Background: To examine the concomitant associations between physical activities (PA) and lifestyle factors in a representative sample of children and adolescents.

Study design: Cross-sectional, observational study.

Methods: Population data were derived from a school-based health survey carried out in 2015 on 177,091 (51% boys) Greek children aged 8 to 17 yr old. PA, sedentary activities and sleeping habits were assessed through self-completed questionnaires. Dietary habits were evaluated using the Mediterranean Diet Quality Index for children and adolescents. Anthropometric and physical fitness measurements were obtained by trained investigators. Logistic regression models were estimated and adjusted for relevant covariates.

Results: More boys as compared to girls (65.1% vs. 50.7%, P<0.001) and children than adolescents (59.8% vs. 52.8%, P<0.001) met the recommendations for PA. Frequent fast food consumption and skipping breakfast were associated with inadequate PA levels. In the whole population, sufficient dietary habits, sufficient (&gt;8-9 h/d) sleeping and accepted screen time increased the participant's odds of adequate PA levels by 38% (95% CI: 1.32, 1.44), 5% (95% CI: 1.01, 1.09) and 21% (95% CI: 1.16, 1.26), respectively, while, overweight/obese and central obesity decreased the odds of adequate PA levels by 7% and 5%, respectively, after adjusting for several covariates. Participants with combination of healthy aerobic fitness/dietary habits/screen time had 60% increased odds for adequate PA levels than those with unhealthy choices.

Conclusion: Healthy aerobic fitness, dietary habits and screen time were strongly associated with PA status among children. The results support the development of interventions to help children adopt a healthy lifestyle.