Associations between parental support for physical activity and moderate-to-vigorous physical activity among Chinese school children:A cross-sectional study

Yng Liu ,Yjun Zhng ,Sitong Chen ,Jilin Zhng ,Zonghen Guo ,Peijie Chen *

a School of Physical Education and Sport Training,Shanghai University of Sport,Shanghai200438,China

b Shanghai Research Center for Physical Fitness and Health of Children and Adolescents,Shanghai University of Sport,Shanghai200438,China

c School of Physical Education,Shaoxing University,Shaoxing 312000,China

d Educational Management Information Center,Ministry of Education,Beijing 100816,China

e School of Kinesiology,Shanghai University of Sport,Shanghai200438,China

1.Introduction

Although engaging in regular physical activity(PA)yields major health benefit for children and youth,1-4increasing evidence shows an overall low level of PA among Chinese school-aged children and adolescents.5,6For example,a recent report on PA in Shanghai revealed that only about 20%of school-aged children and youth met the PA guideline of engaging at least 60m in of daily moderate-to-vigorous physical activity(MVPA);7and in 2010,about 77%of primary school and junior middle school children nationwide failed to meet PA recommendations.5Other studies have shown an increasing trend in sedentary behavior8,9and rates of obesity in children and youth.10-12

Among many factors that influenc children’s PA,family members and parents play an important role in promoting and shaping their children’s behaviors.13Characteristics such as parental PA role modeling,6,14-16support for PA,14,15,17,18PA motivation,19family type,20and socioeconomic status(SES)21-23have been shown to be associated children’s participation in PA.However,few studies in China have systematically examined the specific of parental support for PA in regard to their children’s PA,especially studies involving nationally representative samples.

With significan changes in sociodemographics,24a heavy emphasis on children’s academic achievement,25and the low prevalence of PA among Chinese school children,5,7,26it becomes increasingly important that family and parent factors that either promote or impede children’s PA be identifie so that targeted,family-based PA promotional strategies can be developed for the most vulnerable children and youth populations.This study addresses this significan know ledge gap.

The main purpose of this study was to examine associations between various forms of parental support for PA and levels of MVPA participation among Chinese school-aged children.On the basis of prior research,13-18we hypothesized that parental encouragement,accompanying,financia support,involvement,know ledge-sharing,and role modeling of PA would be positively associated with a high level of participation in MVPA by school children.A secondary purpose of the study was to examine differences in these associations by sex,residence locale,and school grades.

2.Methods

2.1.Study design and participants

The data analyzed in this study were derived from the 2016 Physical Activity and Fitness in China—The Youth Study(PAFCTYS),which was conducted between October and November 2016.The PAFCTYS,described in detail by Fan et al.,26used a 3-stage stratifie cluster(non prob ability)sampling design to sample a nationally representative group of school-aged children(aged 7–17 years)in primary schools(Grades 4–6),junior middle schools(Grades 7–9),and junior high schools(Grades 10–12)from 22 provinces,4municipalities,5 autonomous regions,and 1 Xinjiang Production and Construction Corps(an independent division within Xinjiang Uygur Autonomous Region),in the Mainland of China.

The original PAFCTYS survey sample included a total of 125,281 school children,Grades4–12,who participated in the survey portion of the study.Of these participants,children with missing information on residence locale(n=7029)and those who provided out-of-range data or response values in survey questions,including family-related measures(n=1636)and out come measures of MVPA(n=34,759),were excluded.Asa result,data analyzed in this study came from a total of 81,857 children who provided PA data and whose parents or guardians also completed a survey.

The study was approved by the Institutional Review Board of Shanghai University of Sport.Permission to conduct the study was obtained from principals of each school participating in the PAFCTYS.Verbal consent was obtained from the children’s parents or guardians and from all participating children prior to data collection.

2.2.Procedures

In a school classroom setting,trained research staff provided a detailed description of the study and instructions on completing the survey.Each child completed a4-page survey(online or on paper)that included questions about their PA and other demographic information.The parents or guardians of each child were also asked to complete a 4-page adult version of the survey at home that included questions about parental support for PA and other family-related characteristics.Trained research staff administered the survey and answered any question about it.

