Parental Activity as Influence on Children's BMI Percentiles and Physical Activity

Abstract

Parents play a crucial role in the development of their children's lifestyle and health behaviour. This study aims to examine associations between parental physical activity (PA) and children's BMI percentiles (BMIPCT), moderate to vigorous PA (MVPA) as well as participation in organised sports. Height and body weight was measured in 1615 in German children (7.1 ± 0.6 years, 50.3% male) and converted to BMIPCT. Parental BMI was calculated based on self-reported height and body weight. Children's MVPA and sports participation as well as parental PA were assessed via parental questionnaire. Analysis of covariance (ANCOVA), controlling for age and family income was used to examine the association between parental and children's PA levels as well as BMIPCT. 39.7% of the parents classified themselves as physically active and 8.3% of children were classified as overweight or obese. Lower BMIPCT were observed with both parents being physically active (44.5 ± 26.3 vs. 50.2 ± 26.9 and 52.0 ± 28.4, respectively). There was no association between parental and children's PA levels but children with at least one active parent displayed a higher participation in organised sports (102.0 ± 96.6 and 117.7 ± 123.6 vs. 73.7 ± 100.0, respectively). Children of active parents were less likely to be overweight and obese. The lack of association between subjectively assessed parental PA and child MVPA suggests that parental support for PA in children is more important than parents being a role model. More active parents, however, may be more likely to facilitate participation in organised sports. These results underline the importance of the inclusion of parents in health promotion and obesity prevention programmes in children.

Full text

©Journal of Sports Science and Medicine (2014) 13, 645-650
http://www.jssm.org
Received: 25 March 2013 / Accepted: 06 May 2014 / Published (online): 01 September 2014
Parental Activity as Influence on Children`s BMI Percentiles and Physical Activity
Nanette Erkelenz  , Susanne Kobel, Sarah Kettner, Clemens Drenowatz, Jürgen M. Steinacker and
the Research Group “Join the Healthy Boat – Primary School”
Ulm University Medical Centre, Devision of Sports and Rehabilitation Medicine, Ulm, Germany
Abstract
Parents play a crucial role in the development of their children’s
lifestyle and health behaviour. This study aims to examine asso-
ciations between parental physical activity (PA) and children’s
BMI percentiles (BMIPCT), moderate to vigorous PA (MVPA)
as well as participation in organised sports. Height and body
weight was measured in 1615 in German children (7.1 ± 0.6
years, 50.3% male) and converted to BMIPCT. Parental BMI
was calculated based on self-reported height and body weight.
Children’s MVPA and sports participation as well as parental
PA were assessed via parental questionnaire. Analysis of covari-
ance (ANCOVA), controlling for age and family income was
used to examine the association between parental and children’s
PA levels as well as BMIPCT. 39.7% of the parents classified
themselves as physically active and 8.3% of children were clas-
sified as overweight or obese. Lower BMIPCT were observed
with both parents being physically active (44.5 ± 26.3 vs. 50.2 ±
26.9 and 52.0 ± 28.4, respectively). There was no association
between parental and children’s PA levels but children with at
least one active parent displayed a higher participation in organ-
ised sports (102.0 ± 96.6 and 117.7 ± 123.6 vs. 73.7 ± 100.0,
respectively). Children of active parents were less likely to be
overweight and obese. The lack of association between subjec-
tively assessed parental PA and child MVPA suggests that
parental support for PA in children is more important than par-
ents being a role model. More active parents, however, may be
more likely to facilitate participation in organised sports. These
results underline the importance of the inclusion of parents in
health promotion and obesity prevention programmes in chil-
dren.
Key words: Health and exercise, effects on body weight, health
promotion.
