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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.
©Journal of Sports Science and Medicine (2014) 13, 645-650
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
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-
Key words: Health and exercise, effects on body weight, health
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.
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
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
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
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.
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
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.
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.,
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
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
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.
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.
Nanette Erkelenz and Susanne Kobel contributed equally to this work.
The study was funded by the Baden-Württemberg Foundation. The
Nanette et al.
authors would like to thank the entire study team and all participating
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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
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.
Researcher in Exercise and Sport Science, Division of Sports
and Rehabilitation Medicine, Ulm, Germany.
Dipl. Sportwiss. (equivalent to MSc)
Research interests
Physical activity, physical activity assessment, health promo-
tion, peadiatrics
Susanne KOBEL
Researcher in Exercise and Sport Science, Division of Sports
and Rehabilitation Medicine, Ulm, Germany.
Research interests
Physical activity, physical activity assessment, health promo-
tion, peadiatrics
Researcher in Exercise and Sport Science, Division of Sports
and Rehabilitation Medicine, Ulm, Germany Ulm, Germany.
Dipl. Sportwiss. (equivalent to MSc)
Research interests
Physical activity, physical activity assessment, health promo-
tion, peadiatrics
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
Research interests
Health promotion in children and adolescents, Regulation of
energy balance
Prof. Dr. Dr. ,Head of the Devision of Sports and Rehabilita-
tion Medicine, University of Ulm, Medical Centre, Germany
Research interests
Overtraining, health promotion, physical activity in children
and the elderly
Nanette Erkelenz
Medical Centre, Devision of Sports and Rehabilitation Medi-
cine, Ulm University, Frauensteige 6, Haus 58/33, 89075 Ulm,
... It articulates that respondents (either father or mother) are both matured and educated enough to better look after their children. Similar findings are also observed in the studies conducted in other countries (Kumar, 2013;Erkelenz et al., 2014). This study captures respondents both from nuclear and joint families and result postulates that joint family structure is now shrinking gradually with more emphasis on a nuclear family which further has a 124 significant effect on the physical and mental health status of children, these results are consistent with the study (Troiano et al., 2008;Bansal et al., 2014). ...
... As expected, allotting more time with children exhibits positive association with physical health index (p<0.05). This is due to the fact, parents' spend more time with children, therefore; better understand their needs and look after their physical health; which is consistent with the study of (Erkelenz et al., 2014). TV watching time exerts a positive impact (p<0.01) in the sense that both parents' and school going children watch several campaigns such as regarding upbringing of children, mental and physical support to the adolescent children which remain helpful for better growth at the adolescent period, such result is consistent with (Harris et al., 2009). ...
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Parents’ awareness regarding child health has a significant influence on physical and psychological issues. This study aims to explore the implication of parents’ behavior and attitude on the mental and physical health status of secondary education level children. A total of 130 respondents (either father or mother) is selected using the snowball sampling technique from Khulna City Corporation (KCC), Bangladesh. This study has applied Principal Component Analysis (PCA) and Ordinary Least Square (OLS) techniques for analyzing data. Results reveal that household structure (joint or nuclear) have significant implications in shaping the physical and mental health status of children. A poor level of parental awareness and care may lead children into depression and impede their mental growth. However, regression results postulate that parents’ awareness and spending more time with children is significantly related to the physical and mental fitness of their children which in turn keeps them on the right track. This study has predominantly explored to what extent parents' awareness matters for improving child physical and mental health status. Thus, parents’ awareness regarding child healthcare issues is indispensable.
... Physical activity can also be undertaken as a form of movement-transport or house cleaning duties and through play [14][15][16]. All forms of physical activity can provide health benefits if undertaken regularly and of sufficient duration and intensity [15][16][17][18]. Physical activity is further identified as an essential component of health and inactivity in adolescence may track into adulthood [9]. ...
... Physically active adolescents have reduced symptoms of anxiety and depression [12][13][14]. Moreover, physical activity is associated with improved mental health, and improved quality of life [17][18][19]. Physical activity recommendations provide parents with PA guidance about time, duration, intensity, and types of activities. ...
