS values across corresponding age groups.Conclusion: This study provides the first LMS-based, age- and sex-specific normative reference standards and HBZs for muscular strength among Pakistani adolescents. These standards offer a population-relevant tool for fitness assessment, enable early identification of youth at risk of low muscular strength, and support targeted interventions to enhance strength development and overall physical health in school-aged populations.