Introduction
The high prevalence of childhood obesity is a major con-
cern in Western countries (Lobstein et al., 2004) and in
many parts of the developed world (Kelishadi, 2007,
Wang and Lobstein, 2006). Besides physiologic and ge-
netic properties as well as nutrition, regular physical ac-
tivity (PA) is considered an important component in the
prevention of childhood obesity. Regular engagement in
PA during childhood is a well-documented contributor to
health and quality of life (e.g. Andersen et al., 2006,
Freedson, 1991; Trost et al., 1997). Insufficient PA on the
other hand, has been linked to higher rates of type II dia-
betes mellitus, hypertension, colon cancer, depression,
osteoporosis, and obesity (Pate et al., 1995; Trost et al.,
2001), which will increase medical costs (Kesztyues et
al., 2013) and negatively affect overall public health.
Health behaviours in youth are known to be im-
pacted by a variety of factors (Kettner et al., 2012) with
parents being strong determinants of their children’s PA
behaviour (e.g. Davison et al., 2003; Gustafson and Rho-
des, 2006; Jago et al., 2009; Moore et al., 1991). There
may be several mechanisms underpinning parental impact
such as direct modelling of PA, establishing or eliminat-
ing barriers to PA or sports, and positively reinforcing
children for participation in sports (Sallis et al., 2000). A
recent German study for instance, has shown lower levels
of children’s PA at weekends, compared to weekdays,
suggesting that parents do not engage their children in
enough PA (Kettner et al., 2013). Organised sports, which
typically are performed on the weekdays, are very popular
and highly accessed in Germany. With 1.1 million chil-
dren at the age of below 6 years participating in German
sports clubs (Fehres et al., 2011), extracurricular sports
participation is an important component of children’s total
PA (Cleland et al., 2005). Overall, sports participation has
been shown to contribute between 23% and 60% to chil-
dren’s daily moderate to vigorous PA (MVPA) (Wickel
and Eisenmann, 2007). Further, sports participation has a
positive effect on social behaviour and emotional wellbe-
ing (Morris et al., 2003, Steptoe and Butler, 1996).
There are several reviews (Gustafson and Rhodes,
2006; Trost and Loprinzi, 2011) that addressed the asso-
ciation between parental and children’s PA levels, but
results have been equivocal. The inconclusive results may
be partly attributed to small samples, and different meth-
ods used to assess PA but could also be due to a lack of
considerations of covariates of PA such as body weight.
Still, only little is known about the relationship between
parental activity levels and children’s participation in
organised sports. Since PA and sporting behaviours are
established early in life and are likely to be carried over
into adulthood (Kraut et al., 2003), a sound understanding
of this connection is vital. Identifying parental influences
on children’s PA behaviours are fundamental to health-
related research and will allow recommendations for
future guidelines and health-promoting interventions; the
purpose of this study was to examine associations be-
tween parental PA and children’s BMIPCT, as well as
MVPA and participation in organised sports.
Methods
Baseline data from 1615 children (7.1 ± 0.6 years, 50.3%
male), participating in a school-based health-promotion
programme in south-west Germany, were analysed
(Dreyhaupt et al., 2012). The study was approved by the
Research article

Parental activity influences children´s BMI
646
ethics committee of the institutional review board and
parental consent and child assent were obtained prior to
data collection. Children’s height and body weight was
measured according to standard procedures with children
being bare feet and only wearing shorts and a vest. Stand-
ing height was measured to the nearest 0.1 cm using a
stadiometer (Seca 213, Seca Weighing and Measuring
Systems, Hamburg, Germany) and body weight was
measured to the nearest 0.05 kg with an electronic scale
(Seca 862, Seca Weighing and Measuring Systems, Ham-
burg, Germany). Subsequently body weight index (BMI)
was calculated and converted to BMI percentiles
(BMIPCT) using German reference data (Kromeyer-
Hauschild et al., 2001). As recommended by AGA
(Kromeyer-Hauschild et al., 2001; AGA = German work
group for obesity in childhood and adolescence), over-
weight and obesity was determined above the 90th and
97th percentile, respectively. Children’s MVPA was as-
sessed via a previously validated (Opper et al., 2007)
parental questionnaire. Specifically, parents were asked to
report the number of days per week with children engag-
ing for at least 60 minutes/day of PA that would result in
sweating or breathing heavily (equating to MVPA). Fur-
ther it was asked whether the children participated in any
organised or non-organised sports. Parents provided in-
formation on the type of sport along with frequency per
week and duration by using free text fields in the ques-
tionnaire. Based on this information total minutes/week
spent in sports was calculated. Parents were asked
whether they classify themselves as physically active or
not (yes or no) and reported type of their sporting activi-
ties along with frequency per week and duration by using
free text fields in the questionnaire. In addition parents
reported their height (in cm) and body weight (rounded to
the next kg) to calculate BMI (kg·m-2). Migration status
was determined whether one of the parents was born
abroad or the language the child was spoken to in the first
years was other than German. Family income was ob-
tained using a 7 point scale (ranging from below 1250 €
until 5000 € or more) and then dichotomised into low
income (≥ 1750 €), medium income (1750 € - 3000 €) and
high income (above 3000 € per month). Parental level of
education (assessed using a 5 point scale ranging from no
qualification until high school graduation) was dichoto-
mised into tertiary and elementary/intermediate level of
education, considering the highest education of either
parent.