2.3.Measures

2.3.1.MVPA

Children’s MVPA was assessed via a Chinese version27of the International Physical Activity Questionnaire Short Form(IPAQ-SF).28Psychometric properties of the IPAQ-SF with the Chinese student population have been previously established.27Relevant to this study,items related to participating in moderate-intensity and vigorous-intensity activities were used.26The children’s report of the average number of daily minutes of engaging in MVPA(in the past7 days)was calculated and used as a dependent measure.

2.3.2.Parental support for PA

Parental support for children’s PA was assessed by 6 questions completed by the children’s parents or guardians.The questions included(1)“Do you encourage your child take part in physical activity/exercise?”(Parental PA encouragement),(2)“Do you accompany your child when he/she attends physical activity/exercise sessions?”(Parental PA accompanying),(3)“Do you provide financia support when your child participates in physical activity/exercise?”(Parental financia support of PA),(4)“Do you join your child when he/she participates in physical activity/exercise?”(Parental PA involvement),(5)“Do you share your know ledge of the health benefit of physical activity/exercise with your child?”(Parental PA know ledgesharing),and(6)“Do you serve as a role model for your child by engaging in physical activity/exercise?”(Parental role modeling for PA).The parent or guardian responded these questions on a 5-point scale,based on the following scores:1=never,2=not very much,3=not sure,4=sometimes,and 5=very much so,with high scores indicating positive support for PA.The 6-item scale has a Cronbach α(internal consistency)coefficien of 0.82.In this study,we define the term “parent”to include any guardian who was responsible for the welfare of the child(i.e.,“parent”was not limited to biological parents).

2.3.3.Other measures

Demographic information about each child’s date of birth was retrieved from his or her student ID.Children’s height was measured to the nearest 0.1 cm in bare feet whereas body weight was measured to the nearest0.1 kg.Both of these measures were assessed using a portable instrument(GMCS-IV;Jianmin,Beijing,China).Each child’s body mass index(BM I)was then calculated as(weight in kg)/(height in m)2.Residence locale information(urban,rural)for each child was obtained through his or her self-report on the survey.Information on family type and SES was ascertained from the parent and guardian survey in which the parent or guardian was asked who was most responsible for raising the child:both parents,single parent(father or mother),grandparents,stepfather,stepmother,and MVPA).Correlation matrices by sex,residence locale,and school grades are shown in the online supplement(Tables S1–S3).

Table1 Descriptive statistics for the study population.

Testing of the hypothesized path model for the total sample resulted in χ2=8212.62;df=28;p＜0.001;root-mean-square error of approximation=0.063(95% confidenc interval(CI):0.055–0.072),indicating a reasonable fi of the hypothesized model to the empirical data.Model parameter estimates(both unstandardized and standardized)are presented in Table 3.Results show that parental encouragement(b=1.98),accompanying(b=0.90),financia support(b=1.07),involvement(b=0.85),and role modeling(b=0.71)for PA were positively associated with a high level of child participation in MVPA(p＜0.001).Parental PA know ledge-sharing,however,was not significant y associated with MVPA(p=0.53).

3.3.Multi group analysis by sex,residence locale,and school grades

The χ2difference tests between constrained and unconstrained models in our multi group analyses reveal a similar pattern to the structural relationships shown in our main analyses,which indicates that the path estimates in our model were invariant for boys and girls,between children living in urban and rural areas,and across the3 school grades(see Table S4 of the online supplement for model testing using χ2difference).Estimates of path coefficient in the model by sex,residence locale,and school grades are presented in the online supplement(Tables S4–S5).The results are consistent with the overall model based on the total sample and show no statistically significan difference in the path coefficient between parental PA support variables and children’s MVPA across the 3 demographic variables examined.

4.Discussion

Using the 2016 PAFCTYS data,we examined the associations between various forms of parental support for PA and levels of MVPA participation among Chinese school-aged children.We found that high parental encouragement,accompanying,engagement,role modeling,and financia support for PA were positively associated with high levels of children’s participation in MVPA.These associations were found to be similar across boys and girls,residence locale(urban and rural),and school grades(primary,junior middle,and junior high schools).

