Associations between health-related quality of life and physical fitness in 4–7-year-old Spanish children: the MOVIKIDS study

Accelerometer Monitoring Duration for Reliable Estimates of Physical Activity, Sedentary Behavior, and Step Counts in Preschoolers

PURPOSE

This study aims to establish the reliability of accelerometer-based measurements for physical activity, sedentary behavior, and step counts in preschoolers and determine the optimal monitoring duration necessary for reliable data.

METHODS

The study analyzed data from 434 preschoolers (ages 3-5) who wore waist-worn ActiGraph wGT3X-BT accelerometers for 7 days as part of the Sunrise Study in Spain. Two-way mixed effects intraclass correlation coefficients were calculated for various combinations of daily wear time and number of valid days to assess reliability. The Spearman-Brown prophecy formula was applied to determine the required days to achieve reliability scores of 0.7, 0.8, and 0.9.

RESULTS

The findings showed that reliability improved with increased wear time, although intraclass correlation coefficients values were weaker around 7 to 9 hours per day. To achieve a reliability score of 0.7, moderate to vigorous physical activity required 3 to 4 days, light physical activity required 4 to 7 days, and sedentary behavior required 8 to 13 days. Steps per day required 7 to 9 days for a reliability score of 0.7, while other step outcomes needed 10 to 13 days.

CONCLUSION

The study provides evidence-based recommendations on the monitoring duration required for reliable estimates of physical activity, sedentary behavior, step counts, and sleep duration in preschoolers using accelerometers. These findings are crucial for researchers and practitioners aiming to accurately assess and promote physical activity in early childhood.

Physical Activity, Fitness, and Health-Related Quality of Life in Children and Adolescent Cancer Survivors: A Cross-Sectional Study (iBoneFIT Project)

Background/Objectives: This study aims to evaluate the health-related quality of life (HRQoL) of children and adolescent cancer survivors in relation to previously published normative values for typically developing children and adolescents, as well as to analyze the differences in HRQoL based on their levels of physical activity and fitness. Methods: Cross-sectional study with 116 cancer survivors (12.1 ± 3.3 years, 57.8% boys) from two pediatric oncology units in Andalusia (Spain). HRQoL was assessed using PedsQL 4.0 Generic Core Scales. Physical activity was measured with accelerometers, and fitness was evaluated using self-reported and objective tests for muscular fitness. Independent samples t-tests to compare HRQoL between our sample and the normative values published for typically developing children and adolescents of the same age and analysis of covariance (ANCOVA) were conducted to assess differences in HRQoL according to physical activity and fitness categories in our sample. Results: Children and adolescent cancer survivors had lower HRQoL scores compared to typically developing children's and adolescents' normative values, except for social functioning. Higher levels of moderate-to-vigorous physical activity were associated with better total, physical, and psychosocial HRQoL scores. Children and adolescent cancer survivors with better levels of cardiorespiratory fitness, motor fitness, and flexibility reported better HRQoL scores in total and psychosocial domains. However, muscular fitness (self-reported and objectively measured) did not show a significant difference in HRQoL. Conclusions: Children and adolescent cancer survivors experience lower HRQoL than their typically developing counterparts. Engaging in at least 30 min of moderate-to-vigorous physical activity per day is associated with fewer HRQoL impairments. Improved fitness, particularly cardiorespiratory fitness, motor fitness, and flexibility, are associated with better HRQoL outcomes. These findings highlight the association between physical activity, fitness levels, and HRQoL in children and adolescent cancer survivors, suggesting the potential benefits of promoting physical activity and enhancing fitness levels.

The effect of psychological and behavioral problems on the quality of life of children and adolescents based on self-reports and proxy reports

PURPOSE

Investigations of the quality of life (QoL) of young people have shown that psychological and behavioral problems are associated with lower subjective well-being. The QoL ratings of children and adolescents based on self-reports and proxy reports are significantly different. The aim of the present study was to examine youth self-reported and parent proxy-reported QoL and investigate the effects of age, gender and psychological/behavioral symptoms on the QoL reports of youth. We hypothesized that self-reported emotional and anxiety problems influence self-reported QoL, while proxy-reported behavioral problems influence proxy reports of QoL.

METHODS

The sample consisted of 284 parent-child pairs. Youths were between the ages of 11 and 18 years, the mean age was 14.3 (SD 2.1) years, and 35.6% were males. The Inventory of Life Quality (ILK) scale was used to measure QoL, and the Strengths and Difficulties Questionnaire was used to assess psychological and behavioral problems.

RESULTS

Males had higher self-reported QoL than females, and younger children had better QoL than older children. Emotional peer problems and hyperactivity reported by youth and hyperactivity and conduct problems reported by parents predicted youth self-rated ILK. Only parent-reported psychological/behavioral problems predicted proxy-rated ILK.

CONCLUSION

The evaluation of QoL of children and adolescents should involve both self and proxy reports in order to capture the effects of various psychological/behavioral symptoms and the perspectives of both youth and parents.

Mediating role of physical fitness on the association between diet and health-related quality of life in adolescents

Objective

The aim of this study was to analyse whether the association between adherence to the Mediterranean diet and health-related quality of life (HRQoL) is mediated by physical fitness components (i.e., cardiorespiratory fitness, lower-limb strength, upper-limb strength and motor competence) in adolescents.