Parental activity groups were created (both physi-
cally active, one parent physically active, both inactive)
on the basis of the question whether mother and/or father
consider themselves as physically active (yes/no). Chil-
dren´s time spent in PA (organised and non-organised)
was calculated on the basis of parental responses about
times per week and minutes per session.
Statistical analysis
Correlations were calculated to check for plausibility of
given data (e.g. parental activity level: yes/no with min-
utes of sports per week), t-tests were used to analyse dif-
ferences between two groups (e.g. gender or active/non-
active). Associations between parental and children’s PA
levels, sports participation and BMIPCT were examined
using analysis of covariance (ANCOVA), controlling for
age, migration, family income and parental education. For
MVPA and sports participation BMIPCT were used as
additional covariates in an univariate variance analysis.
Since children’s PA has been shown to differ by gender
(Jago et al., 2005, Sisson et al., 2009) all analyses were
carried out separately for boys and girls. Kolmogorov-
Smirnov-Tests have shown non-normal distributions of
the data. Analyses were performed with SPSS Statistics
19 (SPSS Inc., Chicago, IL) with a significance level set
at α ≤ 0.05 using Bonferroni adjustment for multiple
comparisons.
Results
Descriptive characteristics are shown in Table 1. There
were no gender differences for BMIPCT and parental PA.
More than half of the parents (58% of mothers,
57% of fathers) classified themselves as physically active.
Parental answers about their physical activity (yes/no)
correlated significantly with their time spent in organised
sports (rmother = 0.36, rfather = 0.35, p = 0.001). Mothers
perceiving themselves as physically active engaged in
59.4 ± 92.8 min/week in sports, whereas mothers who
classified themselves as inactive participated in 2.3±29.6
min/week in sports. Similarly, inactive fathers spent
3.3±30.1 min/week doing sports whilst fathers who con-
sidered themselves as active spent 85.0 ± 140.9 min/week
engaging in sports.
Physically active parents (whether both or only one
Table 1. Participant’s characteristics, grouped according to their parents’ activity levels. Values are means (±SD).
Parents Inactive One Parent Active Both Parents Active Total Sample
N (%) 471 (29.2) 502 (31.1) 642 (39.7) 1615 (100)
Gender (male; %) 242 (51.4) 255 (50.8) 316 (49.2) 813 (50.3)
Age (years) ¹ 7.1 (.7) 7.0 (.6) 7.0 (0.6) 7.1 (0.6)
Height (m) 1.24 (.06) 1.24 (.07) 1.24 (.06) 1.24 (.06)
Body Mass (kg) ³ 25.1 (4.8) 25.0 (5.4) 24.1 (4.4) 24.7 (4.9)
BMI PCT ³ 52.0 (28.4) 50.2 (26.9) 44.5 (26.3) 48.4 (27.3)
Overweight/Obese (%) ³ 6.5/4.9 4.5/4.7 4.4/1.6 5.0/3.5
Sports (min/week) ² 73.7 (100.0) 102.0 (96.6) 117.7(123.6) 100.0 (110.5)
Age mother (years) ² 36.1 (5.5) 37.4 (5.6) 38.4 (4.5) 37.4 (5.2)
Age father (years) 39.8 (6.4) 40.4 (5.8) 41.06 (5.3) 40.4 (5.8)
High family income (%) ² 34.0 41.9 60.8 46.5
Higher education (%) 3 22.6 29.9 42.2 32.4
¹ both parents active and one parent active significantly (p ≤ 0.05) different from inactive parents. ² all groups significantly (p ≤ 0.05)
different from each other. ³ both parents active significantly (p ≤ 0.05) different from one active parent and inactive parents

Nanette et al.