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Background: Adolescents are influenced by external factors which may impact their level of physical activity. Parents require specific strategies to become involved and to increase physical activity participation in adolescence. Objective: Thus, the current study aimed to design recommendations to increase physical activity participation and parental involvement. Methods: The current study forms part of a broader mixed-method study in which the results of the phases and stages of the pre-studies informed the current study. Thus, the current study uses an agreement workshop to develop recommendations with stakeholder and expert input in two rounds. Participants were invited to participate in the current study n = 100, and n = 65 participated in round one. Round two consisted of n = 20 experts invited to an agreement workshop, with n = 11 attending and making an input on the final recommendations. Therefore, experts and parents in the field of parenting, physical activity, and physical education, were invited to participate in the study rounds. After each round, the responses from the panellists were collated, interpreted, and developed into a framework for recommendations using thematic analysis. Themes were generated and refined using an agreement format. Results: After results from the stages and phases were consolidated and refined, six themes and 51 sub-themes were identified in a framework for recommendations. The framework was further refined using expert input and the final recommendations were derived using an agreement or agreement. Thus, with input from experts input through the agreement workshop, the findings were discussed, refined, and drafted into recommendations. Agreement and agreement were achieved on six broad recommendations and fifty-one sub-themes. The final recommendations were presented in the current study to increase parental involvement and physical activity in adolescents. Discussion: Recommendations and physical activity resources were developed and are presented as a form of support to parents and adolescents. The recommendations are intended as a source of unbiased information for parents to become more involved and for adolescents to increase physical activity participation.
... Parental behaviours were also important in uencing factors, something that was self-reported by parents and observed by the adolescent. These are associated with frequent physical activity 19 which not only predicted adolescent behaviour but also reduced BMI 20 . Verbal pressure from parents, such as restriction of certain foods, or verbal messages to eat less and exercise more -an observation within the interviews conducted here, has been associated with weight gain 20 . ...
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Background: Few treatments exist for adolescents living with severe obesity. This qualitative study explored the experiences of severely obese adolescents and their families who participated in the BOB study. Methods: Twelve adolescents (5 males;7 females; mean age 15 years; BMI > 3.5 s.d; puberty stage 4 +) who were engaged with the research study BOB (a non-randomised, pilot novel obesity treatment programme that involved the insertion of an intra-gastric balloon coupled with a family lifestyle behavioural support programme). Adolescents attended weekly lifestyle sessions before, during and post balloon insertion. All participants were interviewed at 3 months, (halfway through intra-gastric balloon insertion) and at 12 months follow-up (6 months post intra-gastric balloon removal, 3 months post lifestyle intervention). Results: All BOB participants had exhausted all treatment options deeming this study their final option. Many alluded to feelings of desperation and referred to a sense of hope that this intervention would be effective. Family involvement and attendance within the structured sessions differed significantly. Adolescents and parents perceived support from the research study ceased when the intra-gastric balloon was removed at 6-months despite attendance post balloon removal being poor. All participants emphasised a need for further support longer term with the integration of the family a critical factor. Conclusions: Further research is needed to explore the specific role families play within treatment to optimise health and wellbeing outcomes. Adolescents perspectives should be integrated within treatment to inform and improve the effectiveness of future treatment programmes for severely obese adolescents and their families.
... Consistent with the literature [54][55][56][57], the families in our study were aware of the importance of encouraging children to engage in sports activities, healthy diets and sleep habits, and social and psychological stability. Consistent with other studies [58,59], the parents were aware of community resources to promote active lifestyles in children and the effectiveness of the school in encouraging children to exercise and engage in physical activity. ...
Full-text available
Motivating children to lead a healthy and active lifestyle is a family mission and a responsibility shared by society. This study is important in developing the family’s role in promoting children’s active lifestyle. This study aims to develop the role of the family in promoting an active lifestyle for children in light of the Saudi vision 2030. The sample included 405 parents who filled out an online survey about their children aged 3–12 years. The results show families’ lack of interest in applying the WHO standards and the guidelines of the Saudi Ministry of Health regarding children’s regular daily physical activity. The families are reluctant to involve children in sports clubs. The parents desire to employ crews that enhance the movement and recreational activities of children in shopping centers and parks. The results also show that the presence of the father and mother together inside the house and their educational level have an impact on the effectiveness of the positive reinforcement of the active lifestyle of the children. To promote an active lifestyle for children, there is a need to determine why some families are hesitant to enroll their children in sports clubs. Additionally, there is a need to develop media and awareness campaigns for families in order to achieve the desired goals of developing an active lifestyle for children, which are approved by the WHO and Saudi Ministry of Health standards and are consistent with families’ low educational levels.