Methods

This is a cross-sectional study including mediation analyses. This study involved 181 adolescents (86 girls) aged 15.8 ± 0.3 years recruited from secondary schools and sport clubs located in Castellon (Spain). Adherence to the Mediterranean diet was evaluated using the KIDMED questionnaire. HRQoL was assessed with the KIDSCREEN-10 questionnaire. Cardiorespiratory fitness was assessed using the 20-m shuttle run test. Lower-limb strength was assessed through the standing broad jump test. Upper-limb strength was evaluated using a handgrip dynamometer. Motor competence was assessed using the 4 × 10 m shuttle run test. Mediation analyses were performed for each physical fitness component in order to assess its mediating effect on the association between adherence to the Mediterranean diet and HRQoL. Indirect effects (IE) with confidence intervals (CI) not including zero were interpreted as statistically significant.

Results

Cardiorespiratory fitness and lower-limb strength had a mediating effect on the positive association between adherence to the Mediterranean diet and HRQoL (IE = 0.11, 95 % CI = 0.01; 0.27 and IE = 0.07, 95 % CI = 0.01; 0.19). Upper-limb strength and motor competence did not act as mediators in the association between adherence to the Mediterranean diet and HRQoL (IE = 0.00, 95 % CI = -0.04; 0.07 and IE = 0.01, 95 % CI = -0.03; 0.07, respectively).

Conclusion

Our findings showed that the positive association of adherence to the Mediterranean diet on adolescents' HRQoL was mediated by physical fitness. Educational and public health strategies aiming to improve Spanish adolescents' HRQoL should focus on diet and physical fitness.

Longitudinal Relationships of Physical Activity, Sedentary Time, Cardiorespiratory Fitness, and Muscular Fitness with Body Fatness in Preschoolers

There is still insufficient knowledge about the potential benefits of physical activity and fitness or the adverse impact of sedentary behaviours on body composition at preschool age. Therefore, we aimed to study the relationships of moderate-to-vigorous physical activity (MVPA), sedentary time (ST), cardiorespiratory fitness (CRF), and muscular fitness (MF) with body fat percentage (BF%) in boys and girls. Participants were investigated twice: in the final year of kindergarten, when the boys' median age was 7 years and the girls' median age was 6 years (p = 0.240), and again in the first grade of school. MVPA and ST were measured with an accelerometer, BF% was derived from skinfold thicknesses, CRF was measured with a 20 m shuttle run test, and MF was represented by the mean z-scores from standing long jump and relative upper-limb strength. In girls, higher ST (β = 0.587, p = 0.021) and lower MF (β = -0.231, p = 0.009) at preschool age were related to higher BF% in the first grade of school after adjustment for confounders. MVPA and CRF in preschool children were unrelated to BF% in school among boys and girls. In conclusion, sitting less and having greater muscular fitness at preschool age appear to be beneficial for lower body fatness in the first grade among girls, but not in boys. MVPA and CRF at preschool age are unrelated to body fatness at school age in boys and girls. Our results indicate that girls may especially benefit from decreasing sedentary behaviours and increasing upper- and lower-limb muscular strength at preschool age for a healthy weight profile in the first grade of school.

A 10-week implementation of the FIT FIRST FOR ALL school-based physical activity concept effectively improves cardiorespiratory fitness and body composition in 7-16-year-old schoolchildren

Introduction

The purpose of the present study was to investigate the impact of the FIT FIRST FOR ALL school-based physical activity program on health-related physical fitness in Faroese schoolchildren. The program aimed to add three weekly sessions of organized high-intensity physical activity to the standard weekly physical education sessions for all pupils across the entire school.

Methods

A non-randomized controlled design was used to evaluate the effects of the program. Two schools participated, including one intervention school (INT; n =179) and one control school (CON; n =181), with pupils aged 7-16 years (grades 1-9). The FIT FIRST FOR ALL program consisted of three weekly 40-minute sessions of age-adjusted high-intensity physical activity over 10 weeks for the INT school, while the CON school continued their normal school program. Pre- and post-intervention assessments included cardiorespiratory fitness (Yo-Yo IR1C test), agility (Arrowhead Agility test), postural balance (Stork Stand), standing long jump performance, body composition, blood pressure, and resting heart rate.

Results

A significant time × group effect (p < 0.001) was observed for cardiorespiratory fitness, which increased by 31% [23;39] in INT (p < 0.001) and remained unaltered in CON (7% [-2;16], p = 0.13). In addition, a time × group effect (p < 0.001) was observed for agility, which improved by 2.1% [1.0;3.2] in INT (p < 0.001) and regressed by 3.3% [2.3;4.4] in CON (p < 0.001). No significant between-group effects were found for standing long jump and balance. A time × group effect (p < 0.001) was observed for changes in total muscle mass, which increased by 1.4 kg [1.2;1.5] in INT (p < 0.001) and by 0.4 kg [0.3;0.6] in CON (p < 0.05). Furthermore, a time × group effect (p < 0.001) was observed for total fat percentage, which decreased by -2.3% [-2.8;-1.9] in INT (p < 0.001) and remained unchanged in CON (-0.3% [-0.7;0.1], p = 0.16). No significant time × group effects were found for blood pressure and resting heart rate.

