ObjectiveTo systematically review the adherence rate to the 24-hour movement guidelines among Chinese children and adolescents from preschool to high school age, and to analyze the characteristics of high-risk groups and influencing factors. MethodsThe CNKI, WanFang Data, VIP, Web of Science, PubMed and EBSCOHost databases were electronically searched to collect studies related to the objectives from inception to March 2025. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 18.0 software. ResultsA total of 62 studies were included. The overall adherence rate to all three guidelines among Chinese children and adolescents was 5.78% (95%CI 4.54% to 7.17%), while the non-adherence rate to all three was 17.28% (95%CI 12.29% to 22.93%). Subgroup analysis showed that compliance rate decreased with increasing educational stage. The compliance rate of high-intensity physical activity in males was higher than that in females, and the compliance rate of screen exposure duration in females was slightly better than that in males. The compliance rate of physical activity among urban preschool to adolescent groups was higher than that of the same group in rural areas. The physical activity and sleep adherence rates of ethnic minorities were higher than those of the Han ethnic group. ConclusionOverall adherence to the 24-hour movement guidelines among Chinese children and adolescents is low, with significant disparities across age, gender, urban-rural residence, and ethnicity.