... Eight research articles and one report of a German health insurance company was included in the pool of research potentially addressing the influence of family and parents on children's physical activity behaviour. Two articles used data from the large-scale Baden-Wuerttemberg-wide study "Join the Healthy Boat" (4,5); three articles rely on the large-scale German-wide representative MoMo data (8,12,15); one article used a medium-sized regional sample in Goettingen (16); and three articles included smaller regional samples (7)(8)(9)(10). Furthermore, unpublished data of three studies has been included (KOMPASS Chemnitz, IDEFICS, CReActivity München). ...
Regular and sufficient physical activity is essential for a healthy development of children and adolescents. Current guidelines recommend a minimum of 60 minutes of moderate to vigorous physical activity daily for children and adolescents. Despite this, in Germany, only 22% of girls and 29% of boys are sufficiently physically active, pointing to a great need for physical activity promotion. Health behaviours develop in and depend on social contexts, of which family is the most important. Looking at German research on physical activity in youth with regards to family as a possible determinant, the lack of longitudinal data, diversity of representative cohorts and consistent assessment methods make recommendations for health promoting programmes difficult. However, most importantly, no study addressed the role of family or parents in relation to children’s physical activity nor the interaction between family/parents and children. Understanding the role of family and parents for the development and maintenance of children’s health-related behavioral patterns is crucial for the development of effective interventions. We need to identify relevant factors, situations and contexts of beneficial or detrimental family environments and understand the underlying mechanisms of family influences. For this purpose, studies have to have ‘family’ as the central research topic in relation to children’s physical activity, instead of using family as a “by-product” which can be considered as part of many other determinants.
... The factors that are encompassed in family social risk status individually have an impact on the level of youth sport participation, as well as on parental confidence and attitudes [19]. Children who have higher socioeconomic status (SES) are likely to engage in more hours of physical activity and have increased participation in sports compared with children with lower SES [23][24][25]. Parents with higher SES are most likely to have the financial means and free time to provide their children access to sports compared with parents with lower SES [24,26]. Factors such as parental education may influence the level of understanding that parents have on the positive health outcomes of youth sport participation [24,27,28]. ...
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Aim: This cross-sectional study aimed to better understand parental knowledge and attitudes regarding pediatric sport-related concussions, and association with parent/child biopsychosocial factors. Methods: A community sample of ninety families (n = 140 children) were included. Parental concussion knowledge and attitudes, concussion history, sport participation and social risk status score (SRS) were collected. Results: Parents scored an average of 76% accuracy on factual concussion knowledge, with 74% confidence in responses. Parents endorsed a favorable attitude toward concussion reporting and management. Low SRS had higher perceived accuracy of knowledge than medium or high SRS (p = 0.003). SRS influenced over-and-underestimations of factual knowledge (p = .04). Age at first sport and sport contact level influenced factual and perceived concussion knowledge. Conclusion: These findings identify common gaps in concussion knowledge in parents.
Background Promoting physical activity has been identified as a pillar of obesity treatment and prevention. However, youth with obesity often present with physical, affective, and environmental barriers to physical activity engagement. The construct of physical literacy, which has garnered international attention as a holistic approach to understanding human movement, may improve physical activity promotion strategies for youth with obesity. However, literature has shown that healthcare providers are not engaged with the construct of physical literacy. Methods This qualitative study utilized a phenomenological approach and interpretivist epistemology. Three phases of data collection included member checks, semi-structured interviews, and a focus group with physical therapists treating youth with orthopedic and sport injuries. Simultaneous data collection and inductive analysis was designed to identify themes reflecting how participants utilized the construct of physical literacy to promote physical activity in a clinical setting. Results Four overarching themes were identified in our analysis as strategies for promoting activity and physical literacy development: 1) Movement Experience, 2) Individualized Care, 3) Movement Momentum, and 4) External Factors. Conclusion The findings from this study highlight the usefulness of applying a physical literacy lens within physical activity promotion efforts among youth, which may be particularly important for youth with obesity. A high value was placed on the affective and behavioral determinants of physical activity. By applying a physical literacy lens, healthcare providers treating youth with obesity may be better equipped to address barriers and promote participation in physical activities that are enjoyable and build confidence. The findings from this study provide a foundation for future studies examining how healthcare providers can leverage the construct of physical literacy to improve physical activity outcomes among youth.