Discussion

The FIT FIRST FOR ALL program significantly improved cardiorespiratory fitness and agility, and it led to favorable changes in body composition in the intervention school. These findings suggest that the program is highly effective in enhancing physical fitness and health status across all investigated age groups when implemented at a school-wide level.

Association between Gross Motor Competence and Physical Fitness in Chilean Children Aged 4 to 6 Years

The preschool period is considered critical for the development of motor competence, but as far as we know, no studies have investigated the association between motor competence and physical fitness in Chilean children. The aim of this study was to analyse the association between gross motor competence and physical fitness, controlling for possible confounding factors. A cross-sectional study was conducted with a sample of 144 preschool children (56.25% girls) with an average age of 5.3 years (4 to 6 years) from the Araucanía region, Chile. Motor competence was measured using the Children's Movement Assessment Battery, 2nd Edition (MABC-2). Regarding physical fitness, the components of cardiorespiratory fitness, lower body muscle strength and speed/agility were evaluated using the Battery to Assess FITness in PREschool (PREFIT). Partial correlation models and analysis of variance (ANCOVA) were used to assess differences in physical fitness between motor competence categories, controlling for age and body mass index. The mean fitness scores for cardiorespiratory fitness, lower body muscle strength and speed/agility components were significantly higher in children with higher gross motor competence. In terms of effect size, large values were found for the lower body strength component in model 1 for boys and in model 2 for the total samples of girls and boys. The results of this study suggest that good levels of gross motor competence are associated with better physical fitness levels.

Cross-sectional and longitudinal relationships between cardiorespiratory fitness and health-related quality of life in primary school children in England: the mediating role of psychological correlates of physical activity

AIMS

The aims were (1) to analyse the cross-sectional and longitudinal associations between children's cardiorespiratory fitness (CRF) and health-related quality of life (HRQoL) and (2) to examine whether these associations were mediated by physical activity self-efficacy and physical activity enjoyment.

METHODS

This study involved 383 children (10.0 ± 0.5 years) recruited from 20 primary schools in northwest England. Data were collected on two occasions 12 weeks apart. The number of laps completed in the 20-m Shuttle Run Test was used as the CRF indicator. HRQoL was assessed using the KIDSCREEN-10 questionnaire. Physical activity self-efficacy and enjoyment were assessed with the social-cognitive and Physical Activity Enjoyment Scale questionnaires, respectively. Linear mixed models with random intercepts (schools) assessed associations between CRF and HRQoL cross-sectionally, and longitudinally. Boot-strapped mediation procedures were performed, and indirect effects (IE) with 95% confidence intervals (CI) not including zero considered as statistically significant. Analyses were adjusted for sex, time of the year, socioeconomic status, waist-to-height ratio, maturation, and physical activity.

RESULTS

CRF was cross-sectionally associated with HRQoL (β = 0.09, 95% CI = 0.02, 0.16; p = .015). In the longitudinal analysis, CRF at baseline was associated with HRQoL at 12 weeks after additionally controlling for baseline HRQoL (β = 0.08, 95% CI = 0.002; p = .15, p = .045). Cross-sectionally, physical activity self-efficacy and enjoyment acted individually as mediators in the relationship between CRF and HRQoL (IE = 0.069, 95% CI = 0.038; p = .105 and IE = 0.045, 95% CI = 0.016; p = .080, respectively). In the longitudinal analysis, physical activity self-efficacy showed a significant mediating effect (IE = 0.025, 95% CI = 0.004; p = .054).

CONCLUSION

Our findings highlight the influence of CRF on children's psychological correlates of physical activity and their overall HRQoL.

Predictors of Health-Related Quality of Life in Neurodivergent Children: A Systematic Review

Health-related Quality of Life (HRQoL) is a multi-faceted construct influenced by a myriad of environmental, demographic, and individual characteristics. Our understanding of these influencers remains highly limited in neurodevelopmental conditions. Existing research in this area is sparse, highly siloed by diagnosis labels, and focused on symptoms. This review synthesized the evidence in this area using a multi-dimensional model of HRQoL and trans-diagnostically across neurodevelopmental conditions. The systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Checklist, was completed in June 2023 using Medline, PsycInfo, Embase, PubMed, and Cochrane Library. Our search revealed 78 studies that examined predictors of HRQoL in neurodevelopmental conditions. The majority of these studies focused on autism and ADHD with a paucity of literature in other conditions. Cross-diagnosis investigations were limited despite the fact that many of the examined predictors transcend diagnostic boundaries. Significant gaps were revealed in domains of biology/physiology, functioning, health perceptions, and environmental factors. Very preliminary evidence suggested potentially shared predictors of HRQoL across conditions including positive associations between HRQoL and adaptive functioning, male sex/gender, positive self-perception, physical activity, resources, and positive family context, and negative associations with diagnostic features and mental health symptoms. Studies of transdiagnostic predictors across neurodevelopmental conditions are critically needed to enable care models that address shared needs of neurodivergent individuals beyond diagnostic boundaries. Further understanding of HRQoL from the perspective of neurodivergent communities is a critical area of future work.

