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Rapid urbanization of China has brought lifestyle changes resulting in a continuous decline in children's physical fitness (PF) and out-of-school physical activity (PA). To date, studies have been focused on correlates of PF and out-of-school PA, and patterns and trends based on geographic diversity and urban-rural contrasts. Western China, with a large rural population, has substantial urban-rural differences, but little work has been done to compare its children's physical fitness (PF) and out-of-school physical activity (PA) at a county level. A