Background Prevention of children's overweight/obesity is of utmost importance. Parental characteristics play a pivotal role in shaping the offspring's weight status. Objective To examine associations between a) parental obesity and children's overweight/obesity and b) whether other parental Type 2 Diabetes (T2D) risk factors can predict children's obesity. Methods Logistic regression and receiver operating characteristic analyses were conducted, using cross-sectional data from a European cohort of 20,151 adults (10,967 mothers and 9,184 fathers) and children (n=10,967) participating in the Feel4Diabetes study. Anthropometric measurements were conducted in children and overweight/obesity was defined according to IOTF criteria. Parents’ T2D risk was assessed applying the Finnish Diabetes Risk Score (FINDRISC). Results After adjusting for all other FINDRISC variables, region and maternal/parental education, maternal [ORadj: 2.64 95% CI (2.18-3.20)] and parental [ORadj: 3.21 95% CI (2.65-3.91)] obesity, maternal [ORadj: 1.46 95% CI (1.23-1.74)] and parental [ORadj: 1.59 95% CI (1.32-1.92)] high waist circumference (WC) as well as maternal [ORadj: 1.60 95% CI (1.27-2.01)] and parental [ORadj: 1.87 95% CI (1.58-2.21)] high FINDRISC score, were associated with child overweight/obesity. Maternal [AUC-ROC: 0.638 95% CI (0.628-0.647)] and paternal BMI [AUC-ROC: 0.632 95% CI (0.622-0.642)], were the most accurate in predicting child overweight/obesity. Conclusion Among parental risk factors for T2D, maternal/parental overweight/obesity, central obesity and high FINDRISC score were the main predictors of childhood overweight/obesity, with BMI being the most accurate. Since it is simple-to-use, maternal or paternal BMI, rather than other T2D factors, might be useful for the early identification of children at risk of overweight/obesity.
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To review studies that can examine whether there is any effect of physical activity on obesity. Obesity is defined as an energy deficit caused by lifestyle behaviour such as poor food habits & insufficient physical activity time, both of which are significantly linked to obesity development. Journal articles published between 2011-2021 were secured by searching computerized bibliographical databases. High evidence studies such as systemic reviews and cross-sectional studies were included. A total of 30 studies were selected. After analysing the studies, it was seen that: Physical activity has been shown to reduce obesity in children. Increased physical activity (reduced inactive behaviour) in combination with healthy eating appears to be more beneficial in lowering obesity than either a good diet or increased PA alone.
Background and Aim Childhood obesity is an emerging problem often leading to earlier onset of non-communicable diseases in later life. Biomarkers to identify individual risk scores are insufficient in routine clinical practice, which is related to the need for easily sampled, non-invasive survey methods in children. We aimed to investigate and strengthen possible pro-inflammatory markers and epigenetic risk factors in saliva of obese children compared to lean controls. Methods and Results 19 overweight/obese (OC, 10.1±1.9 years, BMI 27.7±3.2 kg/m²) and 19 lean control children (CC, 9.7±2.5 years, BMI 16.4±1.8 kg/m²) participated in this explorative pilot study. Anthropometric measures, saliva and cheek swab samples were taken. Saliva profiles were examined for acute phase proteins (CRP and neopterin) and pro-inflammatory cytokines (IL-17a/IL-1ß/IL-6). Cheek swabs were analyzed to investigate DNA methylation differences with subsequent hierarchical cluster and principal component analyses (PCA). Saliva analysis showed significant increased CRP concentrations in OC compared to CC (p<0.001). There were no significant differences, but high intra-individual values in neopterin, IL-17a, IL-1ß and IL-6. An unsupervised PCA of CpG loci with high variance (σ/σmax>0.2) clearly separated OC and CC according to their methylation pattern. Furthermore, a supervised approach revealed 7,125 significantly differentially methylated loci, whose corresponding genes were significantly enriched for genes playing roles in e.g., cellular signalling, cytoskeleton organization and cell motility. Conclusions CRP and methylation status determinations in saliva are suitable as non-invasive methods for early detection of risks for non-communicable diseases in children/adolescents and might be a useful supplementary approach in the routine clinical practice/monitoring.