Steps per day and health-related quality of life in schoolchildren: the mediator role of cardiorespiratory fitness

To analyse the relationship between steps per day and health-related quality of life (HRQoL) and cardiorespiratory fitness (CRF) and to examine whether the relationship between steps per day and HRQoL is mediated by CRF in schoolchildren. This was a cross-sectional study including 501 schoolchildren (aged 9-12 years, 47% girls), from Cuenca, Spain. Steps per day were measured using the Xiaomi Mi Band 3 Smart Bracelet, HRQoL was estimated by the KIDSCREEN-27 questionnaire, and CRF was assessed using the 20-m shuttle run test. Analysis of covariance and multivariate analysis of covariance models showed that children with a higher mean number of steps per day (> 9000 steps/day) had better HRQoL (global score, and physical and psychological well-being) and higher CRF levels than their peers with a lower number of steps per day (p < 0.05); however, these differences were no longer significant when controlling for sex, age, mother's education level, and CRF (p > 0.05). Linear regression models estimated that each 1000-step increment was associated with better CRF (β = 0.350; 95% CI, 0.192 to 0.508). In addition, the relationship between steps per day and HRQoL was mediated by CRF (p < 0.05).    Conclusion: Steps per day are a good metric to estimate daily physical activity because of its positive relationship with CRF. Moreover, those children taking more than 9000 steps per day are associated with higher levels of physical and psychological well-being. Finally, a substantial part of the improvement in HRQoL achieved through the increase in physical activity (steps per day) is mediated by CRF. What is Known: • Physical activity is known to have a positive impact on health-related quality of life in children. Steps per day are commonly used as a measure of physical activity. • Cardiorespiratory fitness is a recognized indicator of overall health in youth. What is New: • Increments of steps per day were associated with better CRF, with a nonlinear association after approximately 9000 steps/day. • Schoolchildren with > 9000 steps/ day showed better HRQoL.

Perceived Quality of Life Is Related to a Healthy Lifestyle and Related Outcomes in Spanish Children and Adolescents: The Physical Activity, Sedentarism, and Obesity in Spanish Study

BACKGROUND

Maintaining a healthy lifestyle is crucial for safeguarding the well-being and quality of life perception, appropriate growth, and development of children and adolescents, while also mitigating the risk of future adult-onset diseases.

OBJECTIVE

To assess associations between perceived quality of life and healthy lifestyle and related outcomes in Spanish children and adolescents.

METHODS

Cross-sectional analysis of 8-16-year-old children and adolescents (n = 3534) were included in the nationwide study of Physical Activity, Sedentarism, and Obesity in Spanish Youth (PASOS). Data were collected through (1) questionnaires on health-related quality of life (HRQoL), healthy lifestyle outcomes (dietary intake, physical fitness, sleep, and screen time), and (2) anthropometric measurements for weight status assessment. Data were analysed by logistic regression, using the health-related quality of life (HRQoL) as the grouping variable.

RESULTS

Participants with a lower HRQoL were those with a lower adherence to the MedDiet and lower achievement of the recommended daily intake of fruit and vegetables. They were also less likely to follow the recommendations for screen time and sleep (with the exception of the weekend) compared to participants with a higher HRQoL. Participants with a lower HRQoL showed a lower healthy weight status and poorer physical fitness than those with a higher HRQoL.

CONCLUSIONS

Healthy eating habits, healthy weight status (normal weight), appropriate sleep time, physical fitness, and limited screen time play a crucial role in the perceived quality of life in children and adolescents.

Individual and combined impact of physical fitness on health-related quality of life during adolescence: DADOS Study

The purpose of the present study was to investigate the individual and combined impact of physical fitness components at baseline on health-related quality of life (HRQoL) at 24-month follow-up in adolescents. This longitudinal research included 199 adolescents (13.9±0.3 years at baseline) from the DADOS study. Cardiorespiratory fitness was assessed using the 20-m shuttle run test. Muscular strength was assessed using the standing broad jump test. Motor competence was assessed using the 4 × 10-m shuttle run test. A physical fitness z-score was calculated as the mean of the z-scores values of each fitness test. A fitness index ranging from 0 to 3 was created according to the number of physical fitness components in which participants achieved high levels according to normative values. HRQoL was evaluated by the KIDSCREEN-10 questionnaire. Linear regression analyses showed that cardiorespiratory fitness, muscular strength, and the physical fitness z-score at baseline were individually associated with HRQoL at follow-up (β ranging from 0.123 to 0.183; all p < 0.05). Moreover, logistic regression analysis revealed that adolescents with a fitness index ≥1 at baseline were more likely to achieve high HRQoL at 24-month follow-up, compared with their peers with an index of 0 (OR ranging from 3.554 to 9.087; all p < 0.05). Our results revealed an individual and cumulative positive impact of physical fitness at baseline on HRQoL at 24-month follow-up. These findings underline the key role of promoting the enhancement of overall physical fitness components in order to improve adolescents' health and well-being.Highlights Adolescents with high levels of cardiorespiratory fitness, muscular strength and motor competence will benefit from a greater physical and mental well-being over the time.The more physical fitness components with optimal levels, the greater likelihood of reaching better HRQoL over the time.Public health authorities should focus on the promotion of multiple physical fitness components to increase adolescent's likelihood of achieving greater HRQoL over the time.