This is one of the few studies that examined associations between parents’support of PA and children’s MVPA in China.Findings from this study are consistent with the extant literature published in western countries showing the important role parents play in promoting and facilitating children’s PA13and finding from China that demonstrate the modeling effectparents have in influencin their children’s engagement in and levels of MVPA.15,16The current study,however,extends the literature in a significan way by examining multiple parenting factors that are deemed to be relevant and important to Chinese school children in relation to their MVPA.

Table2 Zero-order correlations between parental support for PA factors and MVPA among Chinese school-aged children(n=81,857).

Table3 Parameter estimates of parental support for PA in association with MVPA in children(n=81,857).

4.1.Study limitations and strengths

As alluded to in other studies published in this special issue,26,30,32,33there are inherent methodological weaknesses in the PAFCTYS data,including the cross-sectional design and the fact that the data are predominantly from self-reports(including the data used in this study).Thus,this study lacks some of the well-developed,well-tested,and psychometrically sound measurement tools used to assess parents’support for PA.Future studies should develop reliable and valid measures in order to better understand the role of parenting practices in promoting and influencin children’s PA.Self-reported PA behavior in children is known to be subject to recall bias and to result in underestimations.27,34Therefore,our observed associations between parents’support of PA and children’s MVPA behavior should be interpreted with that limitation in m ind.Last but not least,among various correlates of PA within a socio-ecological framework,35we only focused on parental influences It is likely that the strengths of parental social support for children’s PA found in this study may interact with other dimensions of social support(e.g.,friends,school teachers,neighborhood networks)and neighborhood environmental factors(e.g.,neighborhood safety,availability of and access to PA facilities,street connectivity).36-38Therefore,a comprehensive evaluation approach may be needed to gain a better understanding of patterns and levels of MVPA among school children.

A notable strength of the study is its use of a large and nationally representative sample of Chinese school children.Another strength is that we considered different forms of parental support for children’s PA,which allowed a clear delineation of the specifi types of support provided by parents in promoting or facilitating their children’s PA behaviors.We were also able to analyze children’s MVPA levels by various important demographics(sex,residence locale,and school grades),which are of high practical importance for developing targeted community-and family-based policies and interventions.The non significan finding across various demographic variables in our study suggest the need for more finey grained analysis of children’s MVPA by considering the effect of interactions,such as between sex and age and specifi forms of parental support,to show how influence of parental support for PA on children’s MVPA may be moderated by demographic characteristics.

4.2.Practical implications

Findings from this study on parental support for PA suggest that the parents’promotion of certain PA-related behaviors,including accompanying their children to PA sessions,offering their children financia support(paying fees for PA or sports training and equipment),and being personally engaged with children in PA,can directly facilitate children’s PA.Our findings corroborate the existing evidence13,15,39and indicate that by offering their children intangible(or indirect)social support,such as verbal encouragement and role modeling for PA,Chinese parents can influenc their children’sMVPA in a positive way.MVPA among Chinese school children could also be enhanced if appropriate interventions were developed that targeted both children and their parents.For example,fostering positive parent–child interactions and engagement in routine and leisure-time PA could reduce sedentary time and improve fitness both of which are needed for populations of Chinese school children.32,33

5.Conclusion

This study indicates that parental support,either direct or indirect,is related to increased levels of MVPA among Chinese school children.

Acknowledgment

This research is supported by the Key Project of the National Social Science Foundation of China(No.16ZDA227).

Authors’contributions

YL made a substantial contribution toward analyzing the data and w rote the original manuscript;YZ,SC,JZ,and ZG carried out the data collection and discussed and commented on the draft;PC designed the study and commented on the draft.All authors have read and approved the fin a version of the manuscript,and agree with the order of presentation of the authors.

Competing interests

The authors declare that they have no competing interests.

Appendix:Supplementary material

Supplementary data to this article can be found online at doi:10.1016/j.jshs.2017.09.008

1.Janssen I,LeBlanc AG.Systematic review of the health benefit of physical and fitnes in school-aged children and youth.Int J Behav Nutr Phys Act 2010;7:40.doi:10.1186/1479-5868-7-40

2.Twisk JW.Physical activity guidelines for children and adolescents:a critical review.Sports Med 2001;31:617–27.