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Next to genetic predispositions, performance of physical activity (PA) in children is infl uenced by a variety of vari-ables including the parents' PA. The aim of this study is to describe associations between PA and sitting in children aged 8–13 and their parents according to sex and to examine whether their participation in organized PA infl uences a higher level of total PA. The level of performed PA, time spent sitting and their participation in organized PA were examined in 193 chil-dren (84 girls and 109 boys) and their parents (183 mothers and 157 fathers) using the Czech version of the IPAQ questionnaire. We have indentifi ed positive associations between parents' physical activities, which are the strongest in the dura-tion of walking (r S = 0.48–0.71; p < 0.001). A longer duration of total PA in daughters, sons and their fathers and mothers is related to a shorter daily period of time spent sitting (r S = 0.08–0.40). A longer period of time spent daily in sitting in parents is associated (r S = 0.28–0.42; p < 0.006) with a longer period of time spent sitting in their children. Children, both daughters and sons, and their mothers, who participate in organized PA twice or more times a week, show a signifi cantly longer period of time spent performing vigorous PA (p < 0.02; K 2 > 0.05) than children whose mothers are without any participation in organized PA. Based on the associations found between physical activity, sitting and participation in organized PA, we can agree with the statement that "more physically active parents are bringing up more physically active children" (it is more apparent in sons). On the other hand "less physically active parents are bringing up less physically active children" (it is more apparent in daughters). Participation in organized PA in children and mothers positively infl uences higher levels of PA in total, especially of vigorous PA.
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Von der frühen Kindheit an werden einige Kinder von ihren Eltern zu einem sportlich-aktiven Lebensstil angeregt, andere hingegen nicht. Diese Unterschiede ergeben sich nicht zufällig, sondern folgen einem sozialstrukturellen Muster: Kinder aus sozial privilegierten Elternhäusern erhalten sportbezogene Anregungen und Unterstützung mit größerer Wahrscheinlichkeit als Kinder aus bildungs- und einkommensschwachen Familien. Der Beitrag nimmt Vorschulkinder (bis 6 Jahre) in den Blick und analysiert mit Hilfe des Sozio-oekonomischen Panels (SOEP) die Teilnahme dieser Kinder an Kindersportangeboten. Ein beachtlicher Anteil von 41% der Kinder nutzt solche Sportangebote, wobei sich aber enorme soziale Unterschiede offenbaren. Die sozioökonomischen Ungleichheiten wirken vor allem vermittelt über den Lebensstil der Eltern: In sozial privilegierten Familien sind die Eltern selbst häufiger sportlich aktiv; und das Sporttreiben der Eltern erweist sich wiederum als der wichtigste Faktor, um die Teilnahme der Kinder am Kindersport zu erklären. Darüber hinaus sind ältere Kinder, Kinder ohne Migrationshintergrund und Kinder, die eine Kindertagesstätte besuchen, besonders häufig in Kindersportgruppen aktiv.