Exploring the self-reported physical fitness and self-rated health, mental health disorders, and body satisfaction among Chinese adolescents: A cross-sectional study

Background

Physical activity (PA) and Physical fitness (PF) have received tremendous attention in the field of physical and mental health. However, limited attention has been given to the associations of self-reported physical fitness with some health-related outcomes. Given the COVID-19 pandemic is still active in many Chinese regions, assessing health-related physical fitness (HRPF) in adolescents using field-based assessment (such as a shuttle run for cardiorespiratory fitness) is unrealistic, therefore, this study was conducted via a self-reported questionnaire.

Purpose

The present cross-sectional study was aimed at delving into the relationship between self-reported physical fitness with self-rated health, depression, anxiety, and body satisfaction in adolescents. Three thousand eight hundred and seven study participants from 12 public schools in South-eastern China were recruited and 2,407 of them provided valid data on variables that this study needed for analysis.

Materials and methods

Study participants were asked to self-report their sociodemographic factors (e.g., sex, grade, age), independence, and outcomes. Generalized linear models were used to explore the associations of self-reported physical fitness (comprising general physical fitness, cardiorespiratory fitness, muscular strength, speed and agility, and flexibility) with depression, anxiety, and body satisfaction. A total of 2,407 children and adolescents with a mean age of 13.82 (±2.1) years were included in the final study analysis.

Results

Higher self-reported levels of general physical fitness and cardiorespiratory fitness were associated with better self-rated health, and body satisfaction but with lower risks of depression and anxiety.

Conclusion

The current study offered evidence on the roles of self-reported physical fitness and health-related outcomes. To facilitate health in children and adolescents, advocating fitness education, and promotion could be a feasible approach.

The relationship between physical activity, physical fitness and fatness in 3-6 years old boys and girls: a cross-sectional study

BACKGROUND

Physical activity (PA), fatness and fitness in children and teenagers have been associated with short and long-term health benefits. However, little research analyzing these variables focuses on the preschool education stage. Thus, the objective of this research is to study the relationship between PA, fatness and fitness in 3-6 years old boys and girls.

METHODS

This cross-sectional study includes 150 boys and girls at age between 3 and 6 years. Fatness and fitness were assessed using a PREFIT (FITness testing in PREschool children) battery as well as the sit and reach test. PA levels were measured using accelerometers for 7 days.

RESULTS

Higher PA levels were related to better fitness values. In addition, differences were found in the PA levels between boys and girls. However, PA subcomponents were not related to fatness. Furthermore, there were no significant differences in fitness tests between underweight, normal-weight and over-weight children, except in handgrip strength.

CONCLUSIONS

The few studies that have analyzed the relationship between fatness, fitness and PA in preschool have revealed controversial results. However, our study is in accordance with the majority of studies which prove that PA is associated with better fitness performances in preschool children. Since fitness is an important indicator of health, schools and parents should encourage children to practice more daily PA, especially girls, who are less active than boys. However, the discrepancy about the relationship between PA and fatness between the results of the different research highlights the necessity of carrying out further studies that analyze the relationship between these 3 variables separately in each age group (3, 4, 5 and 6 years). This is due to the fact that associations were stronger in older children rather than in younger children.

Validity and Reliability of the International FItness Scale (IFIS) in preschool children

OBJECTIVES

Examine the validity and reliability of parent-reported International FItness Scale (IFIS) in preschool-age children.

METHOD

A cross-sectional study of 3051 Spanish preschoolers (3-5 years). Fitness was measured by PREFIT fitness test battery and reported by parents using an adapted version of the IFIS. Waist circumference was evaluated, and the waist-to-height ratio (WHtR) was calculated. Seventy-six parents of randomly selected schoolchildren completed the IFIS twice (two weeks apart) for a reliability assessment.

RESULTS

ANCOVA, adjusted for sex, age and WHtR, showed that preschoolers who were scored by their parents as having average-to-very good fitness had better levels of measured physical fitness than those preschoolers who were classified as having "very poor/poor" fitness levels (18.1laps to 22.1laps vs 15.6laps for cardiorespiratory fitness; 6.6 kg to 7.5 kg vs 5.3 kg for muscular fitness-handgrip-; 71.7 cm to 76.4 cm vs 62.0 cm for muscular fitness-standing long jump-; 17.2s to 16.2s vs 18.2s for speed/agility; and 11.2s to 15.6s vs 8.7s for balance; p < 0.001). The weighted kappa for concordance between parent-reported fitness levels and objective assessment was poor (κ ≤0.18 for all fitness measures). Overall, the mean values of the abdominal adiposity indicators were significantly lower in high-level fitness categories reported by parents than in low-level fitness categories (p < 0.05). The test-retest reliability of IFIS items ranged from 0.46 to 0.62.

CONCLUSIONS

The reliability of the parent-reported IFIS are acceptable, but the concordance between parents reported and objectively measures fitness levels is poor, suggesting that parents' responses may not be able to correctly classify preschoolers according to their fitness level.

