The Influencing Factors On Physical Activity Level Among Children And Adolescents In China

Background:Physical activity (PA) is a most basic and natur survival state ofrnan thathelp human to maintain energy balance by participating various type of PA. In modern society, with the arrivalof digitization and informationage, physical inactivity is greatly growing among children and adolescents all over the world. Now energy balance is destroyed due to lack of PA that will shake our foundation of health. For a long time, lots of research concern about the continous decline in physical fitness of youth in China. However, we lack in-depth and systematic research on influencing factors and mechanism. How is the level of PA among Chinese children and adolescent? Which factors are influencing level of PA? What are relationsships among these factors? How these factors at the individual, family, and community level to affect their physical activity bavior? We know nothing about that to Chinese children and adolescents.Purposes:The study conducts an epidemiological investigation to understand the distribution of PA level and their influencing factor for Chinese children and adolescents from the prespective view of physical activity epidemiology and social ecological model. The infulecning factors at the individual and family level are focused in this study. We feel interesting that how these factors directly or indirectly to influence physical activity behavior. The aim of this study is to examin the relations between PA level and influencing factor including sedentary behavior, social support from parents, exercise benefits & barrires among children and adolescents aged 8-18 years old in the whole of China.Methods:As a cross sectional study, a national epidemiological inverstigation on phsycial activity level and its influencing factors among Chinese children and adolescents is conducted by five questionnaires and scales including Physical Activity for Children and Adolescent(PAQ), Adolescent Sedentary Active Questionnaire(ASAQ), The Activity Support Scale for Multiple Groups (ACTS-MG), Exercise Benefits/Barriers Scale (EBBS-CN), and International Physical Activity Questionnaire (IPAQ).Firstly, we recruit847 students (449 boys,398 girls) from five elememtry, middle and high schools in Shanghai to revisethese questionnaires and test their validity and reliability in Chinese. On this basis, total 18424 students (51.9% boys,49.1% girls) aged 8-18 years old in grade 3 to 12 and 9291 parents (58.2% mother,42.8% father) are collectedfrom six provinces (Shanghai, Chongqing, Shandong, Fujian, Anhui, Inner Mongolia) across China. All of PAQ-CN, ASAQ-CN, ACTS-CN, and EBBS-CN) are mearsured by online version questionnaires and students are asked to uniformly fill out them in their own computer classroom.Parents complete "IPAQ-CN" questionnaire that includes demographic informationby their own computer or smarter phone through the link or quick response code of questionnaire. Additionally, we collect fitness data (FVC, sit-reach,50 meter,800/1000meter,400meter, rope, stand jump) for every student according to National Physical Fitness and Health Standardsfor School-aged Students (NPFHS). Physical education teachers are charge of measuring, entrying during PE classes.Data Analysis:Descriptive analysis is conducted to understand demographic dnformation. LMS method was used to exmine the percentile distrubution of scores of physical activity, social support, and exercise benefits & barrires, and draw LMS curve. Independ T-test and ANOVA was used to understand regularity and characteristic of physical activity level of children and adolescents in the catogorise of gender, fitness level, family environment. The study also conducts general liner regression and multiple logistic regression to indentify influencing factors which makes a great and significant contribution to physical acitivity level. At last, structural equation model is used to exmine the relation among physical activity level, obesity, sedentary behavior, physical fitness, social support from parents, parents' education level and active level by gender and age specificity. Four aspects of content are conducted in the study:1) Review and generalize the regularity and characteristic of physical activity epidemiology and social ecological model-related research; 2) Revise physical activity level and its influencing factors-related questionniares for children and adolescents in Chinese; 3) Describe the distribution characteristic of physical activity level and its influencing factors for Chinese children and adolescents; 4) Build model of influencing factors on physical activity level for Chinese children and adolescents.Conclusions:1) Revise questionnaires and scales of phsycial activity and its influencing factors in ChineseThe reliability and validity of revisedPAQ-CN (Physical Activity for Children and Adolescent), ASAQ-CN (Adolescent Sedentary Active Questionnaire), ACTS-CN (The Activity Support Scale for Multiple Groups), EBBS-CN (Exercise Benefits/Barriers Scale) are tested to demonstrate that all of them are suituable to Chinese children and adolesecnets.2) Examin the distribution characteristics of phsycial activity level and influencing factorsThe level of phsycial activity of Chinese children and adolescents is pretty low. The level of PA of girls is decreasing with age but male is not. The level of boys is higher than girls in all age group.Sedentary behavior is increasing among children and adolescents in China, but gender difference is not found in the database. The distribution characteristics of sitting time is becoming lower in 13-15 age years but higher in both of 8-12 and 16-18 age years. Especially, youths who is physically active every day still has much sitting time in China.The significant gender difference is found in physical fitness (Forced vital capacity, Sit-reach, 50m run,800/1000m run, Stand jump, Rope) in all age group. The scores of physical fitness of girls on sit-reach and rope are higher than boys', but all of others test items'scores of girls are lower than boys'. Physical activity level is becoming higher by increasing socres of fitness test items except forced vital capacity and sit-reach in all age group.In China, boys have more positive congition on exercise benefits than girls in all age group. However, exercise benefits become more negative with age for both of boys and girls. PA level of children and adolescents are increasing by increasing exerceise benefits congnition. All of these demonstate that exercise benefits may be an important influencing factor to PA.In China, girls obtain stronger social support from parents than boys in all age group. However, social support from parents is decreasing with age for both of boys and girls. PA level of children and adolescents become higher by obtaining stronger social support from parents. All of these demonstate that social support may be an important influencing factor to PA.The level of PA is increasing with parents'active level for children aged 8-12 years, but adolescents aged 13-18 years are not. The level of PA does not change with parents'education level distibution. That demonstrates that education level of parents is not directly related to PA.3) Build structral equation model of influencing factors on physical avtivty levelIn the base of physical activity epidemiology and social ecological model, the study build structral equation model to examin the path between physical and influencing factors in individual and family level in different age-gender group in China.Sedentary behavior, exercise benefits, and social support from parents are mainly and directly influencing factos to PA for Chinese children and adolescents which make most of comtribution to PA level. Social support from parents mediates parents' active level and education level to promotechildren and adolescets' PA level.Similarly, exercise benefits mediates the relations of social support or fitness and PA.Varous the influencing factors are becoming weaker with age in the model and PA level of boys is harder to be affected by individual or family factors than girls:For girls aged 16-18 years, daily sedentary behavior does not significantly affect PA level any more. For boys aged 16-18, only daily sedentary behavior and social support from parents are significantly and directly related to PA level. For boys aged 13-15 years, only exercise benefits and parents'active level make significant contribution to PA level. For children aged 8-12 years, sedentary behavior, exercise benefits, fitness (50m run and 400m run) and social support are all to contribute PA level. Parents'high level is strongly related to children'social support and exercise benefits that further promote to increase PA level. Similarly, parents'high PA level and education level is benefical to form strong social support from parents that indirectly promote to increase childen's PA level. However, the significant contribution of physical fitness to PA level is only found among children aged 8-12 years and fitness test itmes "50m run and 400m run" are strongly related to PA level.Father makes more contribution to youth' PA level than mother. For children aged 8-12 years, parents' active level and education level are mediated by social support from parents to promote PA level. However, for children aged 13-18 years, only father's active level and education level are significant indirect factor to PA in various models.Sendentary behavior is an independent factor to affect PA level of children and adolescents in China no matter how other factos are becoming shtronger or weaker in th model.