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Only a small proportion of children and adolescents meet current recommendations of at least 60 min of moderate to vigorous physical activity (MVPA) daily. Most of the available data, however, relies on subjective reports; there is limited objective data on physical activity (PA) levels in German primary school children. The purpose of this study, therefore, was to accurately determine how much time children spend undertaking different intensities of PA and being sedentary during weekdays and weekend using objective assessment tools. Gender-specific and age-related differences were examined along with differences between normal weight and overweight/obese children. Children's height and weight were measured according to standard procedures and objective PA measurements were determined in a sub-cohort of 384 primary school children (20% of the whole cohort), participating in a large school-based intervention study in south-west Germany (n = 1947). Baseline data collection occurred on six consecutive days, including weekend days, using multi-sensor accelerometry (Actiheart, CamNtech Ltd., Cambridge UK). 318 children (7.1 +/- 0.6 years, male: 50%, first grade: 51%) provided data for at least 3 days including one weekend day. According to the amount of energy expended, defined as metabolic equivalents (METs), different activity intensities were categorised as follows: sedentary < 1.5 METs; light = 1.5-3.0 METs; moderate = 3.0-6.0 METs, and vigorous > 6.0 METs. Average wear time was 1403 +/- 94 min/day. Children spent 808 +/- 97 min/day being sedentary; 497 +/- 72 min/day in light; 128 +/- 54 min/day in moderate, and 8 +/- 10 min/day in vigorous intensity. 48% of children met the current MVPA guidelines. MVPA was significantly higher on weekdays compared to weekend days (144 +/- 66 vs. 113 +/- 66 min/day; p < 0.001). Furthermore, boys displayed higher MVPA levels compared to girls (164 +/- 57 vs. 106 +/- 50 min/day; p < 0.001). Measured objectively, less than half of primary school children in the study met current PA recommendations, emphasising the necessity for early intervention to promote PA. Consistent with previous research, PA levels were higher in boys and during weekdays. These results indicate that PA levels of girls should especially be promoted in primary schools and that parents should be more involved in interventions to improve PA, particularly during weekends.
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The purpose of this study was to examine parental influences on children's participation in sport and their later physical activity. The population for the study consisted of a random sample of 1881 9 to 15 year old boys and girls who were exposed to the extensive research program called "Cardiovascular Risk in Young Finns" in 1980. They and their parents have been followed up for twelve years at three year intervals by means of a short questionnaire concerning physical activity and other factors. The results indicated that the fathers' physical activity in 1980 was related to their children's habitual physical activity in the same year, and gave in boys and girls a significant prediction of PAI values twelve years later when the starting point was the age of 9, and also among boys from 15 years of age to 27. During the three years follow up period, the extent of participation in sport was higher in families with active parents than in families with passive parents and single parents. The relationship of physical activity and sports participation with fathers' socioeconomic status and education was not so strong as with fathers' physical activity.
Time spent sitting, standing, walking, jogging and sprinting during practices and games were recorded for a sample of 58 males and 21 females, 11-14 years. The subjects were observed during participation in organized basketball, indoor soccer, outdoor soccer, ice hockey and in-line hockey. Subjects were chosen randomly from the participants and their major activity for every 5 second interval of a game or practice was recorded. There were no significant gender differences in activity profiles but there were significant differences among sports. Sprint time was greater for outdoor soccer than for any other sport with a mean of 35% in males. In-line hockey players spent the least time sprinting with a mean of 3% for males and females combined. Outdoor soccer players spent the greatest proportion of time jogging, with a mean of 32% for males and 33% for females. The significant differences in activity profiles suggest that energy expenditure varies within and among sports. The results have implications for estimates of energy expenditure associated with participation in organized youth sports.
Objective: To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention. Participants: A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented. Evidence: The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles. Consensus process: Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise "public health message" was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine. Conclusion: Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week.
This study investigates the extent of sporting activity in the Federal Republic of Germany. Our presentation of current data for physicians and other healthcare prevention players shows which people in Germany are the most physically active and also indicates which population groups display a below-average level of leisure-time sporting activity. This study is based on a representative nationwide dataset that has been largely neglected to date by the medical community: The Socioeconomic Panel (SOEP). The first part of this study identifies trends and distribution of leisure-time sporting activity for the 10-year period from 1992 to 2001. Part two presents correlations between leisure-time sporting activity, sociodemographic characteristics and life situation. Evaluation discloses that the percentage of the population engaging in weekly sporting activity rose approximately 5 % in the 1992 - 2001 period. The increase in the percentage of those engaging in regular leisure-time physical activity was highest among women and in the states of the former East Germany. One out of two German adults (48.2 %) does not perform sports. Persons with low professional qualifications, low educational qualifications and people from the former East Germany tend to be more likely to have a fairly inactive lifestyle.