A Better Cardiopulmonary Fitness Is Associated with Improved Concentration Level and Health-Related Quality of Life in Primary School Children

This study aimed to examine the physical fitness (PF) levels of primary school children and to determine the associations among PF, concentration, and health-related quality of life (HRQOL) in a subcohort. PF was assessed in 6533 healthy primary school-age children (aged 6−10 years, 3248 boys and 3285 girls) via standardized test batteries. Concentration was measured with the d2-R test, and KINDL questionnaires were used to determine HRQOL. Analysis of variance showed an increase in PF with age in all PF dimensions (all p < 0.001), except cardiopulmonary fitness (estimated VO2max) in girls (p = 0.129). Boys performed better in nearly all PF dimensions, except curl-ups, in all children aged ≥7 years (p < 0.05). Concentration levels increased in boys and girls aged 7−9 years (p < 0.001), whereas HRQOL did not (p = 0.179). The estimated VO2max had a strong impact on concentration (β = 0.16, p < 0.001) and HRQOL (β = 0.21, p < 0.001) in 9- to 10-year-olds. Cardiopulmonary fitness is important for improved concentration and better HRQOL in primary school-age children. However, longitudinal data are needed to provide further insight into the intraindividual relationships of PF and concentration over the course of child development and set up targeted prevention programs.

Health-related quality of life in developmental coordination disorder and typical developing children

PURPOSE

To analyse: 1) the differences in health-related quality of life (HRQoL) between typically developing (TD) children and children with developmental coordination disorder (DCD) according to parents' and children's perception, and 2) the differences and level of agreement between parents and children's perceptions in HRQoL in both children's samples.

METHODS

Cross-sectional analysis in 115 Spanish schoolchildren 4-to-7 years. Motor competence and HRQoL were assessed using the MACB-2 and the KINDL-R questionnaire, respectively.

RESULTS

ANCOVA model showed that children with DCD children obtained lower scores in physical well-being, friends, school and total HRQoL dimensions than TD peers after controlling for covariates (p < 0.05). Moreover, parents' perception scores in HRQoL were lower in children with DCD than in TD peers (79.7 vs 84.8; p = 0.022). Student T-tests for repeated-measures showed non-significant differences between children and parents' perceptions in mean HRQoL scores, by motor competence categories. The intraclass correlations coefficients between parents and children's perception of HRQoL was moderate in DCD category (0.62; p = 0.024) and small in TD category (0.29; p = 0.049).

CONCLUSIONS

Children under 6 years old with DCD have lower HRQoL scores than their TD peers. No differences were found between children's and parents' perceptions in total HRQoL, although the perceptions of children and parents in DCD category showed a significantly higher level of agreement than TD children. Interventions aimed at promoting motor skills in school settings during the preschool age seem necessary to improve children's quality of life.

The "Fat but Fit" Paradigm from a Children's Health-Related Quality of Life Perspective

Background: The fat but fit paradigm originally argues that the detrimental influence of obesity on cardiovascular risk and mortality could be counterbalanced by normal to high cardiorespiratory fitness (CRF) levels. The aim of the study was to determine whether there is a relationship between categories of the fat but fit conceptual model and health-related quality of life (HRQoL) in children. Materials and Methods: Cross-sectional cluster analyses of the MOVI-daFit! baseline data were conducted in 507 children aged 9 to 11 years in Cuenca, Spain. BMI, body fat percentage, VO₂ max estimate, and HRQoL (measured by the KIDSCREEN questionnaire) were assessed. Results: The cluster analysis of BMI/body fat percentage and VO₂ max estimate z-scores resulted in a four-cluster solution that fit the four categories included in the fat but fit paradigm: fat unfit (FU), unfat unfit (UU), fat but fit (FF), and unfat fit (UF). Analysis of variance (ANOVA) models showed the expected mean trends by cluster category: an increasing trend (FU<UU<FF<UF) in terms of VO₂ max estimate and, conversely, a decreasing trend (FU>FF>UU>UF) in terms of adiposity (p < 0.05). These models also indicated, in the whole sample, that schoolchildren in the FF and UF clusters scored higher on physical well-being, psychological well-being, and total HRQoL scores than their peers in the FU and UU clusters (p < 0.05). The results were similar regardless of gender and whether BMI or body fat percentage was used for clustering. Conclusions: This study reinforces the fat but fit paradigm with respect to a previously unexplored outcome, HRQoL, by indicating that CRF may be mediating in the relationship between obesity and HRQoL. Clinical Trial Registration number: NCT03236337.

The social and psychological health of children is associated with Mediterranean diet adherence items, cardiorespiratory fitness, and lifestyle

BACKGROUND

Mediterranean diet (MD) adherence, physical activity (PA) patterns, and physical fitness are associated with physical, social, and psychological health in children.

OBJECTIVE

the purpose of this study was to determine the association of items of MD adherence, fitness components, and lifestyle with psychological and social health in Chilean schoolchildren.

MATERIAL AND METHODS

this cross-sectional study included 615 schoolchildren, both girls (n = 271, 11.7 ± 1.00 years old) and boys (n = 344, 11.8 ± 1.1 years old). Anthropometric parameters, fitness components, lifestyle, health-related quality of life (HRQoL), and self-esteem were measured.

RESULTS

HRQoL showed an association with cardiorespiratory fitness (β: 0.12, p < 0.001) and PA (β: 0.32, p = 0.023). Self-esteem was inversely associated with screen time (β: -1.35, p < 0.001). Moreover, social health presented a positive association with PA after school (β: 0.06, p = 0.037). In relation to MD adherence items, HRQoL was linked to the items "Takes a fruit or fruit juice every day" (β: 1.93, p = 0.004) and "Consumes fresh or cooked vegetables ˃ 1 time/day" (β: 1.12, p = 0.018). Self-esteem was associated to "Consumes a dairy product ˃ 1 time/day" (β: 3.30, p = 0.030). Social health was inversely related to "Eats at a fast food restaurant ≥ 1 time/week" (β: -0.26, p = 0.003) and positively to "Consumes pasta or rice almost every day" (β: 0.35, p = 0.049).