647
parent) had significantly more often children engaging in
organised PA than inactive parents (F = 117.9, p =
0.001). As shown in Figure 1, there was a higher preva-
lence of overweight or obese children with both parents
being inactive (F = 4.1, p = 0.01). These results also re-
mained after controlling for parental BMI.
Figure 1. Boys’ and girls’ BMIPCT according to their par-
ents’ activity level; displayed in mean (SD). * p ≤ 0.05
Figure 2. Boy’s weekly participation in organised sports,
grouped according to their parents’ activity level and gen-
der. * p ≤ 0.05.
Parental PA had no influence on daily time spent at
MVPA and time spent in non-organised sports but there
was a significant association between perceived parental
PA and time spent in organised sports (F = 22.26, p =
0.001). Even though boys spent more time in organised
and non-organised sports these results were significant in
boys and girls (Fboys = 11.87, p = 0.001; Fgirls = 10.88, p =
0.001; Figure 2 and 3). The association was stronger be-
tween perceived maternal PA and time spent in organised
sports in boys and girls compared to the association be-
tween perceived paternal PA and organised sports in
children.
Family income varied significantly between paren-
tal PA groups but did not affect the child’s BMIPCT,
MVPA or sports participation either. Neither did parental
education level and migration status.
Discussion
This study investigated the influence of parental PA on
children’s PA levels in and outside of organised sports as
well as on their BMIPCT. It could be shown that children
of parents who perceive themselves as being physically
active have lower BMIPCT values than children of par-
ents who perceive themselves as being inactive. This was
especially true for children who’s both parents considered
themselves as physically inactive. This was also reflected
by a higher prevalence of children´s overweight and obe-
sity in the group of inactive parents, which may reflect an
overall healthier lifestyle in active parents compared to
inactive parents (Ricci et al., 2012). In this study, more
than half of the parents considered themselves to be
physically active, which is considerably more than re-
search has shown previously. A large German Study us-
ing questionnaires in more than 15000 adults between 18
and 70 years showed, that only around one third of Ger-
man adults are at least once a week physically active
(Becker et al., 2006). In their research, investigating cor-
relates and reasons for physical inactivity, PA was
amongst others influenced by socioeconomic factors such
education and migration. In this study, however, chil-
dren’s BMIPCT values were neither associated with mi-
gration nor parental education.
Figure 3. Girl’s weekly participation in organised sports,
grouped according to their parents’ activity level and gen-
der. * p ≤ 0.05.
Consistent with previous studies (Jago et al., 2010,
Sallis et al., 1992, Trost et al., 2003), in the present study
no association was found between perceived parental PA
and children’s time spent in MVPA nor was there any
relation between parental PA and time spent in non-
organised sports. On the contrary, in a study by Jago et al.
(2010) using objective assessments of MVPA, 4- to 7-
year old children with two active parents engaged in up to
5.8 times higher activity levels. Also, Fuemmeler et al.
(2011) reported that parental MVPA levels were associ-
ated with increased childhood MVPA in primary school
children. The results of this study however, may support
the hypothesis that parental support such as transportation
to sport and fitness activities, rather than being a role
model, affects activity levels in children (Trost et al.,
2003).