Motor fitness and physical activity are important aspects of a healthy development in childhood and adolescence. However, the assessment of motor fitness and physical activity is not subject to standardized criteria; furthermore, the samples investigated do not provide a representative image of the whole population. Therefore, the existing data only allow very limited statements on the state and development of motor fitness and physical activity. The "Motorik" module, as part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), offers nationwide representative data on the motor fitness and physical activity of children and adolescents for the first time. Besides the baseline-analysis, another aim is to analyse the complex relationship between motor fitness, physical activity and health. Motor fitness, based on the systematisation of motor abilities, was assessed using a test profile. The test profile consists of 11 items measuring cardiorespiratory fitness, strength, coordination and mobility. Physical activity was assessed using a questionnaire containing 51 items on the duration, intensity and frequency of physical activity in everyday life, during leisure time, at school and in sports clubs. The above-mentioned questionnaire subtopics were supplemented by questions on the weekly prevalence of at least 60 minutes of daily physical activity, on material and local conditions, as well as on cognition and motivation for physical activity. In the years 2004 to 2006, the motor fitness and physical activity of 4,529 children and young people between the ages of 4 and 17 years was investigated on 168 sample points in the context of the "Motorik" module. Half of the children and adolescents investigated belong to the middle class, approximately 15% have a background of migration. The majority of the subjects come from small towns, about a quarter live in the city, less than 20% are settled in rural areas.
Motorische Leistungsfähigkeit und körperlich-sportliche Aktivität sind wesentliche Bestandteile einer gesunden Entwicklung im Kindes- und Jugendalter. Die Diagnose von motorischer Leistungsfähigkeit und körperlich-sportlicher Aktivität unterliegt jedoch bisher keinen standardisierten Kriterien, darüber hinaus liefern die untersuchten Stichproben kein repräsentatives Abbild der Gesamtbevölkerung. Die vorhandenen Daten lassen somit nur bedingt Aussagen zum Status und zur Entwicklung motorischer Merkmale und des Aktivitätsverhaltens zu. Das im Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS) durchgeführte Motorik-Modul (MoMo) bietet erstmals bundesweit repräsentative Daten zur motorischen Leistungsfähigkeit und körperlich-sportlichen Aktivität von Kindern und Jugendlichen in Deutschland. Ziele des Motorik-Moduls sind die Feststellung des Ist-Zustandes von motorischer Leistungsfähigkeit und körperlich-sportlicher Aktivität sowie die Analyse der komplexen Wirkungszusammenhänge zwischen motorischer Leistungsfähigkeit, körperlich-sportlicher Aktivität und Gesundheit. Die motorische Leistungsfähigkeit wurde auf Grundlage der Systematisierung motorischer Fähigkeiten nach Bös über ein Testprofil erfasst. Hierbei wurden die Basisfähigkeiten Ausdauer, Kraft, Koordination und Beweglichkeit bzw. die ihnen untergeordneten motorischen Beschreibungskategorien über 11 (sport)motorische Tests abgebildet. Zur Erfassung der körperlichsportlichen Aktivität wurde ein 51 Items umfassender Fragebogen entwickelt. Hierbei wurden die Belastungsnormative Dauer, Intensität und Häufigkeit der Aktivität im Alltag, in der Schule, in der Freizeit und im Verein erfragt. Ergänzt wurden die genannten Teilbereiche um Fragen zur Wochenprävalenz mindestens 60-minütiger täglicher Aktivität, den materialen und örtlichen Gegebenheiten sowie zu Kognition und Motivation der Aktivität. Im Rahmen des Motorik-Moduls wurden in den Jahren 2003–2006 insgesamt 4529 Kinder und Jugendliche im Alter von 4–17 Jahren an 167 Orten im gesamten Bundesgebiet hinsichtlich ihrer motorischen Leistungsfähigkeit getestet und ihrer körperlich-sportlichen Aktivität befragt. Die Hälfte aller untersuchten Kinder und Jugendlichen entstammt Familien mit mittlerem sozioökonomischem Status, ca. 15% haben einen Migrationshintergrund. Die Mehrzahl der Untersuchungsteilnehmer kommt aus einer mittelstädtischen Region, etwa ein Viertel wohnt in der Großstadt, unter 20% sind in ländlichen Regionen angesiedelt.