3.U.S.Centers for Disease Control and Prevention.Physical activity facts.Available at:https://www.cdc.gov/healthyschools/physical activity/facts.htm;[accessed 08.10.2017].

4.World Health Organization.Physical activity and young people—Recommended levels of physical activity for children aged 5–17 years.Available at:http://www.who.int/dietphysical activity/factsheet_young_people/en/;[accessed 08.10.2017].

5.Zhang X,Yang SY,Zhang B,Dong B,Ma J.Analysis of the current situation of physical activity and influencin factors in Chinese primary and middle school students in 2010.Zhonghua Yu Fang Yi Xue Za Zhi 2012;46:781–8.[in Chinese].

6.Lu C,Stolk RP,Sauer PJJ,Sijtsma A,Wiersma R,Huang G,et al.Factors of physical activity among Chinese children and adolescents:a systematic review.Int J Behav Nutr Phys Act2017;14:36.doi:10.1186/s12966-017-0486-y

7.Liu Y,Tang Y,Cao ZB,Chen PJ,Zhang JL,Zhu Z,et al.Results from Shanghai’s(China)2016 Report Card on Physical Activity for Children and Youth.J Phys Activ Health 2016;13(Suppl.2):S124–8.

8.Cui Z,Hardy LL,Dibley MJ,Bauman A.Temporal trends and recent correlates in sedentary behaviours in Chinese children.Int J Behav Nutr Phys Act2011;8:93.doi:10.1186/1479-5868-8-93

9.Duan J,Hu H,Wang G,Arao T.Study on current levels of physical activity and sedentary behavior among middle school students in Beijing,China.PLoS One 2015;10:1371–83.

10.Sun H,MaY,Han D,Pan C,Xu Y.Prevalence and trends in obesity among China’s children and adolescents,1985–2010.PLoS One 2014;9:e105469.doi:10.1371/journal.pone.0105469

11.Zhai L,Dong Y,Bai Y,Wei W,Jia L.Trends in obesity,overweight,and malnutrition among children and adolescents in Shenyang,China in 2010 and 2014:a multiple cross-sectional study.BMC Public Health 2017;17:151.doi:10.1186/s12889-017-4072-7

12.Gordon-Larsen P,Wang H,Popkin BM.Overweight dynamics in Chinese children and adults.Obes Res 2014;15(Suppl.1):S37–48.

13.Beets MW,Cardinal BJ,Alderman BL.Parental social support and the physical activity-related behaviors of youth:a review.Health Educ Behav 2010;37:621–44.

14.Yao CA,Rhodes RE.Parental correlates in child and adolescent physical activity:a meta-analysis.Int J Behav Nutr Phys Act 2015;12:10.doi:10.1186/s12966-015-0163-y

15.Wang X,Liu QM,Ren YJ,Lv J,Li LM.Family influence on physical activity and sedentary behaviours in Chinese junior high school students:a cross-sectional study.BMC Public Health 2015;15:287.doi:10.1186/s12889-015-1593-9

16.Dong F,Howard AG,Herring AH,Thompson AL,Adair LS,Popkin BM,et al.Parent–child associations for changes in diet,screen time,and physical activity across two decades in modernizing China:China Health and Nutrition Survey 1991–2009.Int J Behav Nutr Phys Act2016;13:118.doi:10.1186/s 12966-016-0445-z

17.Morrissey JL,Wenthe PJ,Letuchy EM,Levy SM,Janz KF.Specifi types of family support and adolescent non-school physical activity levels.Pediatr Exerc Sci2012;24:333–46.