Nevertheless, parental perceived PA was related to
children’s participation in organised sports which con-
firms the results of recent research (Schmiade and Mutz,
2012). It is also possible that active parents are more
likely to enrol their children in organised sports, pay the

Parental activity influences children´s BMI
648
according fee and ensure transportation to these clubs
(Steptoe and Butler, 1996). Particularly, children with an
active mother were more likely to engage in organised
sports, possibly highlighting the fact that it is mostly
mothers organising their children’s sporting activities and
providing the necessary transportation (Sayer et al., 2004;
Davidson et al., 2003). Mothers seem to be more likely
involved in the activity choices of their children and pro-
vide a higher level of logistic support (Davison et al.,
2003, Bois et al., 2005). Since mothers generally spend
more time with their children than fathers (Sayer et al.,
2004) it can be assumed, that primarily the mother’s atti-
tudes toward a healthy and active lifestyle would influ-
ence participation of their children in organised sports.
Nonetheless, children’s PA levels in organised sports
were even higher if both parents considered themselves as
physically active. Similar results were found in an Austra-
lian study assessing nearly 6000 9- to 15-years olds (Cle-
land et al., 2005). It was concluded that parental PA is
positively associated with children’s participation in out
of school sports, especially if both parents are physically
active. However, Cleland and colleagues (2005) found no
parental gender effect; in their study, if only one parent
was active, the gender was no independent predictor for
children’s sports participation. Yet, Yang et al. (1996)
concluded that especially paternal PA levels play a sig-
nificant role in children’s PA. In their study, it was sug-
gested that fathers are more important socialising agents
than mothers for children’s sports activities (Yang et al.,
1996). That study, however, consisted of a slightly older
sample.
The fact that there is no difference in overall PA
between children of active and inactive parents might be
due to the fact that the time spent in organised sports does
not necessarily equate to MVPA. Leek et al. (2011)
showed that participation in organised sports does not
ensure 7- to 14-year-old children reaching the recom-
mended PA guidelines on practicing days. In their study,
children spent only 46.1% of their practicing time in
MVPA and only 24% met current guidelines of 60 min-
utes of MVPA per day during practice. This may also be
due to the fact that a high percentage of children are inac-
tive during practicing time (Katzmarzyk et al., 2001).
However, Sigmund et al. (2008) showed that more fre-
quent participation in organised sports is positively re-
lated to the amount of weekly PA. They also highlighted
that children participating in organised sports, still have
significantly higher levels of vigorous PA compared to
children not participating in organised sports (Sigmund et
al., 2008).
The lack of significance regarding family income
on BMIPCT or daily MVPA is in agreement with previ-
ous research identifying that parents from all socioeco-
nomic groups encourage their children to be physically
active (Brockman et al., 2009). Further, Yang et al. (1996)
showed that the father’s socioeconomic status does not
correlate with boys organised sporting activities. Al-
though it can be suggested that parental support differs
depending on socioeconomic backgrounds (Brockman et
al., 2009) since children from families with lower income
participate less in organised sports (Voss et al., 2008).
However, children from low socioeconomic families may
engage in more unstructured PA and free play while chil-
dren with a higher socio-economic background may re-
ceive more logistic and financial support and, therefore,
could participate in more organised sports.
Even though the questions used to determine ha-
bitual as well as organised and non-organised PA are
known as well-established and validated instruments
(Kahlert and Brand, 2011), there are some limitations and
therefore, the results should be interpreted with caution.
PA levels in this study are based on self-report only,
which is amongst others known to be influenced by social
desirability (Adams et al., 2005). Apart from children´s
BMIPCT, which were assessed on site, the present study
relied on parental report of PA and organised sport as well
as parental BMI. It can be assumed that active parents
may be more conscious about their activity levels and
those of their children and, therefore, their reports may
possibly be more accurate. Further, it should be consid-
ered that these data are cross sectional which does not
allow for causal interpretation. Moreover, there was no
information on intensity and actual activity time during
organised sports which may influence the outcomes in
this study, especially if considering variable intensities of
different types of sporting activities. Additionally, it
should be noted that the questionnaire was mainly com-
pleted by mothers, whereby it is not known if mothers
answered the questions on the fathers´ PA behaviour with
or without consulting them. Due to the large sample size
and the detailed questions regarding frequency per week
and duration of PA, however, this study may provide
some valuable insights into the association between pa-
rental and children’s PA levels.