CONCLUSION

MD adherence items, fitness, and lifestyle were linked to psychological and social health, therefore it is necessary to develop preventive strategies for schoolchildren to change in a positive way these modifiable lifestyle behaviors.

Relationship between both cardiorespiratory and muscular fitness and health-related quality of life in children and adolescents: a systematic review and meta-analysis of observational studies

Background

No review to date has evaluated the association between physical fitness and health-related quality of life (HRQoL) in healthy children and adolescents. The aims of this systematic review and meta-analysis were to examine the relationship between both cardiorespiratory fitness (CRF) and muscular fitness (MF) and HRQoL in healthy subjects under 18 years of age and to describe the dimensions of HRQoL in which these relationships are more robust.

Methods

The Medline, Embase, Cochrane Library, SCIELO, SPORTDiscus and PEDro databases were systematically searched to collect observational studies that examined the relationship between CRF and HRQoL and between MF and HRQoL in participants under 18 years of age without any diagnosed medical condition. Pooled effect sizes (ES) were estimated for the associations between both CRF and MF and the various HRQoL dimensions.

Results

The pooled ES (95% CI) estimates for the relationship between CRF and HRQoL were as follows: 0.19 (0.10 to 0.27) for physical well-being, 0.19 (0.07 to 0.32) for psychological well-being, 0.20 (− 0.14 to 0.55) for perceived health status, 0.10 (0.00 to 0.20) for self-perception/self-esteem, 0.07 (− 0.05 to 0.19) for quality of family relationship, 0.14 (0.04 to 0.25) for quality of peer relationship, 0.17 (0.04 to 0.29) for everyday functioning at school and 0.20 (0.12 to 0.28) for total HRQoL score. The pooled ES (95% CI) estimates for the relationship between MF and HRQoL were: 0.25 (0.12 to 0.37) for physical well-being, 0.11 (0.04 to 0.17) for psychological well-being, 0.08 (0.01 to 0.15) for quality of family relationship, 0.14 (0.03 to 0.25) for quality of peer relationship, and 0.09 (0.03 to 0.14) for total HRQoL score.

Conclusions

Our data suggest that both CRF and MF are positively associated with HRQoL, mainly in physical, psychological and peer relationships. Moreover, CRF is positively associated with school dimensions and MF is positively associated with family relationships.

Trail registration Protocol PROSPERO registration number: CRD42015025823.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01766-0.

Is children's health-related quality of life associated with physical fitness and mode of commuting? PREVIENE Project

AIM

The aims of this study were (1) to examine the associations between self-reported health-related quality of life (HRQoL), health-related physical fitness (cardiorespiratory fitness, muscular strength, and speed-agility), and mode of commuting to and from school in Spanish children, and separately by gender and (2) to analyse the difference in cardiorespiratory fitness by mode of commuting to and from school by gender.

METHODS

We conducted a cross-sectional analysis that included 415 children aged 8.47 ± 0.36 years from 14 schools in Granada, Spain. The HRQoL outcome was assessed using the valid and reliable KINDL-R questionnaire, which covers six life dimensions, children's physical fitness was assessed using the ALPHA fitness test battery, and while commuting to and from school was assessed using the valid, reliable, and feasible 'Mode and Frequency of Commuting To and From School Questionnaire'.

RESULTS

Cardiorespiratory fitness was positively correlated with all dimensions of HRQoL in boys, whereas higher muscular strength (standing long jump) was positively correlated with the emotional wellbeing dimension in girls. In addition, boys who actively commute to school (walking) presented better cardiorespiratory fitness. Moreover, children who actively commuted to school (walking) presented better scores for the emotional wellbeing, family, and school dimensions, as well as total scores (both, p < .05) of HRQoL.

CONCLUSION

In our study, HRQoL was positively correlated with cardiorespiratory fitness in boys (all dimensions), whereas muscular strength (standing long jump) was positively correlated with the emotional wellbeing dimension only in girls. Active commuting to and from school was associated with higher levels of cardiorespiratory fitness, school dimension, and KINDL-R total score. Improving cardiorespiratory fitness might be especially useful to improve HRQoL in children, and vice versa.

The Mediating and Moderating Effects of Physical Fitness of the Relationship between Adherence to the Mediterranean Diet and Health-Related Quality of Life in University Students