18.Zecevic CA,Tremblay L,Lovsin T,Michel L.Parental influenc on young children’s physical activity.Int J Pediatr 2010;7:468526.doi:10.1155/2010/468526

19.Solomon-Moore E,Sebire S,Thompson JL,Zahra J,Law lor DA,Jago R.Are parents’motivations to exercise and intention to engage in regular family-based activity associated with both adult and child physical activity?BMJ Open Sport Exerc Med 2017;2:e000137.doi:10.1136/bm jsem-2016-000137

20.Wang L,QiJ.Association between family structure and physical activity of Chinese adolescents.Biomed Res Int 2016;2016:4278682.doi:10.1155/2016/4278682

21.Drenowatz C,Eisenmann JC,Pfeiffer KA,Welk G,Heelan K,Gentile D,et al.Influenc of socio-economic status on habitual physical activity and sedentary behavior in 8-to 11-year old children.BMC Public Health 2010;10:214.doi:10.1186/1471-2458-10-214

22.Tandon PS,Zhou C,Sallis JF,Cain KL,Frank LD,Saelens BE.Home environment relationships with children’s physical activity,sedentary time,and screen time by socioeconomic status.Int J Behav Nutr Phys Act 2012;9:88.doi:10.1186/1479-5868-9-88

23.Stalsberg R,Pedersen AV.Effects of socioeconomic status on the physical activity in adolescents:a systematic review of the evidence.Sc and J Med Sci Sports 2010;20:368–83.

24.Li F.Physical activity and health in the presence of China’s economic grow th:meeting the public health challenges of the aging population.J Sport Health Sci2016;5:258–69.

25.Tudor-Locke C,Ainsworth BE,Adair LS,Du S,Popkin BM.Physical activity and inactivity in Chinese school-aged youth:the China Health and Nutrition Survey.Int J Obes Relat Metab Disord 2001;27:1093–9.

26.Fan X,Cao ZB.Physical activity among Chinese school-aged children:national prevalence estimates from the 2016 Physical Activity and Fitness in China—the Youth Study.J Sport Health Sci2017;6:388–94.

27.Wang C,Chen P,Zhuang J.Validity and reliability of international physical activity questionnaire-short form in Chinese youth.Res Q Exerc Sport 2013;84(Suppl.2):S80–6.

28.Craig CL,Marshall AL,Sjostrom M,Bauman A,Booth ML,Ainsworth BE,et al.International Physical Activity Questionnaire:12-country reliability and validity.Med Sci Sports Exerc 2003;35:1381–95.

29.Muthén LK,Muthén BO.Mplus user’s guide.7th ed.Los Angeles,CA:Muthén&Muthén;1998–2015.

30.Wang L,Tang Y,Luo J.School and community physical activity characteristics and moderate-to-vigorous physical activity among Chinese school-aged children:a multilevel path model analysis.J Sport Health Sci 2017;6:416–22.

31.Hu L,Bentler PM.Cutoff criteria for fi indexes in covariance structure analysis:conventional criteria versus new alternatives.Struct Equ Modeling 1999;6:1–55.

32.CaiY,Zhu X,Wu X.Overweight,obesity,and screen-time viewing among Chinese school-aged children:national prevalence estimates from the2016 Physical Activity and Fitness in China—The Youth Study.J Sport Health Sci2017;6:404–9.

33.Zhu Z,Yang Y,Kong Z,Zhang Y,Zhuang J.Prevalence of physical fitnes in Chinese school-aged children:finding from the 2016 Physical Activity and Fitness in China—The Youth Study.J Sport Health Sci 2017;6:395–403.

34.Long C,Brand S,Feldmeth A,Puhse U,Gerber M.Increased self-reported and objectively assessed physical activity predict sleep quality among adolescents.Physiol Behav 2013;120:46–53.

35.Sallis JF,Cervero RB,Ascher W,Henderson KA,Kraft MK,Kerr J.An ecological approach to creating active living communities.Annu Rev Public Health 2006;27:297–322.

36.Tappe KA,Glanz K,Sallis JF,Zhou C,Saelens BE.Children’s physical activity and parent’s perception of the neighborhood environment:neighborhood impact on kids study.Int J Behav Nutr Phys Act2013;10:39.doi:10.1186/1479-5868-10-39

37.Committee on Environmental Health.The built environment:designing communities to promote physical activity in children.Pediatrics 2009;123:1591–8.

38.Ding D,Sallis JF,Kerr J,Lee S,Rosenberg DE.Neighborhood environment and physical activity among youth:a review.Am J Prev Med 2011;41:442–55.

39.Moore LL,Lombardi DA,White MJ,Campbell JL,Oliveria SA,Ellison RC.Influenc of parents’physical activity levels on activity levels of young children.J Pediatr 1991;118:215–8.