Conclusion
In summary, this study shows that parental PA and par-
ents as an active role model have only limited influence
on children’s daily MVPA. Parental support, on the other
hand, may be a crucial aspect in facilitating sufficient PA
in children. Parents, who perceive themselves as being
active, may also be more likely to facilitate their chil-
dren’s participation in various activities, which was indi-
cated by a higher participation in organised sports. Fur-
ther, it can be assumed that active parents have an overall
healthier lifestyle which is passed along to their children,
for example reflected in a healthier diet (Davison and
Birch, 2001; Pearson et al., 2009), resulting in lower
BMIPCT. However, more research is needed to increase
the understanding of the association between the health
behaviours of children and their parents. Current results,
however, indicate that parental PA is an important factor
when it comes to engaging children in sufficient PA,
especially in organised sports. It has also been shown that
parental PA is associated with childhood BMIPCT, which
highlights the necessity of a stronger and active incorpo-
ration of parents into intervention programmes that target
PA, overweight and healthy lifestyle in children.
Acknowledgements
Nanette Erkelenz and Susanne Kobel contributed equally to this work.
The study was funded by the Baden-Württemberg Foundation. The

Nanette et al.
649
authors would like to thank the entire study team and all participating
teachers, children and parents.
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Key points
• A higher prevalence of overweight or obese children
was found with inactive parents.
• Children’s BMI percentiles were lower if both par-
ents were physically active compared to children
whose parents were both inactive or only had one
physically active parent.
• Parental activity had no influence on daily time
spent at MVPA and time spent in non-organised
sports.
• There was a significant association between parental
physical activity and the number of minutes per
week boys and girls participated in organised sports.
• On average, children who had at least one physically
active parent spent significantly more time partici-
pating in organised sports than children with inac-
tive parents.
AUTHORS BIOGRAPHY
Nanette ERKELENZ
Employment
Researcher in Exercise and Sport Science, Division of Sports
and Rehabilitation Medicine, Ulm, Germany.
Degree
Dipl. Sportwiss. (equivalent to MSc)
Research interests
Physical activity, physical activity assessment, health promo-
tion, peadiatrics
E-mail: nanette.fischbach@uni-ulm.de
Susanne KOBEL
Employment
Researcher in Exercise and Sport Science, Division of Sports
and Rehabilitation Medicine, Ulm, Germany.
Degree
MSc
Research interests
Physical activity, physical activity assessment, health promo-
tion, peadiatrics
E-mail: susanne.kobel@uni-ulm.de
Sarah KETTNER
Employment
Researcher in Exercise and Sport Science, Division of Sports
and Rehabilitation Medicine, Ulm, Germany Ulm, Germany.
Degree
Dipl. Sportwiss. (equivalent to MSc)
Research interests
Physical activity, physical activity assessment, health promo-
tion, peadiatrics
E-mail: sarah.kettner@uni-ulm.de
Clemens DRENOWATZ
Employment
Scientific Manager for school-based health promotion pro-
gram “Join the Healthy Boat – Primary School”, Ulm Uni-
versity Medical Centre, Division of Sports and Rehabilita-
tion Medicine, Ulm, Germany
Degree
PhD
Research interests
Health promotion in children and adolescents, Regulation of
energy balance
E-mail: clemens.drenowatz@uni-ulm.de
Jürgen M. STEINACKER
Employment
Prof. Dr. Dr. ,Head of the Devision of Sports and Rehabilita-
tion Medicine, University of Ulm, Medical Centre, Germany
Degree
MD, PhD
Research interests
Overtraining, health promotion, physical activity in children
and the elderly
E-mail: juergen.steinacker@uni-ulm.de
 Nanette Erkelenz
Medical Centre, Devision of Sports and Rehabilitation Medi-
cine, Ulm University, Frauensteige 6, Haus 58/33, 89075 Ulm,
Germany

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