The aim of this study was to estimate the relationship between the adherence to the Mediterranean diet (MD) and health-related quality of life (HRQoL) in university students and to assess whether this relationship is mediated or moderated by cardiorespiratory fitness (CRF) and handgrip strength. A cross-sectional study was performed involving 310 first-year Spanish university students. Adherence to the MD was evaluated with the 14-item Mediterranean Diet Adherence Screener (MEDAS), and the HRQoL was evaluated with the Short Form-12 (SF-12) questionnaire. CRF was assessed by the 20 m shuttle run test, and the handgrip strength was determined by dynamometry. ANCOVA models showed that participants with higher CRF and handgrip strength levels had significantly higher scores in the physical component summary (PCS) and mental component summary (MCS) of the SF-12 and in the MEDAS questionnaire than those with medium and low scores (p < 0.050). Additionally, the ANCOVA models showed that students with good adherence to the MD showed higher scores in the MCS of HRQoL than those with low adherence (p = 0.044, ES = 0.013), but these results did not appear for the PCS of HRQoL (p = 0.728, ES = 0.001). In the mediation analysis, it was found that CRF and handgrip strength acted as full mediators of the relationship between adherence to the MD and the MCS of HRQoL. In the moderation analysis, it was evidenced that CRF and handgrip strength did not act as moderators in the relationship between adherence to the MD and the MCS of HRQoL. In conclusion, adherence to the MD does not seem to have a direct effect on the MCS of HRQoL because this association seems to be fully mediated by CRF and handgrip strength.

Food Habits and Screen Time Play a Major Role in the Low Health Related to Quality of Life of Ethnic Ascendant Schoolchildren

The objective of the present study was to determine the association between lifestyle parameters (i.e., physical activity (PA) level, screen time (ST), fitness and food habits) and health-related quality of life (HRQoL) in ethnic ascendant schoolchildren (i.e., Mapuche ascendant). This cross-sectional study included 619 schoolchildren with ethnic (EA; n = 234, 11.6 ± 1.0 years) and non-ethnicity ascendant (NEA; n = 383, 11.7 ± 1.1 years) from Araucanía, Chile. HRQoL and lifestyle were measured using a standard questionnaire and cardiometabolic markers (body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), systolic (SBP) and diastolic blood pressure (DBP)) and cardiorespiratory fitness (CRF) were additionally included. In the EA schoolchildren, the HRQoL reported association with CRF adjusted by age and sex (β; 0.12, p = 0.018) and non-adjusted with foods habits (β; 0.11, p = 0.034). By contrast, ST adjusted by age and sex presented an inverse association with HRQoL (β; −2.70, p < 0.001). EA schoolchildren showed low HRQoL (p = 0.002), low nutritional level (p = 0.002) and low CRF (p < 0.001) than NEA peers. Moreover, children’s ethnic presence showed an association with low nutritional levels (odd ratio (OR): 3.28, p = 0.002) and ST 5 h/day (OR: 5.34, p = 0.003). In conclusion, in the present study, EA schoolchildren reported lower HRQoL than NEA schoolchildren, which could be explained by the lifestyle patterns such as a low nutritional level and more ST exposure.

Muscular and cardiorespiratory fitness are associated with health-related quality of life among young adult men

Background

Despite numerous studies providing evidence for positive effects of physical activity and physical fitness, evidence for association between physical fitness and health-related quality of life (HRQoL) in young adults is limited. The aim of the present cross-sectional study was to investigate the association of cardiorespiratory and muscular fitness with HRQoL from the perspective of its physical and mental components among young adult Finnish males.

Methods

The sample consisted of 754 men, with the mean age of 26 years (SD 6.7 years), who participated in the military refresher training. HRQoL was measured using the Finnish RAND 36-item health survey. Cardiorespiratory fitness was determined by a bicycle ergometer test, and muscular fitness by various tests measuring maximal strength and muscular endurance. Logistic regression modelling was used to compare low, moderate and high physical and mental component of HRQoL scores to the respective levels of muscular and cardiorespiratory fitness.

Results

The findings of the adjusted (age, educational level, marital status, employment status, smoking, use of alcohol and BMI) analysis showed that cardiorespiratory and muscular fitness are positively associated with both physical and mental components of HRQoL. In terms of the physical component of HRQoL, even a moderate fitness level was positively associated with better HRQoL. In terms of the mental component of HRQoL, the impact was seen only in the group with the highest fitness level.

Conclusions

The findings suggest a positive contribution of physical fitness to mental health and highlight the importance of both muscular and cardiorespiratory fitness in the promotion of HRQoL. Even lighter forms of physical activity that result in moderate physical fitness could contribute to the physical component of HRQoL. In terms of the mental component of HRQoL, higher levels of physical fitness may be needed to gain higher levels of HRQoL among young males.

Reference Values for Fitness Level and Gross Motor Skills of 4-6-Year-Old Chilean Children

In childhood, fitness level is considered an important indicator of health, while gross motor skills are the basis of future motor competence. So far, no reference values have been found for the Chilean population. Therefore, this study aims to provide fitness level and gross motor skill reference values by gender and age of Chilean children aged 4–6 years. A cross-sectional analysis was conducted that included 728 children between 4 and 6 years old from the La Araucanía region of Chile. To assess the fitness level, the 20-m shuttle run test, standing long jump, handgrip dynamometry, 4x10m shuttle run, and Sit and Reach tests were used. Gross motor skills were assessed by five tests including aiming and catching and balance motor tasks. For fitness level, boys have better values in the long jump and dynamometry test, while girls have better values in flexibility. For estimated maximum volume of oxygen, at 5 years old there are significant differences in favour of boys, while at 6 years old in favour of girls. No statistically significant differences in speed/agility by gender were found. For gross motor skills, boys obtain higher values for catching and aiming tests, and girls for balance. The reference values for fitness level and gross motor skills shown in this study could aid physical education and health professionals in identifying children with low reference values, as well as in establishing objectives that will help to improve their health.